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Volume 65, No. 11
126/2022
The British Columbia Gazette, Part II
June 7, 2022

B.C. Reg. 126/2022, deposited June 1, 2022, under the SECURITIES ACT [section 184]. Rule of the British Columbia Securities Commission, dated June 1, 2022.

The British Columbia Securities Commission orders that, effective June 6, 2022,

(a) National Instrument 31-103 Registration Requirements, Exemptions and Ongoing Registrant Obligations, B.C. Reg. 226A/2009, is amended as set out in the attached Schedule 1, and

(b) National Instrument 33-109 Registration Information, B.C. Reg. 226B/2009, is amended as set out in the attached Schedule 2.

— B. LEONG, British Columbia Securities Commission.

Schedule 1

1. National Instrument 31-103 Registration Requirements, Exemptions and Ongoing Registrant Obligations, B.C. Reg. 226A/2009, is amended as set out in this Schedule.

2. Section 12.7 is repealed and replaced with the following:

Notifying the regulator or the securities regulatory authority of a change, claim or cancellation

12.7 (1) A registered firm must, as soon as possible, notify the regulator or, in Québec, the securities regulatory authority in writing of any change in, claim made under, or cancellation of any bonding or insurance required under this Division.

(2) Subsection (1) does not apply with respect to a renewal of bonding or insurance if the term of the renewal is for a period of at least one year and the insurance policy had not lapsed at the time of renewal.

3. The following section is added:

Restrictions on a registered individual who is in a position of influence

13.4.3 (1) In this section, "position of influence" means a position, other than a position with a sponsoring firm, if, due to the nature of the position or the training or specialized knowledge required for the position, an individual in that position would be considered by a reasonable person to have influence over another individual.

(2) For greater certainty, a position of influence under subsection (1) includes the following:

(a) a leader in a religious or similar organization;

(b) a medical doctor;

(c) a nurse;

(d) a professor, instructor or teacher at a degree or diploma granting institution;

(e) a lawyer;

(f) a notary.

(3) A registered firm must not knowingly permit a registered individual of the firm who is in a position of influence to purchase or sell securities or derivatives for, or recommend the purchase, sale or holding of securities or derivatives to,

(a) an individual who

(i) has a relationship with the registered individual arising from the position of influence, and

(ii) to a reasonable person, would be considered to be susceptible to the registered individual’s influence, or

(b) a spouse, parent, sibling, grandparent or child of an individual referred to in paragraph (a).

(4) A registered individual who is in a position of influence must not purchase or sell securities or derivatives for, or recommend the purchase, sale or holding of securities or derivatives to,

(a) an individual who

(i) has a relationship with the registered individual arising from the position of influence, and

(ii) to a reasonable person, would be considered to be susceptible to the registered individual’s influence, or

(b) an individual that the registered individual knows is a spouse, parent, sibling, grandparent or child of an individual referred to in paragraph (a).

Schedule 2

1. National Instrument 33-109 Registration Information, B.C. Reg.226B/2009, is amended as set out in this Schedule.

2. Section 1.1 is amended

(a) in the definition of "cessation date" by deleting ", because of the end of, or a change in, the individual’s employment, partnership, or agency relationship with the firm", and

(b) by replacing the definition of "Form 33-109F1" with the following:

"Form 33-109F1" means Form 33-109F1 Notice of End of Individual Registration or Permitted Individual Status.

3. Subsection 2.3 (2) is amended

(a) by replacing paragraph (b) with the following:

(b) in the case of the individual ceasing to be a registered individual or a permitted individual of a sponsoring firm, at the time of cessation there was no allegation against the individual, in Canada or in any foreign jurisdiction, relevant to an assessment of whether the individual is not suitable for registration or the registration is objectionable, including, for greater certainty, an allegation of any of the following:

(i) a crime;

(ii) a contravention of any statute, regulation or order of a court or regulatory body;

(iii) a contravention of any rule or bylaw of an SRO, of a professional body or of a similar organization;

(iv) a failure to meet any standard of conduct of the sponsoring firm or of any professional body; , and

(b) by adding the following paragraphs:

(b.1) on or before the cessation date, the individual notified, in accordance with section 4.1, the regulator or, in Québec, the securities regulatory authority of any change to the information previously submitted in the individual’s Form 33-109F4;

(b.2) if the Form 33-109F7 is submitted on or after June 6, 2023, on the date Form 33-109F7 is submitted, the individual’s information in the National Registration Database does not state "there is no response to this question" for any item of the individual’s Form 33-109F4; .

4. Section 2.5 is amended

(a) by replacing "10 days" with "15 days" wherever it appears, and

(b) in subsection (2) by replacing paragraph (c) with the following:

(c) the conditions in paragraphs 2.3 (2) (b), (b.1), (b.2) and (c) are met.

5. Section 3.1 is amended

(a) by replacing subsection (1) with the following:

(1) In this section, "authorized affiliate" means, in respect of a registered firm, another registered firm that

(a) is an affiliate of the registered firm, and

(b) has the same principal regulator as the registered firm.

(1.1) Subject to subsection (3) or (4), a registered firm must notify the regulator or, in Québec, the securities regulatory authority of a change to any information previously submitted in Form 33-109F6 or under this subsection as follows:

(a) for a change to information previously submitted in relation to any of the following parts or items of Form 33-109F6, within 30 days of the change:

(i) part 3 [Business history and structure];

(ii) item 4.1 [Securities registration];

(iii) item 5.12 [Auditor];

(iv) item 6.1 [Client assets];

(v) item 6.2 [Conflicts of interest];

(b) for a change to information previously submitted in relation to any other part of Form 33-109F6, within 15 days of the change. ,

(b) in subsection (2), by replacing "subsection (1)" with "subsection (1.1)",

(c) by adding the following subsection:

(2.1) A registered firm may delegate to an authorized affiliate the duty to notify the regulator or, in Québec, the securities regulatory authority under subsection (1.1) of a change to information previously submitted if all of the following apply:

(a) the change in information relates only to one or more of the following items or parts of Form 33-109F6:

(i) item 3.12 [Ownership chart];

(ii) item 4.1 [Securities registration];

(iii) item 4.3 [Membership of exchange or SRO];

(iv) item 4.5 [Refusal of registration, licensing or membership];

(v) item 4.6 [Registration for other financial products];

(vi) part 7 [Regulatory action];

(vii) part 8 [Legal action];

(b) the registered firm has filed a certificate, executed by the officer or partner authorized to certify and sign Form 33-109F5, with the registered firm’s principal regulator, that confirms all of the following:

(i) the registered firm has delegated to the authorized affiliate the duty to notify the regulator or, in Québec, the securities regulatory authority of a change to any information set out in paragraph (a),

(ii) the full legal name and NRD number of the registered firm and the authorized affiliate, and

(iii) that the following certification of the registered firm applies to each notice of change submitted by the authorized affiliate:

