Securities Act

MULTILATERAL INSTRUMENT 33-109
REGISTRATION INFORMATION

Part 1 — Definitions

1.1 Definitions — In this Instrument

"Form 3" means the required form for an application for registration as dealer, adviser, or underwriter in the local jurisdiction;

"Form 4" means the form that was required for an application for registration for an individual in the local jurisdiction before February 21, 2003;

"non-registered individual" means, for a registered firm or for a person or company that is applying for registration, an individual who is not registered to trade or advise on behalf of the firm and who

(a) is a director, partner, officer, or branch manager of the firm, or

(b) in Alberta, British Columbia, and Ontario,

(i) is a director, partner, officer, or branch manager of the firm, or

(ii) beneficially owns, directly or indirectly, or exercises control or direction over, 10 percent or more of the voting securities of the firm;

"MI 31-102" means Multilateral Instrument 31-102 National Registration Database;

"NRD submission number" means the unique number generated by NRD to identify each NRD submission;

"registered firm" means a person or company that is registered as a dealer, adviser, or underwriter;

"registered individual" means, for a registered firm, an individual who is registered to trade or advise on behalf of the registered firm;

"sponsoring firm" means,

(a) for a registered individual, the registered firm on whose behalf the individual trades or advises,

(b) for an individual applying for registration, the registered firm, or the person or company applying to become a registered firm, on whose behalf the individual proposes to trade or advise,

(c) for a non-registered individual of a registered firm, the registered firm, or

(d) for a non-registered individual of a person or company that is applying for registration, the person or company that is applying for registration.

1.2 Interpretation — Terms defined in MI 31-102 and used in this Instrument have the respective meanings ascribed to those terms in MI 31-102.

Part 2 — Application for Registration

2.1 Dealer, Adviser and Underwriter Registration — Except as provided in subsection 2.3 (1), an applicant for registration as a dealer, adviser, or underwriter must submit to the regulator,

(a) in paper format, a completed Form 3;

(b) in accordance with MI 31-102, a completed Form 33-109F3 for each business location of the applicant, other than the applicant's head office; and

(c) in accordance with MI 31-102, a completed Form 33-109F4 for each non-registered individual of the applicant who has not applied to become a registered individual with the applicant under subsection 2.2 (1).

2.2 Individual Registration

(1) Except as provided in subsection (2) and subsection 2.3 (2), an individual who applies for registration under securities legislation must make the application by submitting to the regulator in accordance with MI 31-102 a completed Form 33-109F4.

(2) Despite subsection (1), a non-registered individual of a registered firm who applies to become a registered individual with the firm must make the application by submitting to the regulator in accordance with MI 31-102 a completed Form 33-109F2.

2.3 Commodity Futures Act Registrants

(1) In Manitoba and Ontario, if an applicant for registration under section 2.1 is registered under the Commodity Futures Act, the applicant

(a) is not required to submit a completed Form 33-109F3 under subsection 2.1 (b) for any business location of the applicant that is recorded on NRD; and

(b) is not required to submit a completed Form 33-109F4 under subsection 2.1 (c) for a non-registered individual if the applicant submits to the regulator, in accordance with MI 31-102, a completed Form 33-109F2 for the individual.

(2) In Manitoba and Ontario, despite subsection 2.2 (1), if an individual applies for registration under securities legislation and is recorded on NRD with his or her sponsoring firm as registered under the Commodity Futures Act, the individual must make the application by submitting to the regulator, in accordance with MI 31-102, a completed Form 33-109F2.

Part 3 — Changes to Registered Firm Information

3.1 Changes to Form 3 Information

(1) A registered firm must notify the regulator of a change to any information previously submitted in Form 3, or under this subsection, within 5 business days of the change.

(2) Except as provided in subsection (3), for the purposes of subsection (1), a notice of change must be made by submitting a completed Form 33-109F5 in paper format.

(3) Despite subsection (2), a notice of change under this section is not required to be in Form 33-109F5 if the change relates to

(a) the addition of an officer, partner, or director to the registered firm, and if a completed Form 33-109F4 in respect of the officer, partner, or director is submitted under section 2.2 or 3.3;

(b) the resignation or termination of an officer, partner or director of the registered firm, and if a completed Form 33-109F1 is submitted under section 4.3 or 5.2; or

(c) a business location other than head office, and if a completed Form 33-109F3 is submitted under section 3.2.

3.2 Changes to Business Locations

(1) A registered firm must notify the regulator of the opening of a business location, other than a new head office, by submitting in accordance with MI 31-102 a completed Form 33-109F3 within 5 business days of the opening.

(2) A registered firm must notify the regulator of a change to any information previously submitted in Form 33-109F3 by submitting in accordance with MI 31-102 a completed Form 33-109F3 within 5 business days of the change.

3.3 Addition of Non-registered Individuals — A registered firm must submit to the regulator in accordance with MI 31-102 a completed Form 33-109F4 for a non-registered individual within 5 business days of the individual becoming a non-registered individual of the registered firm.

Part 4 — Changes to Registered Individual Information

4.1 Changes to Form 33-109F4 Information

(1) Except as provided in subsection (2), a registered individual must notify the regulator in accordance with MI 31-102 of a change to any information previously submitted in Form 33-109F4, or under this subsection, within 5 business days of the change.

