FORM 33-109F7 REINSTATEMENT OF REGISTERED INDIVIDUALS AND PERMITTED INDIVIDUALS (sections 2.3 and 2.5(2)) GENERAL INSTRUCTIONS Complete an d sub mit this form to the rele vant re gulator(s) or in Québe c, th e securi ties reg ulatory authority, or self-regulatory organization (SRO) if an individual has left a sponsoring firm and is seeking to reinstate their registration in the same category or reinstate their same status of permitted individual as before with a sponsoring firm. You only need to complete and submit one form regardless of the number of registration categories or permitted individual statuses you are seeking to be reinstated in. An in dividual may reinstat e th eir re gistration or p ermitted individual st atus by s ubmitting t his form . This form may only be used if all of the following apply: 1. this form is subm itted o n or before t he end of three months after the c essation date of th e individual’s e mployment, partn ership o r agency rel ationship w ith the i ndividual’s form er sponsoring firm, 2. there h ave b een no c hanges to t he information previously su bmitted i n res pect of Item s 13 (Regulatory Disclosure), 14 (Crim inal Disclosure), 15 (Civil Disclosu re) and 16 (Financial Disclosure) of the individual’s Form 33-109F4 since the individual left their former sponsoring firm, and 3. the individual’s employment, p artnership or ag ency re lationship w ith the ir former sponsoring firm did not end because the individual was asked by the firm to resign, resigned voluntarily or was dismissed, fol lowing an al legation against the individual of criminal ac tivity, a bre ach of securities legislation, or a breach of the rules of an SRO. If you do not meet all of the above conditions then you must apply for reinstatement by completing on NRD a Form 33-109F4 by making the NRD submission entitled ‘Reactivation of Registration’. Terms In this f orm, "you ", "your " and "individual " means the individual who is see king to reinstate their registration or their status as permitted individual. "former sponsoring firm " means th e registered firm where you most recently carried out dut ies as a registered or permitted individual. "major shareholder " and "shareholder " mean a sharehol der who, in total, directly or indirec tly owns voting securities carrying 10 per cent or more of the votes carried by all outstanding voting securities. "new spons oring firm " means t he reg istered firm where y ou w ill begi n carry ing o ut d uties as a registered or permitted individual when your registration or permitted individual status is reinstated. Several t erms used in t his form are defined i n th e Fo rm 33-109F 4 [ Registration of Individuals and Review of Permitted Individuals] that you sub mitted when you first became registered or elsew here in the securities legislation of your province or territory. Please refer to those definitions.
How to submit this form NRD format Submit this form at th e National Registration Database (NRD) website in NRD fo rmat at www.n rd.ca. If y ou ha ve any q uestions, co ntact t he com pliance, regis tration or le gal d epartment of the new sponsoring firm or a legal adviser, or visit the NRD information website at www.nrd-info.ca. Format, other than NRD format If you are rel ying on the t emporary hardship exemption in se ction 5 .1 of N ational Instrument 31-102 National Registration Database, you may submit this form in a format other than NRD format. If you need more space, use a separat e sheet of paper. Clearly identify the Item and question number. Complete an d sign t he form , and send it to t he rel evant regu lator(s) or, in Québec , th e sec urities regulatory authority, SRO (s) or sim ilar authority. The number of origin ally signed copies of th e form you are re quired t o su bmit dep ends o n t he pr ovince o r territory , a nd o n t he re gulator, t he se curities regulatory authority or SRO. To avoid delays in processing this form, be sure to answer all of the items that apply to you. If you have questions, contact the compliance, registration or legal department of the new sponsoring firm or a legal adviser, or visit the National Registration Database information website at www.nrd-info.ca. Item 1 Name 1. NRD number: 2. Legal name Last name First name Second name (N/A ) Third name (N/A ) 3. Date of birth (YYYY/MM/DD): 4. Use of other names Are you currently using, or have you ever used, operated under, or carried on business under, a name other than the name(s) mentioned above (for example, trade names for sole proprietorships or team names)? Yes No If "yes ", complete Schedule A.
Item 2 Number of jurisdictions 1. Are you seeking to reinstate your registration or p ermitted individual status in m ore than one jurisdiction of Canada? Yes No 2. Check e ach province or t erritory in w hich you are seeking re instatement of registra tion or reinstatement as a permitted individual: All jurisdictions Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon Item 3 Individual categories 1. On Schedule B, check each category for which you are seeking to reinstate your registration or permitted individual status. If you are seeking reinstatement of status as a permitted individual, check each category that describes your position with your new sponsoring firm.