"I have read this form and understand all matters within this form, including the questions, and to the best of my knowledge and after reasonable inquiry, all of the information provided on this form is true and complete.";

(c) the registered firm directs the authorized affiliate to include the full legal name and NRD number of the registered firm and to state the following in each notice of change submitted by the authorized affiliate:

"The registered firm has delegated to the authorized affiliate the duty to notify the regulator or, in Québec, the securities regulatory authority of a change to any of the following items or parts of Form 33-109F6:

(i) item 3.12 [Ownership chart];

(ii) item 4.1 [Securities registration];

(iii) item 4.3 [Membership of exchange or SRO];

(iv) item 4.5 [Refusal of registration, licensing or membership];

(v) item 4.6 [Registration for other financial products];

(vi) part 7 [Regulatory action];

(vii) part 8 [Legal action]." ,

(d) in subsection (3), by replacing "subsection (1)" with "subsection (1.1)", by replacing "termination" with "cessation" in paragraph (b), and by adding the following paragraphs:

(e) a change in a person or company’s ownership of the firm’s voting securities referred to in item 3.12 of Form 33-109F6, if the change did not result in the person or company’s percentage of ownership falling below or exceeding 10%, 20% or 50% of the firm’s voting securities;

(f) a renewal of the bonding or insurance referred to in item 5.5 or in item 5.6 of Form 33-109F6, if the bonding or insurance has not lapsed and the only change is the expiry date of the bonding or insurance policy to a new date that is at least one year from the previous expiry date. , and

(e) in subsection (4) by replacing "a completed Schedule B" with "an executed Schedule B" wherever it appears, adding "in" before "item 4", and replacing "10 days" with "15 days".

6. Section 3.2 is amended by replacing "10 days" with "15 days".

7. Section 4.1 is amended

(a) by replacing subsection (1) with the following:

(1) Subject to subsection (2), a registered individual or permitted individual must notify the regulator or, in Québec, the securities regulatory authority of a change to any information previously submitted in respect of the individual’s Form 33-109F4 as follows:

(a) for a change to information previously submitted in any of the following items, within 30 days of the change:

(i) item 2.1 [Current and previous residential addresses];

(ii) item 2.2 [Mailing address];

(iii) item 4 [Citizenship];

(iv) item 10 [Reportable activities];

(v) item 11 [Previous employment and other activities];

(b) for a change to information previously submitted in any other items of Form 33-109F4, within 15 days of the change. ,

(b) by replacing subsection (2) with the following:

(2) A notice of change is not required under subsection (1) if the change only relates to any of the following:

(a) information previously submitted in item 3 [Personal information] of Form 33-109F4;

(b) the individual ceasing to have authority to act on behalf of the sponsoring firm as a registered individual or be a permitted individual of the sponsoring firm if a Form 33-109F1 is required to be submitted by the sponsoring firm under subsection 4.2 (1). , and

(c) by replacing paragraph (4) (a) with the following:

(a) a change in a category of permitted activities of a permitted individual, .

8. Section 4.2 is amended

(a) by replacing subsection (1) with the following:

(1) A registered firm must notify the regulator or, in Québec, the securities regulatory authority if an individual ceases to have authority to act on behalf of the registered firm as a registered individual or be a permitted individual of the registered firm by submitting Form 33-109F1 to the regulator or, in Québec, the securities regulatory authority in accordance with National Instrument 31-102 National Registration Database with

(a) items 1 to 4 of the Form completed, and

(b) item 5 of the Form completed unless the reason for cessation under item 4 was death of the individual. , and

(b) by replacing "10 days" with "15 days" wherever it appears.

9. The following section is added:

Updating NRD

4.3 A registered individual or permitted individual must submit in accordance with National Instrument 31-102 National Registration Database to the regulator or, in Québec, the securities regulatory authority, a completed Form 33-109F5 for any item of the individual’s Form 33-109F4 in the National Registration Database that states "there is no response to this question" by the earlier of

(a) the date the individual is required to notify the regulator or, in Québec, the securities regulatory authority under subsection 4.1 (1) of the first change after June 6, 2022 to any information previously submitted in respect of the individual’s Form 33-109F4, and

(b) June 6, 2023.

10. Form 33-109F1 is amended

(a) by replacing the title with the following:

"Form 33-109F1
Notice of End of Individual Registration or Permitted
Individual Status

(section 4.2)",

(b) by adding the following immediately before the heading "General instructions":

WARNING – It is an offence to knowingly give false or misleading information to the regulator or the securities regulatory authority.

CERTIFICATION

I, on behalf of the firm, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where the firm is submitting this form and to any applicable self-regulatory authority (SRO) that

NRD format:

☐   I, the authorized firm representative, am making this submission under authority delegated by the firm. By checking this box, I certify that the firm

(a) provided me with all of the information on this form, and

(b) makes the certification above.

Non-NRD format:

By signing below, I, on behalf of the firm, make the certification above.

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)

(c) by deleting the heading "Terms" and replacing the text between the heading "Terms" and "How to submit the form" with the following:

As set out in section 1.1 of National Instrument 33-109 Registration Information, "cessation date" means the last day on which an individual had authority to act as a registered individual on behalf of their sponsoring firm or the last day on which an individual was a permitted individual of their sponsoring firm. ,

(d) by replacing the text between the heading "When to submit the form" and "Item 1 – Terminating firm" with the following:

As set out in paragraph 4.2 (2) (a) of National Instrument 33-109 Registration Information, you must submit the responses to Items 1, 2, 3 and 4 within 15 days of the cessation date.

If you are required to complete Item 5, you must submit those responses within 30 days of the cessation date. If you are submitting the responses to Item 5 in NRD format, after Items 1 to 4 have been submitted at NRD, use the NRD submission type called "Update/Correct Cessation Information" to complete Item 5 of this form. ,

(e) in Item 1 by replacing in the heading "Terminating" with "Former sponsoring",

(f) in Item 2 by replacing in the heading "Terminated individual" with "Individual",

(g) in Item 3 by deleting in the heading "terminated",

(h) by replacing Item 4 with the following:

Item 4 – Date and reason for cessation

1.

Cessation date ____________________
                             (YYYY/MM/DD)

The above date is the last day on which the individual had authority to act as a registered individual on behalf of the sponsoring firm, or the last day on which the individual was a permitted individual of the sponsoring firm.

2.

Reason for cessation (check one):

Resigned - voluntary

Resigned - at the firm’s request

Terminated in good standing

Terminated for cause

Completed temporary employment contract

Retired

Deceased

Other

If "Other", explain:

_____________________________________________________________ ,

(i) in Item 5 by replacing "termination" in the heading with "cessation" and by replacing the text between the heading and "Answer the following questions to the best of the firm’s knowledge." with the following:

Complete Item 5 except if the individual is deceased. In the space below

[For NRD format only:]

☐   This information will be disclosed within 30 days of the cessation date

☐   Not applicable: individual is deceased ,

(j) in Item 5 by replacing "outside business activity" in question 7 with "outside activity", and

(k) by repealing Items 7 and 8.