(2) Despite subsection (1), a registered individual must notify the regulator in accordance with MI 31-102 of a change to information previously submitted in Item 3 or Item 8 of Form 33-109F4, or under this subsection, within 1 year of the change.

4.2 Application To Change or Surrender Individual Registration Categories — A registered individual of a registered firm who applies to change or surrender his or her registration category with the firm must make the application by submitting to the regulator in accordance with MI 31-102 a completed Form 33-109F2.

4.3 Termination of Relationship — A registered firm must, within 5 business days of a termination of an employment, partner, or agency relationship with a registered individual, notify the regulator of the termination of the relationship by submitting in accordance with MI 31-102 a completed Form 33-109F1.

Part 5 — Changes to Non-registered Individual Information

5.1 Changes to Form 33-109F4 Information

(1) Except as provided in subsections (2), (3) and (4), a registered firm must notify the regulator in accordance with MI 31-102 of a change to any information previously submitted in Form 33-109F4, or under this subsection, for a non-registered individual within 5 business days of the change.

(2) Despite subsection (1) and except as provided in subsection (4), a registered firm must notify the regulator in accordance with MI 31-102 of a change to information previously submitted in Item 3 of Form 33-109F4, or under this subsection, for a non-registered individual within 1 year of the change.

(3) Despite subsection (1) and except as provided in subsection (4), a registered firm must notify the regulator of a change to any information regarding a category of non-registered individual listed in Item 6 of Form 33-109F4 for a non-registered individual by submitting in accordance with MI 31-102 a completed Form 33-109F2 within 5 business days of the change.

(4) Despite subsections (1), (2), and (3), a registered firm is not required to notify the regulator of a change to information if another firm has notified the regulator of the change in accordance with MI 31-102 and within the required time.

5.2 Termination of Relationship — A registered firm must, within 5 business days of an individual ceasing to be a non-registered individual of the registered firm, notify the regulator in accordance with MI 31-102 of the termination of the relationship by submitting a completed Form 33-109F1.

Part 6 — Due Diligence and Record-keeping

6.1 Sponsoring Firm Obligations

(1) A sponsoring firm must make reasonable efforts to ensure that information submitted by

(a) the firm for a non-registered individual; or

(b) a registered individual, or an individual applying for registration, for whom the firm is the sponsoring firm,

is true and complete.

(2) A sponsoring firm must retain all documents used by the firm to satisfy its obligation under subsection (1),

(a) in the case of a non-registered individual, for a period of 7 years after the individual ceases to be a non-registered individual; or

(b) in the case of a registered individual, or an individual applying for registration, for a period of 7 years after the individual ceases to be a registered individual with the firm.

(3) Without limiting the generality of subsection (2), if a registered individual, or an individual applying for registration, appoints an agent for service, the sponsoring firm must keep the original Appointment of Agent for Service executed by the individual for the period of time set out in paragraph (2) (b).

(4) A sponsoring firm that retains a document under subsection (2) or (3) in respect of an NRD submission must record the NRD submission number on the document.

Part 7 — Exemption

7.1 Exemption

(1) The regulator or the securities regulatory authority may grant an exemption from this Instrument, in whole or in part, subject to such conditions or restrictions as may be imposed in the exemption.

(2) Despite subsection (1), in Ontario only the regulator may grant such an exemption.

Part 8 — Transition to NRD

8.1 Definitions — In this Part

"NRD access date" means, for an NRD firm filer, the date the NRD firm filer receives notice that it has access to NRD to make NRD submissions; and

"NRD freeze period" means the period that begins on the day specified in a notice of the securities regulatory authority and ends on the day that is 5 business days after the NRD access date.

8.2 Changes to Form 3 Information — A notice of change under section 3.1 is not required during the NRD freeze period if the change relates to

(a) the addition of an officer, partner, or director to the registered firm, and if a completed Form 33-109F4 in respect of the officer, partner, or director is submitted in accordance with MI 31-102 within 30 business days of the NRD access date;

(b) the resignation or termination of an officer, partner or director of the registered firm, and if a completed Form 33-109F1 is submitted in accordance with MI 31-102 within 30 business days of the NRD access date; or

(c) a business location other than head office, and if a completed Form 33-109F3 is submitted in accordance with MI 31-102 within 30 business days of the NRD access date.

8.3 Changes to Business Location — A registered firm is exempt from the requirement to make a submission under section 3.2 during the NRD freeze period, if the firm makes the submission in accordance with MI 31-102 within 30 business days of the NRD access date.

8.4 Addition of Non-registered Individuals — A registered firm is exempt from the requirement to make a submission under section 3.3 during the NRD freeze period, if the firm makes the submission in accordance with MI 31-102 within 30 business days of the NRD access date.

8.5 Changes to Form 4 Information — Registered Individuals

(1) This section applies to a registered individual who has not submitted in accordance with MI 31-102 a completed Form 33-109F4.

(2) A registered individual must notify the regulator of a change to any information previously submitted in Form 4, or under this subsection, by submitting a completed Form 33-109F5 in paper format within 5 business days of the change.

(3) A registered individual who has submitted a completed Form 33-109F5 under subsection (2), must submit in accordance with section 7.7 of MI 31-102 a completed Form 33-109F4.

8.6 Termination of Relationship — Registered Individuals — A registered firm is exempt from the requirement to make a submission under section 4.3 during the NRD freeze period, if the firm makes the submission in accordance with MI 31-102 within 30 business days of the NRD access date.