2. If you are seeking rei nstatement as a represent ative of a mutual fund dealer or of a schol arship plan de aler in Québe c, are you co vered by y our new sponsoring fir m’s professio nal liability insurance? Yes No If "No ", state: The name of your insurer Your policy number Item 4 Address and agent for service 1. Address for service You must have one address for service in each province or territory where you are submitting this form. A residential or business address is acce ptable. A pos t office box is not acceptable. Complete Schedule C for each additional address for service you are providing. Address for service: (number, street, city, province or territory, postal code) Telephone number _________________ Fax number, if applicable____________________ E-mail address, if available 2. Agent for service If y ou have a ppointed an a gent for servi ce, pro vide t he foll owing i nformation for the agent in eac h province or territory where you have an agent for service. The address of your agent for service must be the same as t he address for service above. If your agent for servic e is not an i ndividual, provide t he name of your contact person. Name of agent for service: Contact person: Last name, First name Item 5 Location of employment 1. Provide the following information for your new sponsoring firm. If you will be working out of more than one location, provide the following information for the location out of which you will be doing most of your business. Unique Identification Number (optional): NRD location number: ___________________________________
Business address: (number, street, city, province, territory or state, country, postal code) Telephone number: ( ) Fax number: ( ) 2. If the n ew sponsoring firm has a f oreign head office, and/or you are not a res ident of Canada, provide the address for the location in which you will be conducting business. Business address:__ ________________________________________________________________ (number, street, city, province, territory or state, country, postal code) Telephone number: ( ) Fax number: ( ) [The following under #3 "Type of location ", #4 and #5 is for a Format other than NRD format only] 3. Type of location: Head office Branch or Business Location Sub-branch 4. Name of branch manager: 5. Check here if the mailing address of the location is the same as the business address provided above. Otherwise, complete the following: Mailing address: (number, street, city, province, territory or state, country, postal code) Item 6 Previous employment Provide the following information for your former sponsoring firm. Name: Date on w hich y ou w ere n o lo nger a uthorized to a ct on b ehalf of y our form er spo nsoring fir m as a registered individual or permitted individual: ______________________________________________ (YYYY/MM/DD) The reason why you left your former sponsoring firm: ____________________________________________________________________________ Item 7 Current employment, other business activities, officer positions held and directorships Name of your new sponsoring firm: _____________________________________________________ Complete a separate Schedule D for each of your current business and employment activities, including employment and b usiness activities with your new sponsoring firm and any employment and business activities outside your new sponsoring firm. Also include all business related officer or director positions and any other equivalent positions held, whether you receive compensation or not.
Item 8 Ownership of securities in new sponsoring firm Are you a partner or major shareholder of your new sponsoring firm? Yes No If "Yes ", complete Schedule E. Item 9 Confirm permanent record 1. Check the appropriate box to indicate that, since leaving your former sponsoring firm, there has been a c hange to any information previously submitted for th e i tems of y our Form 33-109F4 that are listed below. Regulatory disclosure (Item 13) Criminal disclosure (Item 14) Civil disclosure (Item 15) Financial disclosure (Item 16) 2. Check the box below - I am eligible to file this Form 33-109F7, only if you satisfy both of the following conditions: (a) there are no changes to any of the disclosure items under Item 9.1 above, and (b) your employment, partnership or agency relationship with your former sponsoring firm did not end because you were asked by the firm to resign or resigned voluntarily, or were dismissed, following an allegation against you of criminal activity, a breach of securities legislation, or a breach of the rules of an SRO. If you do not meet the above conditions for selecting the box ‘I am eligible to file this Form 33-109F7’, then you must apply for reinstat ement by co mpleting on NRD a Form 33-109F4 by making the NRD submission entitled ‘Reactivation of Registration’. If you are s ubmitting a Form 33-109F4 in a format other than NRD format you must complete the entire form. I am eligible to file this Form 33-109F7.