11. Form 33-109F2 is amended

(a) by adding the following immediately before the heading "General instructions":

WARNING – It is an offence to knowingly give false or misleading information to the regulator or the securities regulatory authority.

CERTIFICATION

Individual

I, the individual, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where I am submitting this form and to any applicable self-regulatory organization (SRO) that

I consent to and authorize the collection, directly and indirectly, of personal information by each regulator, securities regulatory authority and SRO and to the use of my personal information as set out in item 6.

Firm

I, on behalf of the firm, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where the firm is submitting this form and to any applicable SRO that

NRD format:

☐   I, the authorized firm representative, am making this submission under authority delegated by the firm and the individual identified in this form. By checking this box, I certify that

(a) the firm provided me with all of the information on this form and makes the firm certification above,

(b) the individual provided the firm with all of the information on this form and makes the individual certification above, and

(c) the individual provided the above consent and authorization for the collection and use of the individual’s personal information.

Non-NRD format:

Individual

By signing below, I, the individual, make the above individual certification and provide my consent and authorization for the collection, directly and indirectly, and use of my personal information.

Signature of individual __________________________________________

Date signed _____________________

                (YYYY/MM/DD)

Firm

By signing below, I, on behalf of the firm, make the firm certification above.

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)

(b) in Item 4 by deleting "industry" in the subheading "3. Relevant securities industry experience" and by replacing the text between that subheading and "Item 5 – Reason for surrender" with the following:

Do you have securities experience?

Yes  ☐      No  ☐      N/A  ☐

If you are an individual applying for IIROC approval, select "N/A".

If "Yes", complete Schedule A. ,

(c) by replacing Item 6 with the following:

Item 6 – Notice and consent for collection and use of personal information

1. Notice of collection and use of personal information

Your personal information is collected by, or on behalf of, each securities regulatory authority and SRO set out in Schedule B. Any of the securities regulatory authorities or SROs set out in Schedule B may contact governmental or regulatory authorities, private bodies or agencies, individuals, corporations, employers, and other organizations, in Canada and in other countries, for information about you.

This personal information is being collected under the authority of the applicable securities legislation, derivatives legislation (including commodity futures legislation) or both of the securities regulatory authorities and under the SRO rules of an SRO set out in Schedule B. The collection, use and disclosure are done in accordance with applicable freedom of information and privacy legislation.

The principal purpose of this collection by the securities regulatory authorities is to administer, enforce, carry out their duties or exercise their powers under their respective securities legislation, derivatives legislation (including commodity futures legislation) or both, and by the SROs to administer and enforce the rules of the SROs.

The information submitted by you on this form with your consent, or collected indirectly with your authorization, may be collected

If you have any questions about the collection, use and disclosure of this information, contact the securities regulatory authority or SRO in any jurisdiction in which the required information is submitted. See Schedule B for details.

Certain information, such as your name(s) (including aliases, trade names or some past names), your sponsoring firm, and other relevant registration information, will be listed in a publicly available registry of registered individuals and, if applicable, on the Disciplined List.

Certain securities regulatory authorities may provide to or receive from certain entities information under separate provisions of their securities legislation or derivatives legislation (including commodity futures legislation) or both, and SROs may provide or receive information under the rules of the SROs. This consent and notice does not limit the authority, powers, obligations, or rights conferred on any of the securities regulatory authorities by legislation or regulations in effect in their jurisdiction.

2. Consent to collect and use personal information

By submitting this form, you consent to and authorize the collection, directly and indirectly, of personal information by each securities regulatory authority and SRO and to the use of your personal information as set out above.

The personal information that each securities regulatory authority or SRO collects includes the following:

(d) by repealing Item 7,

(e) by repealing Item 8,

(f) by replacing Schedule A with the following:

Schedule A
Relevant securities experience (Item 4)

Instructions:

1. If you are applying

For each position in which you gained relevant experience, provide the following information:

(a) the name of the firm or entity with which you gained this experience;

(b) your title;

(c) the start and end dates of this position;

(d) the details of the activities you performed that are relevant for the category of registration that you are applying for;

(e) the percentage of your time in this position that was spent on activities relating to the experience.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

2. Indicate the continuing education activities in which you have participated during the last 36 months and that are relevant to the category of registration you are applying for:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

(g) in Schedule B, by replacing "Notice of" in the title with "Notice and Consent for",

(h) in Schedule B in the contact information for British Columbia, by replacing "Freedom of Information Officer" with "Registration staff" and adding "E-mail: Registration@bcsc.bc.ca" at the end,

(i) in Schedule B in the contact information for Saskatchewan, by deleting "Deputy" and adding "E-mail: registrationfcaa@gov.sk.ca" at the end,

(j) in Schedule B in the contact information for Nova Scotia, by replacing "Deputy Director, Capital Markets" with "Registration",

(k) in Schedule B in the contact information for Yukon, by adding "Office of the Yukon" before "Superintendent of Securities" and replacing "(867) 667-5314" with "(867) 667-5466", and

(l) in Schedule B in the contact information for Northwest Territories, by deleting "Deputy".

12. Form 33-109F3 is amended

(a) by adding the following immediately before the heading "General instructions":

WARNING – It is an offence to knowingly give false or misleading information to the regulator or the securities regulatory authority.

CERTIFICATION

I, on behalf of the firm, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where the firm is submitting this form and to any applicable self-regulatory organization (SRO) that

NRD format:

☐   I, the authorized firm representative, am making this submission under authority delegated by the firm.

☐   By checking this box, I, the authorized firm representative, certify that

(a) the firm provided me with all of the information on this form, and

(b) the firm makes the certification above.

Non-NRD format:

By signing below, I, on behalf of the firm, make the certification above.

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)

(b) by adding the following at the end of Item 3:

Notice regarding a business location that is a residence

For the administration of securities legislation or derivatives legislation, including commodity futures legislation, or both, the regulator or, in Québec, the securities regulatory authority may require access to the business location to review the books, records and documents of the registered firm. If applicable, the SRO may also require access to the business location for the administration of the rules of the SRO.

If the business location specified in this form is a residence, the regulator, securities regulatory authority or SRO may request consent to enter the residence.

If consent is not provided, it may affect the ability of the regulator, securities regulatory authority or SRO to access the books, records or documents of a registered firm and to determine whether securities legislation, derivatives legislation (including commodity futures legislation) or the rules of the SRO are being complied with. As a result, the regulator, securities regulatory authority or SRO may take action if it is unable to access and review the books, records or documents of a registered firm held at the business location. ,

(c) by repealing Item 4,

(d) by repealing Item 5,

(e) by repealing Item 6, and

(f) by repealing Schedule A.

13. Form 33-109F4 is amended

(a) by adding the following immediately before the heading "General instructions":

WARNING – It is an offence to knowingly give false or misleading information to the regulator or the securities regulatory authority.