8.7 Changes to Form 4 Information — Non-registered Individuals

(1) This section applies to a registered firm that has not submitted in accordance with MI 31-102 a completed Form 33-109F4 for a non-registered individual.

(2) A registered firm must notify the regulator of a change to any information previously submitted in Form 4 for a non-registered individual, or under this subsection, by submitting a completed Form 33-109F5 in paper format within 5 business days of the change.

(3) A registered firm that has submitted a completed Form 33-109F5 for a non-registered individual under subsection (2), must submit in accordance with section 7.8 of MI 31-102 a completed Form 33-109F4 for the non-registered individual.

8.8 Termination of Relationship — Non-registered Individuals — A registered firm is exempt from the requirement to make a submission under section 5.2 during the NRD freeze period, if the firm makes the submission in accordance with MI 31-102 within 30 business days of the NRD access date.

Part 9 — Effective Date

9.1 Effective Date — This Instrument comes into force on February 21, 2003.

Form 33-109F1
Notice of Termination

Enter the following information using the online version of this submission at the NRD web site (www.nrd.ca). If the NRD filer is relying on the temporary hardship exemption in MI 31-102 this form is required to be delivered to the regulator in paper format.

1. Individual

Name of individual: ......................................................................................................................................

NRD number of individual: ..........................................................................................................................

2. Business location

Address of business location: .......................................................................................................................

NRD number of business location: ...............................................................................................................

3. Termination

Effective date of termination: ..................................

Indicate whether the individual:

• was dismissed for cause .....................................................................
• was dismissed in good standing ..........................................................
• resigned in good standing ...................................................................
• is deceased .......................................................................................

Include details regarding any:

• unresolved client complaints:

• internal discipline matters:

• restrictions for violation of regulatory requirements:

• financial obligations the individual has to clients:

Notice of Collection and Use of Personal Information

The personal information required under this form is collected on behalf of and used by the securities regulatory authorities set out below for the administration and enforcement of certain provisions of the securities legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and Labrador, Northwest Territories, Yukon Territory and Nunavut.

If you have any questions about the collection and use of this information, you may contact the securities regulatory authority in any jurisdiction in which the required information is filed, at the address or telephone number provided in Schedule "A".

WARNING:

It is an offence to submit information that, in a material respect and at the time and in the light of the circumstances in which it is submitted, is misleading or untrue.

CERTIFICATION

The following certification is to be used when submitting this form in NRD format:

[ ] I am making this submission as agent for the NRD filer. By checking this box I certify that all statements of fact in this submission were provided to me by the NRD filer.

The following certification is to be used when submitting this form in paper format:

I, the undersigned, certify that I have read and that I understand the questions in the notice and the Warning set out above. I also certify that all statements of fact made in the answers to the questions are true.

Schedule "A"
Notice and Collection and Use of Personal Information

Form 33-109F2
Change or Surrender of Individual Categories

Enter the following information using the online version of this submission at the NRD web site (www.nrd.ca). If the NRD filer is relying on the temporary hardship exemption in MI 31-102 this form is required to be delivered to the regulator in paper format.

1. Individual

Name of individual: ......................................................................................................................................

NRD number of individual: ..........................................................................................................................

2. Individual categories

Indicate the individual categories that the individual is adding or removing:

3. Details of surrender

If the individual is surrendering his or her registration include details regarding any:

• unresolved client complaints:

• internal discipline matters:

• restrictions for violation of regulatory requirements that occurred at any time during the individual's employment with the firm:

• financial obligations the individual has to clients:

Notice of Collection and Use of Personal Information

The personal information required under this form is collected on behalf of and used by the securities regulatory authorities set out below for the administration and enforcement of certain provisions of the securities legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and Labrador, Northwest Territories, Yukon Territory, and Nunavut.

By submitting this information you consent to the collection by the securities regulatory authority of the personal information provided above, police records, records from other government or non-governmental regulatory authorities or self-regulatory organizations, credit records and employment records about you as may be necessary for the securities regulatory authority to complete its review of the information submitted above including your continued fitness for registration, if applicable, in accordance with the legal authority of the securities regulatory authority for the duration of the period which you remain registered or approved by the securities regulatory authority. The sources the securities regulatory authority may contact include government and private bodies or agencies, individuals, corporations and other organizations.

If you have any questions about the collection and use of this information, you may contact the securities regulatory authority in any jurisdiction in which the required information is filed, at the address or telephone number provided in Schedule "A".

WARNING:

It is an offence to submit information that, in a material respect and at the time and in the light of the circumstances in which it is submitted, is misleading or untrue.

CERTIFICATION:

The following certification is to be used when submitting this form in NRD format:

[ ] I am making this submission as agent for the individual to whom this submission relates. By checking this box I certify that all statements of fact in this submission were pr4ovided to me by the individual.

Both of the following certifications are to be used when submitting this form in paper format:

I, the undersigned, certify that I have read and that I understand the questions in this form and the Warning set out above. I also certify that all statements of fact provided in this application are true.

I, the undersigned, certify on behalf of the sponsoring firm that the individual will be engaged by the sponsoring firm as a registered individual or a non-registered individual. I certify that I have, or a branch manager or another officer or partner has, discussed the questions set out in this form and I am satisfied that the individual fully understands the questions.

