Collection of personal information required for Form 3 – filer’s aid
This draft sheet can be used by a filer to collect personal information from new officers / directors / trustees for whom a Form 3 filing needs to be submitted. It will not be accepted if sent to Toronto Stock Exchange as a
replacement for Form 3. Form 3 has to be submitted through TMX LINX.
NEW OFFICER / DIRECTOR / TRUSTEE Civil title: First Name(s):
Date of Birth (MM/DD/YYYY):
Full Middle Name(s):
Surname:
Previously used names and/or names commonly known by, maiden name, etc.:
RESIDENTIAL HISTORY - Provide all residential addresses for the past 10 YEARS starting with your current principal residential address. If you are unable to correctly identify the complete residential address for a period more than five years ago, the municipality, province or state and country must be identified. TSX reserves the right to require the full address.
STREET ADDRESS, CITY, PROVINCE/STATE, COUNTRY & POSTAL/ZIP CODE
Email address:
Are you a Canadian Citizen?
Telephone:
FROM MM YY
Do you hold citizenship in any countries other than Canada?
TO MM
YY
If “Yes”, provide the names of the countries:
Please provide U.S. Social Security Number, where you have such a number:
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REPRESENTATION AND WARRANTY REGARDING PERSONAL INFORMATION By submitting this Form 3 to TSX, the Company represents and warrants that the Company has obtained all consents required under applicable law (including without limitation the Personal Information Protection and Electronic Documents Act (Canada)) in order for TSX to use, collect and disclose information contained in this Form 3 that relates to an identifiable individual, and information about such individual collected subsequently by TSX in accordance with Exhibit 1 to this Form 3 (Form 3 Personal Information Collection Policy), for the purposes set out in Exhibit 1 to this Form 3.
EXHIBIT 1: FORM 3 PERSONAL INFORMATION COLLECTION POLICY Collection, Use and Disclosure TSX Inc. and its affiliates, their authorized agents, subsidiaries and divisions, including Toronto Stock Exchange and TSX Venture Exchange (collectively referred to as “TSX”) collect the information (which may include personal, confidential, non-public, criminal or other information) in Form 3 and in other forms that are submitted by an Issuer and use it for the following purposes:
o o o o o
to conduct background checks on the individual to whom such information relates (the “Subject”), to verify the information that has been provided about the Subject, to consider the Subject’s suitability to act as an officer, director or insider of an Issuer, as applicable, to detect and prevent fraud, and to determine whether to request a TSX Personal Information Form (Form 4) for the Subject.
As part of this process, TSX also collects additional information about the Subject from public and non-public sources, including news, regulatory, bankruptcy and court records, and internal TSX databases, to ensure that the purposes set out above can be accomplished. TSX may from time to time use third parties to process information and/or provide other administrative services. In this regard, we may share the information with our carefully selected service providers.
Security The personal information that is retained by TSX is kept in a secure environment and is updated from time to time. Only those employees of TSX who require access to the information in order to accomplish the purposes identified above, will be given access to the information. Employees of TSX who have access to the information are made aware of how to keep it confidential.
Accuracy Information about the Subject maintained by TSX that is identified by the Subject as inaccurate or obsolete will be replaced or removed, as applicable.
Questions If you have any questions or enquiries with respect to the privacy principles outlined above or about our practices, contact TMX Group's Privacy Officer: privacyofficer@tmx.com
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