Item 10 Acknowledgements, submission to jurisdiction and notice of collection and use of personal information By submitting this form, you: acknowledge that the submission to jurisdiction, consent to collection and use of personal information, and a uthorization in resp ect of SRO s (to th e ex tent appl icable) that y ou provided in your Form 33-109F4 remain in effect and extend to this form consent to the collection and disclosure of your personal information by regulators and by your sponsoring firm, in each case, for registration and other related regulatory purposes. If y ou ha ve any q uestions ab out t he c ollection a nd use of y our perso nal i nformation, c ontact t he securities regulatory authority or applicable SRO in the relevant jurisdiction. See Schedule F for details. In Québec, you ca n also contact the Commission d’accès à l’i nformation at 1-888-528-7741 or visit its website at www.cai.gouv.qc.ca. You acknowledge and agree that if you are seeking reinstatement of your registration and it was subject to any undischarged terms and conditions when you left your former sponsoring firm, those terms and conditions will remain in effect at your new sponsoring firm. Item 11 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 12 Certification 1. Certification - NRD format: I confirm I have discussed the questions in this form with an officer, branch manager or supervisor of my sponsoring firm. To the best of my knowledge, the officer, branch manager or supervisor was satisfied that I fully understood the questions. I will limit my activities to those permitted by my category of registration. I am making this submission as agent for the individual. By checking this box, I certify that the individual provided me with all of the information on this form. 2. Certification - Format other than NRD format: Individual By signing below, I certify to the regulator, or in Québec the securities regulatory authority, in each jurisdiction where I am submitting this form, either directly or through the principal regulator that: I have read the form and understand the questions, and all of the information provided on this form is true, and complete. Signature of individual Date signed (YYYY/MM/DD)
Authorized partner or officer of the new sponsoring firm By signing below, I certify to the regulator, or in Québec the securities regulatory authority, in each jurisdiction where I am submitting this form for the individual that: the individual will be engaged by the new sponsoring firm as a regi stered individual or a permitted individual I have, or a branch manager or another officer or supervisor has, discussed the questions set out in this form with the individual and, to the best of m y knowledge, the individual fully understands the questions, and the n ew spon soring firm u nderstands th at if the i ndividual’s reins tatement of registrati on was subject to any undischarged terms and conditions when the individual left their former sponsoring fir m, those term s and c onditions rem ain in effect an d a grees t o assu me an y ongoing o bligations that a pply t o t he s ponsoring firm in res pect of the i ndividual u nder those terms and conditions. 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 Use of other names (Item 1.4) Item 1.4 Use of other names Name 1: Name: Provide the reasons for the use of this other name (for example, trade name or team name)?: _________ If this oth er nam e is or was used i n co nnection w ith any sponsori ng firm , did the sp onsoring firm approve the use of the name? Yes No When did you use this name? From: To: _________________ (YYYY/MM) (YYYY/MM) Name 2: Name: Provide the reasons for the use of this other name (for example, trade name or team name): If this oth er nam e is or was used i n co nnection w ith any sponsori ng firm , did the sp onsoring firm approve the use of the name? Yes No When did you use this name? From: To: (YYYY/MM) (YYYY/MM)
Name 3: Name: Provide the reasons for the use of this other name (for example, trade name or team name): If this oth er nam e is or was used i n co nnection w ith any sponsori ng firm , did the sp onsoring firm approve the use of the name? Yes No When did you use this name? From: To: (YYYY/MM) (YYYY/MM)
SCHEDULE B Individual Categories (Item 3) Check e ach c ategory for w hich y ou ar e seek ing rei nstatement of registra tion, approval o r permitted individual status Categories Common to all jurisdictions under securities legislation Firm categories [Format other than NRD format only] [ ] Investment Dealer [ ] Mutual Fund Dealer [ ] Scholarship Plan Dealer [ ] Exempt Market Dealer [ ] Restricted Dealer [ ] Portfolio Manager [ ] Restricted Portfolio Manager [ ] Investment Fund Manager Individual categories and permitted activities [ ] Dealing Representative [ ] Advising Representative [ ] Associate Advising Representative [ ] Ultimate Designated Person [ ] Chief Compliance Officer [ ] Officer – Specify title: [ ] Director [ ] Partner [ ] Shareholder [ ] Branch Manager (MFDA members only) [ ] IIROC approval only IIROC Approval categories [ ] Executive [ ] Director (Industry) [ ] Director (Non-Industry) [ ] Supervisor [ ] Investor [ ] Registered Representative [ ] Investment Representative [ ] Trader Additional approval categories [ ] Chief Compliance Officer [ ] Chief Financial Officer [ ] Ultimate Designated Person
Products [ ] Non-Trading [ ] Securities [ ] Options [ ] Futures Contracts and Futures Contract Options [ ] Mutual Funds only Customer type [ ] Retail [ ] Institutional [ ] Not Applicable Portfolio management [ ] Portfolio Management Categories under local commodity futures and derivatives legislation Ontario Firm categories [ ] Commodity Trading Adviser [ ] Commodity Trading Counsel [ ] Commodity Trading Manager [ ] Futures Commission Merchant Individual categories and permitted activities [ ] Advising Representative [ ] Salesperson [ ] Branch Manager [ ] Officer – Specify title: [ ] Director [ ] Partner [ ] Shareholder [ ]IIROC approval only Manitoba Firm categories [ ] Dealer (Merchant) [ ] Dealer (Futures Commission Merchant) [ ] Dealer (Floor Broker) [ ] Adviser [ ] Local
Individual categories and permitted activities [ ] Floor Trader [ ] Salesperson [ ] Branch Manager [ ] Adviser [ ] Officer – Specify title [ ] Director [ ] Partner [ ] Futures Contracts Portfolio Manager [ ] Associate Futures Contracts Portfolio Manager [ ] IIROC approval only [ ] Local Québec – activities relating to derivatives For information purposes, indicate whether you will carry on activities as a representative of: [ ] An Investment Dealer Acting as a Derivatives dealer [ ] A Portfolio Manager Acting as a Derivatives portfolio manager