Schedule "A"
Notice and Collection and Use of Personal Information

 Form 33-109F3
Business Locations Other than Head Office

Enter the following information using the online version of this submission at the NRD web site (www.nrd.ca). If the NRD filer is relying on the temporary hardship exemption in MI 31-102 this form is required to be delivered to the regulator in paper format.

Please select one box:

[ ] This form is being submitted to notify the regulator of the opening of this business location. Complete the entire form.

[ ] This form is being submitted to notify the regulator of the closing of this business location. Complete the entire form.

[ ] This form is being submitted to notify the regulator of the change of information previously submitted in respect of this business location. Complete the entire form and describe the information that has changed (for example, "telephone number" or "type of business location"):..................................................................................

1. Type of business location

............................................................................... branch

............................................................................... sub-branch

2. Supervisor or branch manager

NRD number of the designated supervisor or branch manager: ....................................................................

Name of designated supervisor or branch manager: ......................................................................................

3. Business location information

Business address: ..........................................................................................................................................

Telephone number: ( )......................................

Facsimile number: ( ).....................................

Mailing address (if different from business address): ...................................................................................

Notice of Collection and Use of Personal Information

The personal information required under this form is collected on behalf of and used by the securities regulatory authorities set out below for the administration and enforcement of certain provisions of the securities legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and Labrador, Northwest Territories, Yukon Territory, and Nunavut.

If you have any questions about the collection and use of this information, you may contact the securities regulatory authority in any jurisdiction in which the required information is filed, at the address or telephone number provided in Schedule "A".

WARNING:

It is an offence to submit information that, in a material respect and at the time and in the light of the circumstances in which it is submitted, is misleading or untrue.

CERTIFICATION

The following certification is to be used when submitting this form in NRD format:

[ ] I am making this submission as agent for the NRD filer. By checking this box I certify that all statements of fact in this submission were provided to me by the NRD filer.

The following certification is to be used when submitting this form in paper format:

I, the undersigned, certify that I have read and that I understand the questions in this notice and the Warning set out above. I also certify that all statements of fact made in the answers to the questions are true.

Schedule "A"
Notice and Collection and Use of Personal Information

Form 33-109F4
Registration Information for an Individual

SUBMISSION TO NRD

Enter the following information using the online version of this submission at the NRD web site (www.nrd.ca). If the NRD filer is relying on the temporary hardship exemption in MI 31-102 this form is required to be delivered to the regulator in paper format.

INSTRUCTIONS FOR FILING IN PAPER FORMAT

1. This form is to be used by every individual seeking registration from a securities regulatory authority or a self-regulatory organization or who is a non-registered individual with a registered firm or a firm seeking registration.

2. This form is also to be used by any sole proprietor submitting an application for registration as a dealer, broker, adviser or underwriter to a securities regulatory authority.

3. Failure to answer all applicable questions may cause delays in the processing of the application form.

4. This form must be legible.

5. To complete the application, individuals should seek advice from an authorized officer of the sponsoring firm or from a legal adviser.

6. The number of originally signed copies of the form to be filed with the self-regulatory organization and/or securities regulatory authority or similar authority varies from province to province. If unsure of the procedure, please consult the Registration Department of the self-regulatory organization to which you are applying or the applicable securities regulatory authority, or similar authority.

Item 1 — Name

1. Legal Name

2. Other Names

Are you currently, or have you previously been, known by a name other than the name provided above?
[ ] Yes [ ] No
If "Yes", complete Schedule "A".

Item 2 — Residential Address

Current address

Provide all residential addresses, including any foreign residential addresses, for the past 10 years.

Telephone number: (   )............................ Resided at this address since: ..............................(YYYY/MM)

If you have resided at this address for less than 10 years, complete Schedule "B".

Item 3 — Personal Information

Personal description

Date of birth: .............................(YYYY/MM/DD)

Place of birth: .............................................................................(city, province, territory or state, country)

Gender: [ ] Female [ ] Male Colour of eyes: ............................. Colour of hair: .............................

Height: imperial units:............................. OR metric units: .............................

Weight: imperial units: ............................. OR metric units: .............................

Item 4 — Citizenship

Citizenship information

What is your citizenship?

[ ] Canadian

[ ] Other, specify: ....................................................

If you are a citizen of a country other than Canada, complete the following for that other citizenship. You are only required to provide the following information for one citizenship.

Passport number: .............................Country of citizenship: .............................

Date of issue: .............................(YYYY/MM/DD)

Place of issue: .............................................................................(city, province, territory or state, country)

Item 5 — Registration Jurisdictions

Jurisdictions

Indicate, by checking the appropriate box, each province or territory to which you are submitting this form:

Item 6 — Individual Categories

Categories

Indicate, by checking the appropriate box in Schedule "C", each registration category for which you are applying. If you are a non-registered individual and you are not applying for registration, indicate each category that describes your position with your sponsoring firm.

Item 7 — Address and Agent for Service

1. Address For Service

You must have one address for service in each province or territory in which you are now, or are applying to become, a registered individual or non-registered individual. A post office box is not an acceptable address for service. Complete Schedule "D" for each additional address for service you are providing.

Telephone number: (  )............................. Fax number: (  ).............................

E-mail address: .............................................................................

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 any agent named below.

Name of agent for service:

Item 8 — Proficiency

1. Course or Examination Information

Complete Schedule "E" to indicate each course and examination that you have successfully completed or for which you have received an exemption.