CERTIFICATION

Individual

I, the individual, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where I am submitting this form and to any applicable self-regulatory organization (SRO) that

I consent to and authorize the collection, directly and indirectly, of personal information by each regulator, securities regulatory authority and SRO and to the use of my personal information as set out in Item 20.

Firm

I, on behalf of the firm, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where the firm is submitting this form and to any applicable SRO that

NRD format:

☐   I, the authorized firm representative, am making this submission under authority delegated by the firm and the individual identified in this form. By checking this box, I certify that

(a) the firm provided me with all of the information on this form and makes the firm certification above,

(b) the individual provided the firm with all of the information on this form and makes the individual certification above, and

(c) the individual provided the above consent and authorization for the collection and use of the individual’s personal information.

Non-NRD format:

Individual

By signing below, I, the individual, make the above individual certification and provide my consent and authorization for the collection, directly and indirectly, and use of my personal information.

Signature of individual __________________________________________

Date signed _____________________

                (YYYY/MM/DD)

Firm

By signing below, I, on behalf of the firm, make the firm certification above.

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)

(b) in Item 5 by replacing the portion of the form in section 2 with the following:

2. Check each jurisdiction where you are seeking registration or, if you are seeking review as a permitted individual, check each jurisdiction where your sponsoring firm is registered:

☐   All jurisdictions
☐   Alberta
☐   British Columbia
☐   Manitoba
☐   New Brunswick
☐   Newfoundland and Labrador
☐   Northwest Territories
☐   Nova Scotia
☐   Nunavut
☐   Ontario
☐   Prince Edward Island
☐   Québec
☐   Saskatchewan
☐   Yukon ,

(c) in Item 8 by replacing the portion of the form after the subheading "1. Course, examination or designation information and other education" and before the subheading "2. Student numbers" with the following:

Complete Schedule E to state each course, examination and designation that

☐   Check here if you are not required under securities legislation or derivatives legislation (including commodity futures legislation), or the rules of an SRO, to satisfy any course, examination or designation requirements. ,

(d) in Item 8 by deleting "industry" in the subheading "4. Relevant securities industry experience" and replacing the text between that subheading and "Item 9 – Location of employment" with the following:

If you are an individual applying for IIROC approval, select "N/A".

Do you have securities experience?

Yes  ☐      No  ☐      N/A  ☐

If "Yes", complete Schedule F. ,

(e) by adding the following at the end of Item 9:

6. Notice regarding a business location that is a residence

For the administration of securities legislation or derivatives legislation, including commodity futures legislation, or both, the regulator or, in Québec, the securities regulatory authority may require access to the business location to review the books, records and documents of the registered firm. If applicable, the SRO may also require access to the business location for the administration of the rules of the SRO.

If the business location specified in this form is a residence, the regulator, securities regulatory authority or SRO may request consent to enter the residence.

If consent is not provided, it may affect the ability of the regulator, securities regulatory authority or SRO to access the books, records or documents of a registered firm and to determine whether securities legislation, derivatives legislation (including commodity futures legislation) or the rules of the SRO are being complied with. As a result, the regulator, securities regulatory authority or SRO may take action if it is unable to access and review the books, records or documents of a registered firm held at the business location. ,

(f) by replacing Item 10 with the following:

Item 10 – Reportable activities

1. Activities with your sponsoring firm

Instructions: Describe all of your roles and responsibilities with your sponsoring firm, whether these roles and responsibilities are securities-related or not (e.g., sale of securities, review of marketing materials, IT help desk, negotiation of employment contracts, sales of banking and insurance products and services). Include any other information about your position with your sponsoring firm that is relevant for the regulator or, in Québec, the securities regulatory authority to know (e.g., if your role is specialized). For example, if you are applying as an advising representative limited to client relationship management, indicate this by including the following statement in Schedule G: "Individual is seeking registration as CRM AR."

Complete a Schedule G with respect to your roles and responsibilities with your sponsoring firm.

2. Reportable outside activities

Instructions: Consider all of the activities that you participate in outside of your sponsoring firm, whether or not you receive compensation for such activities and whether or not any such activity is business-related. Activities performed for an affiliated entity are considered activities outside of your sponsoring firm. If any of the categories below describes one or more activities that you participate in, complete a separate Schedule G for each activity or entity. If multiple activities are performed for one entity, complete a single Schedule G identifying all the activities performed.

Uncompensated activities that do not fall within Categories 1 to 5 (i.e., generally activities that do not involve securities or financial services and are not a position of influence, such as being a little league soccer coach) are not reportable.

Category 1 – Activities with another registered firm

Instructions: Report activities with registered firms, other than your sponsoring firm. All activities in this category are reportable, whether or not you receive compensation for such activities. Major shareholder means a shareholder who, in total, directly or indirectly owns voting securities carrying 10 percent or more of the votes carried by all outstanding voting securities.

If you are a director, officer, employee, contractor, consultant, agent or service provider of a registered firm other than your sponsoring firm, or are in any other equivalent position with or for that registered firm, or are a major shareholder or partner of that registered firm, complete a separate Schedule G for the registered firm.

Category 2 – Activities with an entity that receives compensation from a registered firm

If you are a director, officer, employee, contractor, consultant or agent of a specified entity, or are in any other equivalent position with or for a specified entity, or are a shareholder or partner of a specified entity, complete a separate Schedule G for the specified entity.

For the purposes of this category, "specified entity" means an entity that receives compensation from a registered firm for activities that you provide for your sponsoring firm or another registered firm.

Category 3 – Other securities-related activities

Instructions: All activities in this category are reportable, whether or not you receive compensation for such activities. Charitable or other fundraising activities that do not involve the issuance of securities or derivatives are not reportable.

If you have been at any time in the last 7 years directly involved in raising money for an entity through the issuance of securities or derivatives or promoting the sale of an entity’s securities or derivatives outside of your activities with your sponsoring firm or another registered firm, complete a separate Schedule G for each entity for which you performed these activities.

Directors and officers of reporting issuers and of entities that have been at any time in the last 7 years raising money through the issuance of securities or derivatives are considered to be directly involved in raising money for that entity.

Category 4 – Provision of financial or finance-related services

Instructions: All activities in this category are reportable, whether or not you receive compensation for such activities. For example, volunteer activities pertaining to your securities or financial services knowledge must be reported under this category. Also report if you are the owner or management of an entity that provides these services. Major shareholder means a shareholder who, in total, directly or indirectly owns voting securities carrying 10% or more of the votes carried by all outstanding voting securities.

Complete a separate Schedule G for each activity, as applicable, if you

Also complete a separate Schedule G for each activity, as applicable, if you are a director or officer, or are in any other equivalent position with or for, or are a major shareholder or active partner of, an entity that provides one or more of the services in the above list.

