FORM 33-109F3 BUSINESS LOCATIONS OTHER THAN HEAD OFFICE (section 3.2) GENERAL INSTRUCTIONS Complete and submit this f orm to no tify the relevant regulator(s) or, in Qu ébec, the securities regulatory authority, or self-regulatory organization (SRO) that a business location has opened or closed, or information ab out a business location has changed. Check one of the following and complete the entire form: Opening this business location Closing this business location Change to the information previously submitted about this business location. Clearly specify the information that has changed. How to submit this form Submit this form at the National Registration Database (NRD) website in NRD format at www.nrd.ca. If you are relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102, you may complete and submit this form in a format other than NRD format. Item 1 Type of business location Branch or Business Location Sub-branch Item 2 Supervisor or branch manager Name of designated supervisor or branch manager NRD number of the designated supervisor or branch manager Item 3 Business location information Business address Mailing address (if different from business address) Telephone number ( ) Fax number ( ) Item 4 Notice of collection and use of personal information The personal information r equired u nder th is form is col lected o n behalf of, a nd us ed by , the sec urities r egulatory authorities in the juris dictions set out in Sched ule A to administer and enforce c ertain pro visions of t heir securi ties legislation or derivatives legislation or both. The personal information required under this form is also col lected by and used by the SROs set out in Sch edule A to administer and enforce their respective by-laws, regulations, rules, rulings and policies.
By submitting this form , the in dividual consents to the col lection by the se curities regulatory authorities or a pplicable SRO of this person al i nformation, and any po lice records, rec ords fro m other go vernment or n on-governmental regulators or SROs, credit records and employment records about the individual that the securities regulatory authorities or ap plicable SRO may need to c omplete t heir revi ew of the in formation su bmitted i n t his form relatin g to the individual’s continued fit ness for registra tion or approval, if a pplicable, i n ac cordance wit h t he leg al authority of the securities regulatory authorities while the individual is registered with or approved by it. Securities regulatory authorities or SROs may contact government and private bodies or agencies, individuals, corporations and other organizations for information about the individual. If you have any questions about the collection and use of this information, contact the securities regulatory authorities or applicable SRO in any jurisdiction in which the required information is submitted. See Schedule A for details. In Québec, you ca n als o conta ct t he Com mission d’ac cès à l’inform ation at 1-888-528-7741 or visit its w ebsite at www.cai.gouv.qc.ca. Item 5 Warning It is an offence under securities legislation and/or derivatives legislation, including commodity futures legislation to give false or misleading information on this form. Item 6 Certification Certification-NRD format: I am making this submission as agent for the firm. By checking this box, I certify that the firm provided me with all of the information on this form. Certification-Format other than NRD format: By signing below, I certify to the securities regulator or, in Québec, the securities regulatory authority, in each jurisdiction where I am submitting this form for the firm, either directly or through the principal regulator, that: I have read this form and understand the questions, and all of the information provided on this form is true, and complete. Name of firm ________________________________________________________ Name of authorized signing officer or partner ______________________________ Title of authorized signing officer or partner ________________________________ Signature of authorized signing officer or partner ___________________________ Date signed (YYYY/MM/DD)
Schedule A Contact information for Notice of collection and use of personal information Alberta Alberta Securities Commission, Suite 600, 250–5th St. SW Calgary, AB T2P 0R4 Attention: Information Officer Telephone: (403) 355-4151 British Columbia British Columbia Securities Commission P.O. Box 10142, Pacific Centre 701 West Georgia Street Vancouver, BC V7Y 1L2 Attention: Freedom of Information Officer Telephone: (604) 899-6500 or (800) 373-6393 (in BC) Manitoba The Manitoba Securities Commission 500 - 400 St. Mary Avenue Winnipeg, MB R3C 4K5 Attention: Director of Registrations Telephone (204) 945-2548 Fax (204) 945-0330 New Brunswick New Brunswick Securities Commission Suite 300, 85 Charlotte Street Saint John, NB E2L 2J2 Attention: Director, Regulatory Affairs Telephone: (506) 658-3060 Newfoundland and Labrador Securities NL Financial Services Regulation Division Department of Government Services P.O. Box 8700, 2nd Floor, West Block Confederation Building St. John's, NL A1B 4J6 Attention: Manager of Registrations Tel: (709) 729-5661 Nova Scotia Nova Scotia Securities Commission Suite 400, 5251 Duke Street Halifax, NS B3J 1P3 Attention: Deputy Director, Capital Markets Telephone: (902) 424-7768 Northwest Territories Government of the Northwest Territories P.O. Box 1320 Yellowknife, NWT X1A 2L9 Attention: Deputy Superintendent of Securities Telephone: (867) 920-8984 Nunavut Legal Registries Division Department of Justice Government of Nunavut P.O. Box 1000 Station 570 Iqaluit, NU X0A 0H0 Attention: Deputy Registrar of Securities Telephone: (867) 975-6590 Ontario Ontario Securities Commission Suite 1903, Box 55 20 Queen Street West Toronto, ON M5H 3S8 Attention: Compliance and Registrant Regulation Telephone: (416) 593-8314 e-mail: registration@osc.gov.on.ca Prince Edward Island Securities Registry Office of the Attorney General B Consumer, Corporate and Insurance Services Division P.O. Box 2000 Charlottetown, PE C1A 7N8 Attention: Deputy Registrar of Securities Telephone: (902) 368-6288 Québec Autorité des marchés financiers 800, square Victoria, 22e étage C.P. 246, tour de la Bourse Montréal (Québec) H4Z 1G3 Attention: Responsable de l’accès à l’information Telephone: (514) 395-0337 or (877) 525-0337 (in Québec) Saskatchewan Saskatchewan Financial Services Commission Suite 601, 1919 Saskatchewan Drive Regina, SK S4P 4H2 Attention: Director Telephone: (306) 787-5842 Yukon Yukon Securities Office Department of Community Services P.O. Box 2703 C-6 Whitehorse, YT Y1A 2C6 Attention: Superintendent of Securities Telephone: (867) 667-5225 Self-regulatory organization Investment Industry Regulatory Organization of Canada 121 King Street West, Suite 1600 Toronto, Ontario M5H 3T9 Attention: Privacy Officer Telephone: (416) 364-6133 E-mail: PrivacyOfficer@iiroc.ca
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.