If you are not required under securities legislation or the rules of a self-regulatory organization to satisfy any course or examination requirements you are not required to complete this item.

2. Student Numbers

If you have a student number with one of the following institutions, provide it below:

Canadian Securities Institute (CSI): .............................................................................................................

Investment Funds Institute of Canada (IFIC): ...............................................................................................

Institute of Canadian Bankers (ICB): ............................................................................................................

Association for Investment Management and Research (AIMR): ................................................................

Canadian Association of Insurance and Financial Advisors (CAIFA): .........................................................

3. Exemption Refusal

Has any securities regulatory authority or self-regulatory organization refused to grant you an exemption from a course, examination or experience requirement? ...................................................... [ ] Yes [ ] No

If "Yes", complete Schedule "F".

Item 9 — Location of Employment

Location of employment

Provide the following information for the location of the sponsoring firm at which you will be working. 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.

NRD number: ....................................

Telephone number: (  )............................. Fax number: (  ).............................

[ ] Check here if the mailing address of the location is the same as the business address provided above. Otherwise, complete the following:

Item 10 — Current Employment

Employment information

On Schedule "G", provide the information requested for your current business and employment activities, including those with your sponsoring firm.

[ ] Check here if you are not required under securities legislation to provide this information.

Item 11 — Previous Employment

Employment information

On Schedule "H", provide the information requested for your previous business and employment activities for the 10-year period before the date of this application. Include any periods of self-employment or unemployment during this period. Do not include summer employment while you were a full-time student.

In addition, provide the information requested for all of your securities or exchange contracts (including commodity futures contracts and commodity futures options) business and employment activities during and prior to the ten-year period.

[ ] Check here if you are not required under securities legislation to provide this information.

[ ] Check here if the information required by this section has been provided in Item 10.

Item 12 — Resignations and Terminations

Resignation and termination information

Have you ever resigned or been terminated following allegations, made by a client, sponsoring firm, self-regulatory organization, securities regulatory authority or any other regulatory authority that you:

a) violated investment related statutes, regulations, rules or industry standards
of conduct? ...................................................................................................[ ] Yes [ ] No

b) failed to supervise in connection with investment related statutes, regulations,
rules or industry standards of conduct? ...........................................................[ ] Yes [ ] No

c) committed fraud or the wrongful taking of property? ...................................[ ] Yes [ ] No

If "Yes", to any of the above questions, complete Schedule "I".

Item 13 — Regulatory Disclosure

1. Securities Regulatory Authorities

a) Other than a registration that has been recorded on NRD under the NRD number you
are using to make this submission, are you now, or have you ever been, registered or
licensed to trade in or advise on securities or exchange contracts (including commodity
futures contracts and commodity futures options) in any province, territory, state or
country? ........................................................................................................[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 1 (a).

b) Are you now, or have you ever been, a partner, director, officer, or holder of voting
securities carrying more than 10 percent of the votes carried by all outstanding voting
securities of any firm which has been registered or licensed, or is now registered or
licensed, to trade in or advise on securities or exchange contracts (including commodity
futures contracts and commodity futures options) in any province, territory, state or
country? ........................................................................................................[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 1 (b).

c) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)), when
you were a partner, director, officer or holder of voting securities carrying more than
10 percent of the votes carried by all outstanding voting securities of that firm,
been refused registration or a license to trade in or advise on securities or exchange
contracts (including commodity futures contracts and commodity futures options)
in any province, territory, state or country? .....................................................[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 1 (c).

d) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)),
when you were a partner, director, officer or holder of voting securities carrying more
than 10 percent of the votes carried by all outstanding voting securities of that firm,
been denied the benefit of any exemption from registration provided by securities
legislation or legislation governing exchange contracts (including commodity futures
contracts and commodity futures options) in any province, territory, state or
country? .......................................................................................................[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 1 (d).

e) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)), when
you were a partner, director, officer or holder of voting securities carrying more than
10 percent of the votes carried by all outstanding voting securities of that firm,
been subject to a cease trade order, a cease distribution order, a suspension or termination
order, any disciplinary proceedings or any order resulting from disciplinary
proceedings pursuant to securities legislation or legislation governing exchange
contracts (including commodity futures contracts and commodity futures
options) in any province, territory, state or country? ........................................[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 1 (e).

2. Self-regulatory Organizations

a) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)),
when you were a partner, director, officer or holder of voting securities carrying more
than 10 percent of the votes carried by all outstanding voting securities of that firm,
been a member or participating organization of any stock exchange or other
self-regulatory organization in any province, territory, state or country? .............[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 2 (a).

b) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)),
when you were a partner, director, officer or holder of voting securities carrying more
than 10 percent of the votes carried by all outstanding voting securities of that firm,
been refused membership or entry as a participating organization in any stock exchange
or other self-regulatory organization in any province, territory, state or country? [ ] Yes [ ] No

If "Yes", complete Schedule "J", section 2 (b).

c) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)),
when you were a partner, director, officer or holder of voting securities carrying more
than 10 percent of the votes carried by all outstanding voting securities of that firm,
been subject to a suspension, expulsion or termination order, or been subject to any
disciplinary proceedings or any order resulting from disciplinary proceedings conducted
by any stock exchange or other self-regulatory organization in any province,
territory, state or country? ..............................................................................[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 2 (c).