Category 5 – Positions of influence

Instructions: All positions of influence (e.g., medical doctor, leader in a religious organization) are reportable, whether or not you receive compensation for such activities. Guidance: see also section 13.4.3 of National Instrument 31-103 Registration Requirements, Exemptions and Ongoing Registrant Obligations and the Companion Policy to National Instrument 31-103 Registration Requirements, Exemptions and Ongoing Registrant Obligations.

Complete a separate Schedule G for each position of influence that you are in. ,

(g) by replacing Item 12 with the following:

Item 12 – Resignations and terminations

Instructions: Disclose all allegations against you that existed at the time of your resignation or termination. The allegation does not need to be the reason for or cause of your resignation or termination. Sales targets are not considered a standard of conduct of a sponsoring firm.

Have you ever resigned or been terminated from a position or contract when, at the time of your resignation or termination, there existed an allegation that you:

1. Contravened any statutes, regulations, orders of a court or regulatory body, rules or bylaws or failed to meet any standard of conduct of a sponsoring firm or of any professional body?

Yes  ☐      No  ☐

If "Yes", complete Schedule I, Item 12.1.

2. Failed to appropriately supervise compliance with any statutes, regulations, orders of a court or regulatory body, rules or bylaws or with any standard of conduct of a sponsoring firm or of any professional body?

Yes  ☐      No  ☐

If "Yes", complete Schedule I, Item 12.2.

3. Committed fraud or the wrongful taking of property, including theft?

Yes  ☐      No  ☐

If "Yes", complete Schedule I, Item 12.3. ,

(h) in Item 13, by adding "Instructions: Only disclose registration or licences to deal with the public in any capacity." immediately after the subheading "3. Non-securities regulation",

(i) in question 3 (a) of Item 13, by adding ", medical doctor, mortgage broker or agent" after "teacher",

(j) in question 3 (b) of Item 13, by deleting "professional",

(k) in question 3 (c) of Item 13, by deleting "professional",

(l) in Item 14, by replacing the text between the heading "Item 14 – Criminal disclosure" and "You are not required to disclose:" with the following:

You must disclose all offences, including:

(m) in question 3 of Item 14 by replacing "firm" with "entity",

(n) in question 4 of Item 14 by replacing "firm" with "entity",

(o) in Item 15 by replacing "a firm" with "an entity" wherever it appears,

(p) by replacing Item 16 with the following:

Item 16 – Financial disclosure

1. Bankruptcies, insolvencies, consumer proposals and creditor arrangements

Instructions: You must provide the following information no matter when the event occurred (even if it was longer than 7 years ago).

The information is required to be reported even if you or the entity has been discharged or released from bankruptcy.

Under the laws of any jurisdiction of Canada or any foreign jurisdiction, have any of the following events ever occurred to you or to any entity when you were a partner, director, officer or major shareholder of the entity:

(a) had a petition in bankruptcy issued or made a voluntary assignment into bankruptcy or any similar proceeding (no matter when it occurred, even if it was longer than 7 years ago, and even if you or the entity have been discharged or released from bankruptcy)?

Yes  ☐      No  ☐

If "Yes", complete Schedule M, Item 16.1 (a).

(b) a proposal, including a consumer proposal, under any legislation relating to bankruptcy or insolvency or any similar proceeding?

Yes  ☐      No  ☐

If "Yes", complete Schedule M, Item 16.1 (b).

(c) proceedings under any legislation relating to the winding up or dissolution of the entity, or under the Companies’ Creditors Arrangement Act (Canada)?

Yes  ☐      No  ☐

If "Yes", complete Schedule M, Item 16.1 (c).

(d) any proceedings, arrangement or compromise with creditors?

Yes  ☐      No  ☐

If "Yes", complete Schedule M, Item 16.1 (d).

2. Debt obligations

During the past 10 years

Yes  ☐      No  ☐

If "Yes", complete Schedule M, Item 16.2.

3. Surety bond or fidelity bond

Have you ever been refused for a surety or fidelity bond?

Yes  ☐      No  ☐

If "Yes", complete Schedule M, Item 16.3.

4. Garnishments, seizure in the hands of third persons, unsatisfied judgments or directions to pay

Has any governmental or regulatory authority or court, in any jurisdiction, ever issued any of the following

Yes

No

Garnishment or seizure in

the hands of third persons

Unsatisfied judgment

Direction to pay

If "Yes", complete Schedule M, Item 16.4. ,

(q) by replacing Item 20 with the following:

Item 20 – Notice and consent for collection and use of personal information

1. Notice of collection and use of personal information

Your personal information is collected by, or on behalf of, each securities regulatory authority and SRO set out in Schedule O. Any of the securities regulatory authorities or SROs set out in Schedule O may contact governmental or regulatory authorities, private bodies or agencies, individuals, corporations, employers, and other organizations, in Canada and in other countries, for information about you.

This personal information is being collected under the authority of the applicable securities legislation, derivatives legislation (including commodity futures legislation) or both of the securities regulatory authorities and under the SRO rules of an SRO set out in Schedule O. The collection, use and disclosure are done in accordance with applicable freedom of information and privacy legislation.

The principal purpose of this collection by the securities regulatory authorities is to administer, enforce, carry out their duties or exercise their powers under their respective securities legislation, derivatives legislation (including commodity futures legislation) or both, and by the SROs to administer and enforce the rules of the SROs.

The information submitted by you in this form with your consent, or collected indirectly with your authorization, may be collected

If you have any questions about the collection, use and disclosure of this information, contact the securities regulatory authority or SRO in any jurisdiction in which the required information is submitted. See Schedule O for details.

Certain information, such as your name(s) (including aliases, trade names or some past names), your sponsoring firm, and other relevant registration information, will be listed in a publicly available registry of registered individuals and, if applicable, on the Disciplined List.

Certain securities regulatory authorities may provide to or receive from certain entities information under separate provisions of their securities legislation or derivatives legislation (including commodity futures legislation) or both, and SROs may provide or receive information under the rules of the SROs. This consent and notice does not limit the authority, powers, obligations, or rights conferred on any of the securities regulatory authorities by legislation or regulations in effect in their jurisdiction.

2. Consent to collect and use personal information

By submitting this form, you consent to and authorize the collection, directly and indirectly, of personal information by each securities regulatory authority and SRO and to the use of your personal information as set out above.

The personal information that each securities regulatory authority or SRO collects includes the following:

(r) by repealing Item 21,

(s) by repealing Item 22,

(t) in Schedule C, by replacing the text between the subheading "Approval categories" and "Additional approval categories" with the following:

[  ] Executive
[  ] Director (Industry)
[  ] Director (Non-Industry)
[  ] Supervisor
[  ] Investor
[  ] Registered Representative
[  ] Investment Representative
[  ] Portfolio Manager
[  ] Associate Portfolio Manager
[  ] Trader ,

(u) in Schedule E, by adding the following immediately after "Item 8.1 – Course, examination or designation information and other education":

Instructions: Please see Division 2 [Education and experience requirements] in Part 3 [Registration requirements - individuals] of National Instrument 31-103 Registration Requirements, Exemptions and Ongoing Registrant Obligations for the education and experience requirements for the categories that you are seeking to be registered in or the relevant SRO rules for the SRO approval categories.

