FORM 31-102F3 ACCOUNT HOLDER AUTHORIZATION TO: NRD Administrator 85 Richmond Street West, Toronto, Ontario M5H 2C9 Please select one box: Initial Filing All sections must be completed. This form must be returned by the firm filer with a Form 31-102F1 and, if required, a Form 31-102F2. Change to Previous Filing Changes will be effective after the NRD administrator has completed its processing of all required information. Describe change(s): Change to contact information - complete sections 1, 2 & 5 The NRD administrator must receive this form within 5 business days of the change. The account holder may return this form directly to the NRD administrator. Change to NRD account information - complete sections 1, 3 & 5 Desired business date of change: , 200___. The firm filer must return this form with a Form 31-102F1. The NRD administrator must receive this form at least 10 business days before the desired business date of change. General Instructions: A. This form may be downloaded from the NRD web site at www.nrd.ca. B. Complete the information requested in this form in type or legible print. The NRD account information completed in section 3 below must match the information completed in section 3 of Form 31-102F1. C. Return this completed form, together with a blank cheque for the NRD account named in section 3 below, marked on the front with “VOID” and deliver by prepaid mail, personal delivery or fax to the NRD administrator at the address above, or by fax to 1-800 - _______, or to such other address or fax number as may be provided on the NRD web site. Page 1
Section 1 Firm Filer Information Full legal name of firm filer: Section 2 Contact Information for NRD Account Name of account holder: Business address (street name and number): Province/territory/state: Postal code: Last name of account holder’s contact person: Direct phone number: ( ) Extension if applicable: Section 3 NRD Account Information for Electronic Pre-authorized Debit Name of account holder’s financial institution*: Branch transit number: *The financial institution selected must be a member of the Canadian Payments Association. Section 4 Authorization and Acknowledgements of Account Holder The account holder authorizes the payment of fees on behalf of the firm filer by electronic preauthorized debit in the National Registration Database to one or more of the payees, as such list of payees may be amended from time to time: British Columbia Securities Commission Alberta Securities Commission Saskatchewan Securities Commission Page 2 Firm NRD number (only required if a change to previous filing) Municipality (city, town, etc.): Main Phone Number: Fax number: ( ) ( ) First name of account holder’s contact person: E-mail address: Account number:
The Manitoba Securities Commission Ontario Securities Commission Nova Scotia Securities Commission Securities Commission of Newfoundland New Brunswick Office of the Administrator of Securities Prince Edward Island Department of Community Affairs and Attorney General Government of Yukon, Registrar of Securities Nunavut Department of Justice, Legal Registries Division Government of the Northwest Territories, Securities Registry, Department of Justice Investment Dealers Association of Canada NRD administrator The account holder further acknowledges that payments of fees are authorized by the chief AFR of the firm filer or other AFRs appointed to act on behalf of the firm filer. The account holder agrees to comply with any rules that may affect payment by pre-authorized debit and to execute any further documents that are reasonably required by the NRD administrator, its financial institution or the rules affecting the payment services provided in NRD. The account holder agrees that an executed copy of this form delivered to the NRD administrator by fax shall have the same effect as an originally executed copy delivered to the NRD administrator. The account holder has caused this form to be signed by its duly authorized signatories on its behalf. Name of account holder: Print name: Date: (dd/mm/yyyy) Signature of authorized signatory Print name: Date: (dd/mm/yyyy) Signature of authorized signatory Page 3
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.