3. Non-securities Regulation

a) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)),
when you were a partner, director, officer or holder of voting securities carrying more
than 10 percent of the votes carried by all outstanding voting securities of that firm,
been registered or licensed under any legislation which requires registration or licensing
to deal with the public in any capacity other than to trade in or advise on securities or
exchange contracts (including commodity futures contracts and commodity futures
options) in any province, territory, state or country? .......................................[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 3 (a).

b) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)),
when you were a partner, director, officer or holder of voting securities carrying more
than 10 percent of the votes carried by all outstanding voting securities of that firm,
been refused registration or a licence under any legislation which requires registration
or licensing to deal with the public in any capacity other than to trade in or advise on
securities or exchange contracts (including commodity futures contracts and commodity
futures options) in any province, territory, state or country? ...........................[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 3 (b).

c) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)),
when you were a partner, director, officer or holder of voting securities carrying more
than 10 percent of the votes carried by all outstanding voting securities of that firm,
been subject to a suspension or termination order, or disciplinary proceedings or any
order resulting from disciplinary proceedings conducted under any legislation which
requires registration or licensing to deal with the public in any capacity other than to
trade in or advise on securities or exchange contracts (including commodity
futures contracts and commodity futures options) in any province, territory, state
or country? .................................................................................................[ ] Yes [ ] No

If "Yes", complete Schedule "J", section 3 (c).

Item 14 — Criminal Disclosure

Criminal, provincial and territorial offences

With respect to questions (b) and (d) below, if you or your firm have pleaded guilty or been found guilty of an offence, that offence must be reported even if an absolute or conditional discharge has been granted with respect to the offence. You are not required to disclose any offence for which a pardon has been granted under the Criminal Records Act (Canada) unless the pardon has been revoked. You are not required to disclose speeding or parking violations.

a) Is there currently an outstanding charge against you alleging an offence that was
committed in any province, territory, state, or country? ..................................[ ] Yes [ ] No

If "Yes", complete Schedule "K", section (a).

b) Have you, since attaining the age of 18, ever been convicted of, pleaded guilty to or
no contest to an offence that was committed in any province, territory, state, or
country? .......................................................................................................[ ] Yes [ ] No

If "Yes", complete Schedule "K", section (b).

c) Have charges been laid, alleging an offence that was committed in any province, territory,
state, or country against any firm (other than your sponsoring firm or a firm that is or
was registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b))
in which you are or were at the time of that event a partner, director, officer or holder of
voting securities carrying more than 10 percent of the votes carried by all outstanding
voting securities? ...........................................................................................[ ] Yes [ ] No

If "Yes", complete Schedule "K", section (c).

d) Has any firm (other than your sponsoring firm or a firm that is or was registered in a
Canadian jurisdiction and identified in response to Item 13 (1) b)), when you were
a partner, director, officer or holder of voting securities carrying more than 10 percent
of the votes carried by all outstanding voting securities of that firm, been convicted of,
pleaded guilty to or no contest to an offence that was committed in any province,
territory, state, or country? ............................................................................[ ] Yes [ ] No

If "Yes", complete Schedule "K", section (d).

Item 15 — Civil Disclosure

Current and past civil proceedings

a) Have you, or has any firm (other than your sponsoring firm or a firm that is or was
registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)),
when you were a partner, director, officer or holder of voting securities carrying more
than 10 percent of the votes carried by all outstanding voting securities of that firm,
been a defendant or respondent in any civil proceeding in which fraud, theft, deceit,
misrepresentation, or similar conduct is, or was, alleged? ...............................[ ] Yes [ ] No

If "Yes", complete Schedule "L", section (a).

b) Other than what you disclosed in Item 15(a), were you, at the time the events that led to
the civil proceeding occurred, a partner, director or officer or a holder of securities
carrying more than 10 percent of the votes of all outstanding voting securities of a
firm (other than your sponsoring firm or a firm that is or was registered in a Canadian
jurisdiction and identified in response to Item 13 (1) (b)) that is or was a defendant or
respondent in any civil proceeding in which fraud, theft, deceit, misrepresentation,
or similar conduct is or was alleged? .............................................................[ ] Yes [ ] No

If "Yes", complete Schedule "L", section (b).

Item 16 — Financial Disclosure

1. Bankruptcy

Under the law of any province, territory, state, or country have you, or has any firm (other than your sponsoring firm or a firm that is or was registered in a Canadian jurisdiction and identified in response to Item 13 (1) (b)), when you were a partner, director, officer or holder of voting securities carrying more than 10 percent of the votes carried by all outstanding voting securities of that firm:

a) had a petition in bankruptcy issued against you or the firm or made a voluntary
assignment in bankruptcy? .............................................................................[ ] Yes [ ] No

b) made a proposal under any legislation relating to bankruptcy or insolvency? [ ] Yes [ ] No

c) been subject to proceedings under any legislation relating to the winding up,
dissolution or companies' creditors arrangement? ............................................[ ] Yes [ ] No

d) been subject to or instituted any proceedings, arrangement or compromise with
creditors (including having a receiver, receiver-manager, administrator or trustee
appointed by or at the request of creditors, either privately, or through court process,
or by order of a regulator, to hold your assets)? ..............................................[ ] Yes [ ] No

If "Yes" to any of the above questions, complete Schedule "M", section 1.