Below, state each course, examination and designation that:

*For IIROC applicants only - If applicable, please indicate the date of any exemption granted for any course, examination, designation or other education required for approval. ,

(v) in the table to Schedule E, by adding "*" at the end of "Date exempted" and by adding "*" at the end of "Regulator / securities regulatory authority granting the exemption",

(w) by replacing Item 8.4 in Schedule F with the following:

Item 8.4 – Relevant securities experience

Instructions:

1. If you are applying

For each position in which you gained relevant experience, provide the following information:

(a) the name of the firm or entity with which you gained this experience;

(b) your title;

(c) the start and end dates of this position;

(d) the details of the activities you performed that are relevant for the category of registration that you are applying for;

(e) the percentage of your time in this position that was spent on activities relating to the experience.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

2 Indicate the continuing education activities in which you have participated during the last 36 months and that are relevant to the category of registration you are applying for:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

(x) by replacing Schedule G with the following:

Schedule G
Reportable activities (Item 10)

1. Start date _____________________

                            (YYYY/MM/DD)

2. Sponsoring firm or other entity information

☐   Check here if the reportable activity is with your sponsoring firm.

If the reportable activity is with your sponsoring firm, you are not required to indicate the firm’s name and address but are required to provide the name and title of your immediate supervisor. For all other types of reportable activity, enter all of the 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 the reportable activity and your roles and responsibilities

Instructions: If you are completing this schedule in relation to your activities with your sponsoring firm, for (e) below, provide the title(s) you will use once registered, and if you are already registered, provide the title(s) you use as of the date of this filing.

(a) Describe the entity that you carry on the activity with or for, including the nature of the entity’s business.

(b) Is the entity listed on an exchange?

(c) Describe your relationship with the entity.

(d) Describe all of your roles and responsibilities relating to the activity.

____________________________________________________________________________________

(e) Provide all business title(s) and professional designation(s) you use for the activity.

____________________________________________________________________________________

4. Number of work hours per week

How many hours per week do you spend on this activity?_______________________

5. Conflicts of interest

Instructions: Complete this section if you have a reportable activity outside your sponsoring firm. Do not complete this section if your reportable activity is solely with your sponsoring firm.

Take into consideration existing and reasonably foreseeable material conflicts of interest and existing and potential client confusion.

(a) Does the activity give rise to any material conflicts of interest between the client and the sponsoring firm or you? Does the activity give rise to client confusion? If no material conflicts of interest or client confusion are expected, explain why.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

(b) Describe (i) the material conflicts of interest, and (ii) how these conflicts will be addressed in the best interest of the client.

____________________________________________________________________________________

(c) Describe (i) the client confusion, and (ii) how the client confusion will be addressed.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

(d) Does your sponsoring firm and the entity have procedures for identifying and addressing material conflicts of interest? If so, confirm you are complying with both sets of procedures.

____________________________________________________________________________________

(e) State the name and title of the individual at your sponsoring firm who has reviewed and approved the activity.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

(y) in Schedule H by deleting "If you are seeking registration in a category of registration that requires specific experience, include details of that experience. Examples include level of responsibility, value of accounts under direct supervision, number of years of that experience and research experience, and percentage of time spent on each activity.",

(z) by replacing Schedule I with the following:

Schedule I
Resignations and terminations (Item 12)

Item 12.1

For each allegation of contravention of any statute, regulation, order of a court or regulatory body, rule or bylaw or failure to meet any standard of conduct of a sponsoring firm or of any professional body, state 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 ceased to carry on duties, (4) the circumstances relating to your resignation or termination, (5) details of the allegation (regardless of whether the allegation caused or contributed to your resignation or termination), including the statutes, regulations, orders, rules or bylaws allegedly contravened or standards of conduct allegedly not met, (6) details of how the allegation was addressed, and (7) any details of the resignation, termination, or allegation relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

_______________________________________________________________________________________________________

Item 12.2

For each allegation of failure to supervise compliance with any statute, regulation, order of a court or regulatory body, rule or bylaw or with any standard of conduct of a sponsoring firm or of any professional body, state 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 ceased to carry on duties, (4) the circumstances relating to your resignation or termination, (5) details of the allegation of failure to supervise (regardless of whether the allegation caused or contributed to your resignation or termination), (6) details of how the allegation was addressed, and (7) any details of the resignation, termination, or allegation relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

_______________________________________________________________________________________________________

Item 12.3

For each allegation that you committed fraud or the wrongful taking of property, including theft, state 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 ceased to carry on duties, (4) the circumstances relating to your resignation or termination, (5) details of the allegation (regardless of whether the allegation caused or contributed to your resignation or termination), (6) details of how the allegation was addressed, and (7) any details of the resignation, termination, or allegation relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

(aa) in Schedule J by replacing Item 13.2 (c) with the following:

(c) For each order or disciplinary proceeding, state below (1) the name of the firm, (2) the SRO 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, (6) whether you are or were a partner, director, officer or major shareholder of the firm and named individually in the order or disciplinary proceeding, and (7) any details of the order or disciplinary proceeding relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

____________________________________________________________________________________

(bb) in Schedule J by replacing Item 13.3 with the following:

Item 13.3 – Non-securities regulation

(a) For each registration or licence, state below (1) the party who is, or was, registered or licensed, (2) if applicable, the employer or entity for whom you performed the registerable or licensable activity, (3) the period that the party held the registration or licence, (4) the type or category of registration or licence, (5) with which regulatory authority, or under what legislation, the party is, or was, registered or licensed, and (6) the licence number.

____________________________________________________________________________________

(b) For each registration or licence refused, state below (1) the party that was refused registration or licensing, (2) if applicable, the employer or entity for whom you performed the registerable or licensable activity, (3) with which regulatory authority, or under what legislation, the registration or licence was refused, (4) the type or category of registration or licence refused, (5) the date of the refusal, and (6) the reasons for the refusal.

____________________________________________________________________________________

(c) For each order or disciplinary proceeding, indicate below (1) the party against whom the order was made or the proceeding taken, (2) the regulatory authority that made the order or that is, or was, conducting the proceeding, or under what legislation the order was made or the proceeding is being, or was conducted, (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, (6) whether you are or were a partner, director, officer or major shareholder of the entity and named individually in the order or disciplinary proceeding, and (7) any details of the order or disciplinary proceeding relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

____________________________________________________________________________________

(cc) in Schedule K, by replacing "firm" with "entity" wherever it occurs,

(dd) in Item 15.1 of Schedule L, by replacing

(i) "the name of the plaintiff(s) in the proceeding" with "the name of each plaintiff in the proceeding", and

(ii) "a firm" with "an entity" wherever it occurs,

(ee) in Item 15.2 of Schedule L, by replacing

(i) "each plaintiff in the proceeding" with "the name of each plaintiff in the proceeding",

(ii) "a firm" with "an entity", and

(iii) "the allegations" with "the allegations,",

(ff) by replacing Schedule M with the following:

Schedule M
Financial disclosure (Item 16)

Item 16.1 – Bankruptcies, insolvencies, consumer proposals and creditor arrangements

Instructions: Proposals includes consumer proposals.