SCHEDULE C Address and agent for service (Item 4) Item 4.1 Address for service You must have one address for service in each province or territory in which you are now, or are seeking to become, a registered individual or permitted individual. A post office box is not an acceptable address for service. Address for service: (number, street, city, province or territory, postal code) Telephone number: ( ) Fax number: ( ) E-mail address: Item 4.2 Agent for service If you have appointed an agent for service, provide the following information for the agent. The address for service provided above must be the address of the agent named below. Name of agent for service: _____________________________________________ ______ (if applicable) Contact person: Last name, First name
SCHEDULE D Current employment, other business activities, officer positions held and directorships (Item 7) Complete a separate Schedule E for each of your current business and employment activities with your sponsoring firm and w ith all other organizations. This includes any business related officer or director positions held, or any other equivalent positions held, whether you receive compensation or not. 1. Start date _________________ (YYYY/MM/DD) 2. Firm information Check here if this activity is employment with your sponsoring firm. If the a ctivity is w ith your sponsoring firm, you are no t required to indicate the firm name and a ddress information below: Name of business or employer: _________________________________________________________________________ Address of business or employer: _________________________________________________________________________ (number, street, city, province, territory or state, country) Name and title of your immediate supervisor: ____________________________________ 3. Description of duties Describe al l em ployment and b usiness acti vities rel ated to t his em ployer. Inc lude the na ture of the business and your d uties, title or re lationship w ith t he bus iness. If you are see king reg istration that requires spe cific ex perience, i nclude d etails wit h t his firm such as lev el of resp onsibility, value of accounts under direct supervision, number of years of experience, and percentage of time spent on each activity. 4. Number of work hours per week How many hours per week do you devote to this business or employment? If this act ivity is em ployment w ith y our sponsoring fi rm and y ou w ork less t han 30 hours pe r w eek, explain why.
5. Conflict of Interest If you have more than one employer or are engaged in business related activities: A. Disclose any potential for confusion by clients and any potential for conflicts of interest arising from your multiple employment or business related activities or proposed business related activities. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ B. Indicate whether or not any of your employers or organizations where you engage in business related activities are listed on an exchange. ____________________________________________________________________________________ C. C onfirm whether t he firm has pro cedures f or m inimizing p otential c onflicts of i nterest a nd if so, confirm that you are aware of these procedures. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ D. If you do not perceive any conflicts of interest arising from this employment, explain why. ____________________________________________________________________________________ ____________________________________________________________________________________
SCHEDULE E Ownership of securities and derivatives firms (Item 8) Firm name: What is your relationship to the firm? Partner Major shareholder What is the period of this relationship? From: To: (if applicable) (YYY Y/MM) (YYY Y/MM) Provide the following information: a) State the number, value, class and percentage of securities, or the amount of partnership interest you own or propose to acquire when you are reinstated or approved as a result of th e review of this f orm. If acquiri ng s hares when you are so approved or re gistered, st ate t he sourc e (for example, treasury shares, or if upon transfer, state name of transferor). _________________________________________________________________________ b) State the market value (approximate, if nece ssary) of any subordinated debentures or bonds of the firm to be held by you or any other subordinated loan to be made by you to the firm: _________________________________________________________________________ c) If another person or firm has provided you with funds to invest in the firm, provide the name of the person or firm and state the relationship between you and that person or firm: _________________________________________________________________________ d) Are the funds to be i nvested (or propos ed to b e invested) guaranteed directly or i ndirectly by any person or firm? Yes No If "Yes ", provide the name of the person or firm and state the relationship between you and that person or firm: _________________________________________________________________________ e) Have you directly or indirectly given up any rights relating to these securities or this partnership interest, or do you, when you are re gistered or approved as a res ult of the re view of this f orm, intend to g ive up any of th ese righ ts (in cluding by hy pothecation, p ledging or d epositing as collateral the securities or partnership interest with any firm or person)? Yes No
If "Yes ", provide the name of the person or firm, state the relationship between you and that person or firm and describe the rights that have been or will be given up: f) Is a person o ther th an y ou the beneficial ow ner of th e shares, b onds, deb entures, partn ership units or notes held by you? Yes No If "Yes ", complete (g), (h) and (i). g) Name of beneficial owner: Last name First name Secon d name Third name (if applicable) (if applicable) h) Residential address: (number, street, city, province, territory or state, country, postal code) i) Occupation:
SCHEDULE F 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 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
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 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.