2. Debt Obligations

Have you ever failed to meet a financial obligation of $500 or more as it came due, or has any
firm (other than your sponsoring firm or a firm that is or was registered in a Canadian jurisdiction
and identified in response to Item 13 (1) (b)), when you were a partner, director, officer or holder of
voting securities carrying more than 10 percent of the votes carried by all outstanding voting
securities of that firm, failed to meet a financial obligation as it came due? ................[ ] Yes [ ] No

If "Yes", complete Schedule "M", section 2.

3. Surety Bond or Fidelity Bond

Have you ever applied for a surety or fidelity bond and been refused? ....................[ ] Yes [ ] No

If "Yes", complete Schedule "M", section 3.

4. Garnishments, Unsatisfied Judgments or Directions to Pay

Are there currently, or have there been, outstanding against you any of the following:

a) garnishments,

b) unsatisfied judgments, or

c) directions to pay;

issued by a federal, provincial, territorial or state authority? ...................................[ ] Yes [ ] No

If "Yes", complete Schedule "M", section 4.

Item 17 — Related Securities Firms

Related securities firms and holdings

Are you a partner, director, or officer of a firm (other than your sponsoring firm) whose principal
business is trading in or advising on securities or exchange contracts (including commodity
futures contracts and commodity futures options) or are you a holder of 10 percent or more of the
voting securities of any firm (including your sponsoring firm) whose principal business is trading
in or advising on securities or exchange contracts (including commodity futures contracts and
commodity futures options)? ................................................................................[ ] Yes [ ] No

If "Yes", complete Schedule "N".

Agent for Service

By submitting this form you certify that in each jurisdiction in which you have appointed an agent for service you have properly executed the appointment of agent for service required by the regulator or the securities legislation of that jurisdiction.

Submission to Jurisdiction

By submitting this application you irrevocably and unconditionally submit to the non-exclusive jurisdiction of the judicial, quasi-judicial and administrative tribunals of each jurisdiction to which you have submitted this application and any administrative proceeding in that jurisdiction, in any action, investigation or administrative, criminal, quasi-criminal, penal or other proceeding (each, a "Proceeding") arising out of or relating to or concerning your activities as a registrant or an officer, partner or director of a registrant under the securities legislation of the jurisdiction, and irrevocably waive any right to raise as a defence in any Proceeding any alleged lack of jurisdiction to bring that Proceeding.

Notice of Collection and Use of Personal Information

The personal information required under this form is collected on behalf of and used by the securities regulatory authorities set out below for purposes of the administration and enforcement of certain provisions of the securities legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Qu้bec, Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland, Northwest Territories, Yukon Territory and Nunavut.

By submitting this application you consent to the collection by the securities regulatory authority to which this application is being submitted of the personal information contained in the application, police records, records from other government or non-governmental regulatory authorities or self-regulatory organizations, credit records and employment records about you as may be necessary for the securities regulatory authority to complete its review of your application or continued fitness for registration in accordance with the legal authority of the securities regulatory authority for the duration of the period which you remain registered or approved by the securities regulatory authority. The sources the securities regulatory authority may contact include government and private bodies or agencies, individuals, corporations and other organizations.

The principal purpose for which this collection of personal information is to be used is to assess your suitability for registration and to assess your continued fitness for registration in accordance with the applicable securities legislation.

If you have any questions about the collection and use of this information, you may contact the securities regulatory authority in any jurisdiction in which the required information is filed, at the address or telephone number set out in Schedule "O". In Qu้bec, questions may also be addressed to the Commission d'acc่s เ l'information du Qu้bec (1-888-528-7741, web site: www.cai.gouv.qc.ca).

WARNING:

It is an offence to submit information that, in a material respect and at the time and in the light of the circumstances in which it is submitted, is misleading or untrue.

The following certification is to be used when submitting this form in NRD format:

[ ] I am making this submission as agent for the individual to whom this submission relates. By checking this box I certify that all statements of fact in this submission were provided to me by the individual.

Both of the following certifications are to be used when submitting this form in paper format:

I, the undersigned, certify that I have read and that I understand the questions in this form and the Warning set out above.

I also certify that all statements of fact provided in this application are true.

I, the undersigned, certify on behalf of the sponsoring firm that the individual will be engaged by the sponsoring firm as a registered individual or a non-registered individual. I certify that I have, or a branch manager or another officer or partner has, discussed the questions set out in this form with the individual and I am satisfied that the individual fully understands the questions.

Schedule "A"
Name

Item 1

Other names

Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name).

When did you use this name? From: .............................(YYYY/MM) To: .............................(YYYY/MM)

Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name).

When did you use this name? From: .............................(YYYY/MM) To: .............................(YYYY/MM)

Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name).

When did you use this name? From: .............................(YYYY/MM) To: .............................(YYYY/MM)

Schedule "B"
Residential Address

Item 2

Previous addresses

A postal code (or ZIP code) and a telephone number are not required for any previous address.

Residential address:......................................................................................................................................
(number, street, city, province, territory or state, country)

When did you live at this address? From: ...........................(YYYY/MM) To: ...........................(YYYY/MM)

When did you live at this address? From: ...........................(YYYY/MM) To: ...........................(YYYY/MM)

When did you live at this address? From: ...........................(YYYY/MM) To: ...........................(YYYY/MM)

When did you live at this address? From: ...........................(YYYY/MM) To: ...........................(YYYY/MM)

When did you live at this address? From: ...........................(YYYY/MM) To: ...........................(YYYY/MM)

Schedule "C"
Individual Categories

Item 6

Categories

Indicate, by checking the appropriate box, each category for which you are applying.