(a) For each event, state below (1) the date of the petition or voluntary assignment into bankruptcy or similar proceeding, (2) the person or entity about whom this disclosure is being made, (3) any amounts currently owing, (4) the creditors, (5) the status of the matter, (6) a summary of any disposition or settlement, (7) the date of discharge or release, if applicable, and (8) any details of the petition or voluntary assignment into bankruptcy or similar proceeding relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

____________________________________________________________________________________

(b) For each event, state below (1) the date of the proposal, (2) the person or firm about whom this disclosure is being made, (3) any amounts currently owing, (4) the creditors, (5) the status of the matter, (6) a summary of any disposition or settlement, and (7) any details of the proposal relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

____________________________________________________________________________________

(c) For each event, state below (1) the date of the proceeding, (2) the person or entity about whom this disclosure is being made, (3) any amounts currently owing, (4) the creditors, (5) the status of the matter, (6) a summary of any disposition or settlement, and (7) any details of the proceeding relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

____________________________________________________________________________________

(d) For each proceeding, arrangement or compromise with creditors, state below (1) the date of the proceeding, arrangement or compromise, (2) the person or entity about whom this disclosure is being made, (3) any amounts currently owing, (4) the creditors, (5) the status of the matter, (6) a summary of any disposition or settlement, and (7) any details of the proceeding, arrangement or compromise relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

____________________________________________________________________________________

Item 16.2 – Debt obligation

For each event, state below (1) the person or entity that failed to meet its financial obligation, (2) the amount that was owing at the time the person or entity failed to meet its financial obligation, (3) the person or entity to whom the amount is, or was, owing, (4) any relevant dates (for example, when payments are due or when final payment was made), (5) any amounts currently owing, and (6) any details of the debt obligation relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable, including why the obligation has not been met or satisfied.

_______________________________________________________________________________________________________

Item 16.3 – Surety bond or fidelity bond

For each bond refused, state below (1) the name of the bonding company, (2) the address of the bonding company, (3) the date of the refusal, and (4) the reasons for the refusal.

_______________________________________________________________________________________________________

Item 16.4 – Garnishments, seizure in the hands of third persons, unsatisfied judgments or directions to pay

For each garnishment, seizure in the hands of third persons, unsatisfied judgment or direction to pay regarding your indebtedness or the indebtedness of an entity incurred at the time you were a partner, director, officer or major shareholder, indicate below (1) the amount that was owing at the time the garnishment, seizure in the hands of third persons, judgment or direction to pay was rendered, (2) the person or entity to whom the amount is, or was, owing, (3) any relevant dates (for example, when payments are due or when final payment was made), (4) why the indebtedness has not been met or satisfied, (5) the percentage of earnings to be garnished or seized in the hands of third persons or the amount to be paid, (6) any amounts currently owing, and (7) any details of the garnishment, seizure in the hands of third persons, unsatisfied judgment or direction to pay relevant to the determination of your suitability for registration or whether your registration is otherwise objectionable.

_______________________________________________________________________________________________________

(gg) in Schedule N, by replacing paragraphs (c), (d) and (e) with the following:

(c) If another person or entity has provided you with funds to invest in the firm, provide the name of the person or entity and state the relationship between you and that person or entity:

____________________________________________________________________________________

(d) Is the payment of the funds to be invested (or proposed to be invested) guaranteed directly or indirectly by any person or entity?

Yes  ☐      No  ☐

If "Yes", provide the name of the person or entity and state the relationship between you and that person or entity:

____________________________________________________________________________________

(e) Have you directly or indirectly given up any rights relating to these securities or this partnership interest, or do you, when you are registered or approved as a result of the review of this form, intend to give up any of these rights (including by hypothecation, pledging or depositing as collateral the securities or partnership interest with any entity or person)?

Yes  ☐      No  ☐

If "Yes", provide the name of the person or entity, state the relationship between you and that person or entity and describe the rights that have been or will be given up:

____________________________________________________________________________________

(hh) in Schedule O, by replacing "Notice of" in the title with "Notice and Consent for",

(ii) in Schedule O in the contact information for British Columbia, by replacing "Freedom of Information Officer" with "Registration staff" and adding "E-mail: Registration@bcsc.bc.ca" at the end,

(jj) in Schedule O in the contact information for Saskatchewan, by deleting "Deputy" and adding "E-mail: registrationfcaa@gov.sk.ca" at the end,

(kk) in Schedule O in the contact information for Nova Scotia, by replacing "Deputy Director, Capital Markets" with "Registration",

(ll) in Schedule O in the contact information for Yukon, by adding "Office of the Yukon" before "Superintendent of Securities" and replacing "(867) 667-5314" with "(867) 667-5466", and

(mm) in Schedule O in the contact information for Northwest Territories, by deleting "Deputy".

14. Form 33-109F5 is amended

(a) by adding the following immediately before the heading "General instructions":

WARNING – It is an offence to knowingly give false or misleading information to the regulator or the securities regulatory authority.

CERTIFICATION

1. Form 33-109F4: Use the following certification when making changes to Form 33-109F4:

Individual

I, the individual, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where I am submitting this form and to any applicable self-regulatory organization (SRO) that

I consent to and authorize the collection, directly and indirectly, of personal information by each regulator, securities regulatory authority and SRO and to the use of my personal information as set out in Item 3.

Firm

I, on behalf of the firm, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where the firm is submitting this form and to any applicable SRO that

NRD format:

☐   I, the authorized firm representative, am making this submission under authority delegated by the firm and the individual identified in this form. By checking this box, I certify that

(a) the firm provided me with all of the information on this form and makes the firm certification above,

(b) the individual provided the firm with all of the information on this form and makes the individual certification above, and

(c) the individual provided the above consent and authorization for the collection and use of the individual’s personal information.

Non-NRD format:

Individual

By signing below, I, the individual, make the above individual certification and provide my consent and authorization for the collection, directly and indirectly, and use of my personal information.

Signature of individual __________________________________________

Date signed _____________________

               (YYYY/MM/DD)

Firm

By signing below, I, on behalf of the firm, make the firm certification above.

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)

2. Form 33-109F6: Use the following certification when making changes to Form 33-109F6:

By signing below, I, on behalf of the firm, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where the firm is submitting this form and to any applicable SRO that

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)

(b) by replacing Item 3 with the following:

Item 3 – Notice and consent for collection and use of personal information

1. Notice of collection and use of personal information

Your personal information is collected by, or on behalf of, each securities regulatory authority and SRO set out in Schedule A. Any of the securities regulatory authorities or SROs set out in Schedule A may contact governmental or regulatory authorities, private bodies or agencies, individuals, corporations, employers, and other organizations, in Canada and in other countries, for information about you.