Schedule "D"
Address and Agent for Service

Item 7

Address for Service

1. Address for service

You must have one address for service in each province or territory in which you are now, or are applying to become, a registered individual or non-registered individual. A post office box is not an acceptable address for service.

Telephone number: (  )............................. Fax number: (  ).............................

E-mail address: .....................................................................................

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)

Schedule "E"
Proficiency

Item 8

Course or examination information

Indicate each course and examination that you have successfully completed or for which you have received an exemption.

Schedule "F"
Proficiency

Item 8

Exemption refusal

Complete the following for each exemption that was refused.

Which securities regulatory authority or self-regulatory organization refused to grant the exemption?

 

State the name of the course, examination or experience requirement:

 

State the reason given for not being granted the exemption:

  

Which securities regulatory authority or self-regulatory organization refused to grant the exemption?

  

State the name of the course, examination or experience requirement:

 

State the reason given for not being granted the exemption:

 

Schedule "G"
Current Employment

Item 10

Employment information

Provide the information requested for each of your current business and employment activities, including those with your sponsoring firm.

[ ] Unemployed

[ ] Full-time student

[ ] Employed or self-employed

From: ......................................(YYYY/MM/DD)

You are only required to fill in the following if you have indicated above that you are employed or self-employed.

Name of business or employer: .....................................................................................................................

Name and title of immediate supervisor: ......................................................................................................

Describe the type of business or employment and your duties. If you are seeking a type of registration for which specified experience is required, provide details of that experience below (for example, level of responsibility, value of accounts under direct supervision, and research experience):

Indicate the number of hours per week you will be devoting to this business or employment: .................

If the business or employment described above is with the sponsoring firm and if you are working less than 30 hours per week for the firm, explain why you are working less than 30 hours per week for the firm:

If the business or employment described above is not with the sponsoring firm, disclose any potential for confusion by clients and any potential for conflicts of interest arising from your proposed activities as a registrant and the business or employment described above (include whether the business is listed on an exchange):

Schedule "H"
Previous Employment

Item 11

Employment information

Provide the information requested for your previous business and employment activities for the 10-year period before the date of this application. Include any periods of self-employment or unemployment during this period. Do not include summer employment while you were a full-time student.

In addition, provide the information requested in respect of all of your securities or exchange contracts (including commodity futures contracts and commodity futures options) business and employment activities during and prior to the ten-year period.

[ ] Unemployed

[ ] Full-time student

[ ] Employed or self-employed

From: ......................................(YYYY/MM/DD) To: ......................................(YYYY/MM/DD)

You are only required to fill in the following if you have indicated above that you are, or were, employed or self-employed.

Name of business or employer: .....................................................................................................................

Name and title of immediate supervisor: ......................................................................................................

Describe the type of business or employment and your duties. If you are seeking a type of registration for which specified experience is required, provide details of that experience below (for example, level of responsibility, value of accounts under direct supervision, and research experience):

Schedule "I"
Resignations And Terminations

Item 12

Resignation and Termination information

For each resignation or termination indicate below, (1) the name of the firm from which you resigned or were terminated, (2) whether you resigned or were terminated, (3) the date you resigned or were terminated, and (4) the circumstances relating to your resignation or termination (including whether the allegations were made by a client, sponsoring firm, self-regulatory organization or regulatory authority).

Schedule "J"
Regulatory Disclosure

Item 13

1. Securities regulatory authorities

a) For each registration or licence, indicate below (1) the securities regulatory authority with which you are, or were, registered or licensed, (2) the type or category of registration or licence, and (3) the dates between which you held the registration or licence.

b) For each registration or licence, indicate below (1) the name of the firm, (2) the securities regulatory authority with which the firm is, or was, registered or licensed, (3) the type or category of registration or licence, and (4) the dates between which you held the registration or licence.

c) For each registration or licence refused, indicate below (1) the party that was refused the registration or licence, (2) the securities regulatory authority that refused the registration or licence, (3) the type or category of registration or licence refused, (4) the date of the refusal, and (5) the reasons for the refusal.

d) For each exemption from registration denied, indicate below (1) the party that was denied the exemption, (2) the securities regulatory authority that denied the exemption, (3) the date the exemption was denied, and (4) any other information that you think is relevant or that is requested by the regulator.

e) For each order or disciplinary proceeding, indicate below (1) the party against whom the order was made or the proceeding taken, (2) the securities regulatory authority that issued the order or that is, or was, conducting the proceeding, (3) the date any notice of proceeding was issued, (4) the date any order or settlement was made, (5) a summary of any notice, order or settlement (including any sanctions imposed), and (6) any other information that you think is relevant or that is requested by the regulator.

2. Self-regulatory organizations

a) For each membership or participation, indicate below (1) the party that is, or was, a member or participating organization, (2) the self-regulatory organization with which the party is, or was, a member or participating organization, (3) the type or category of membership or participation, and (4) the dates between which the party was a member or participating organization.

b) For each membership or participation refused, indicate below (1) the party that was refused membership or participation, (2) the self-regulatory organization that refused the membership or participation, (3) the type or category of membership or participation refused, (4)