This personal information is being collected under the authority of the applicable securities legislation, derivatives legislation (including commodity futures legislation) or both of the securities regulatory authorities and under the SRO rules of an SRO set out in Schedule A. The collection, use and disclosure are done in accordance with applicable freedom of information and privacy legislation.

The principal purpose of this collection by the securities regulatory authorities is to administer, enforce, carry out their duties or exercise their powers under their respective securities legislation, derivatives legislation (including commodity futures legislation) or both, and by the SROs to administer and enforce the rules of the SROs.

The information submitted by you in this form with your consent, or collected indirectly with your authorization, may be collected

If you have any questions about the collection, use and disclosure of this information, contact the securities regulatory authority or SRO in any jurisdiction in which the required information is submitted. See Schedule A for details.

Certain information, such as your name(s) (including aliases, trade names or some past names), your sponsoring firm, and other relevant registration information, will be listed in a publicly available registry of registered individuals and, if applicable, on the Disciplined List.

Certain securities regulatory authorities may provide to or receive from certain entities information under separate provisions of their securities legislation or derivatives legislation (including commodity futures legislation) or both, and SROs may provide or receive information under the rules of the SROs. This consent and notice does not limit the authority, powers, obligations or rights conferred on any of the securities regulatory authorities by legislation or regulations in effect in their jurisdiction.

2. Consent to collect and use personal information

By submitting this form, you consent to and authorize the collection, directly and indirectly, of personal information by each securities regulatory authority and SRO and to the use of your personal information as set out above.

The personal information that each securities regulatory authority or SRO collects includes the following:

(c) by repealing Item 4,

(d) by repealing Item 5,

(e) in Schedule A, by replacing "Notice of" in the title with "Notice and Consent for",

(f) in Schedule A in the contact information for British Columbia, by replacing "Freedom of Information Officer" with "Registration staff" and adding "E-mail: Registration@bcsc.bc.ca" at the end,

(g) in Schedule A in the contact information for Saskatchewan, by deleting "Deputy" and adding "E-mail: registrationfcaa@gov.sk.ca" at the end,

(h) in Schedule A in the contact information for Nova Scotia, by replacing "Deputy Director, Capital Markets" with "Registration",

(i) in Schedule A in the contact information for Yukon, by adding "Office of the Yukon" before "Superintendent of Securities" and replacing "(867) 667-5314" with "(867) 667-5466", and

(j) in Schedule A in the contact information for Northwest Territories, by deleting "Deputy".

15. Form 33-109F6 is amended

(a) by replacing the text between the heading "Contents of the form" and "You are also required to submit the following supporting documents with your completed form:" with the following:

This form consists of the following:

Collection and use of personal information

Certification

Part 1 – Registration details

Part 2 – Contact information

Part 3 – Business history and structure

Part 4 – Registration history

Part 5 – Financial condition

Part 6 – Client relationships

Part 7 – Regulatory action

Part 8 – Legal action

Part 9 – [repealed]

Schedule A – Contact information for consent and notice of collection and use of personal information

Schedule B – Submission to jurisdiction and appointment of agent for service

Schedule C – Form 31-103F1 Calculation of excess working capital ,

(b) by replacing the text between the sentence "However, the questions in Part 4 – Registration History and Part 7 – Regulatory Action are to be answered in respect of any jurisdiction in the world." and the heading "Updating the information on the form" with the following:

It is an offence to knowingly give false or misleading information to the regulator or securities regulatory authority. ,

(c) by replacing the text between the heading "Collection and use of personal information" and the heading "Part 1 – Registration details" with the following:

In obtaining information about the firm, each securities regulatory authority and SRO set out in Appendix A may receive and collect personal information about individuals, if any, associated with the firm and its directors, officers, partners, employees, contractors and agents.

This may include the collection of

Any of the securities regulatory authorities or SROs set out in Schedule A may contact governmental or regulatory authorities, private bodies or agencies, individuals, corporations, employers, and other organizations, in Canada and in other countries, for information about the individual.

This personal information is being collected under the authority of the applicable securities legislation, derivatives legislation (including commodity futures legislation), or both of the securities regulatory authorities and under the SRO rules of an SRO set out in Schedule A. The collection, use and disclosure are done in accordance with applicable freedom of information and privacy legislation.

The principal purpose of this collection by the securities regulatory authorities is to administer, enforce, carry out their duties or exercise their powers under their respective securities legislation, derivatives legislation (including commodity futures legislation) or both, and for the SROs to administer and enforce the rules of the SROs.

The information may be collected

If you or anyone referred to in this form has any questions about the collection, use, and disclosure of this information, you or they can contact the regulator or, in Québec, the securities regulatory authority, or SRO in any jurisdiction in which the required information is submitted. See Schedule A for details.

Certain registration information about the firm and its registered individuals will be listed in a publicly available registry, including names used by the firm, the address of the firm’s head office, whether the firm is on the Disciplined List, the jurisdictions and categories in which the firm is registered, and whether any terms and conditions have been imposed on the firm’s registration, and the firm’s registered individuals.

Certain securities regulatory authorities may provide to or receive from certain entities information under separate provisions of their securities legislation or derivatives legislation (including commodity futures legislation) or both, and SROs may provide or receive information under the rules of the SROs. This consent and notice does not limit the authority, powers, obligations, or rights conferred on any of the securities regulatory authorities by legislation or regulations in effect in their jurisdiction.

WARNING: It is an offence to knowingly give false or misleading information to the regulator or the securities regulatory authority.

CERTIFICATION

By signing this form, I, on behalf of the firm,

1. certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where the firm is submitting this form and to any applicable self-regulatory organization (SRO) that

2. authorize the principal regulator to give each non-principal regulator and, where applicable, SRO access to any information the firm has submitted or filed with the principal regulator under securities legislation or derivatives legislation or both in relation to the firm’s registration in that jurisdiction,

3. acknowledge that the regulator or, in Québec, the securities regulatory authority, and SRO may collect and provide personal information about the individuals referred to in this form under the heading Collection and Use of Personal Information, and

4. confirm that the individuals referred to in this form have been notified that the individuals’ personal information is disclosed on this form, the legal reason for doing so, how it will be used and who to contact for more information.

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)

(d) in Item 2.4, by replacing "a completed Schedule B" with "an executed Schedule B",

(e) by replacing Item 3.10 with the following:

3.10 Permitted individuals

List all permitted individuals of the firm.

State why the individual is considered a permitted individual (e.g., director, partner, officer, shareholder, or a permitted individual as described in paragraph (c) of the definition of "permitted individual" in section 1.1 of National Instrument 33-109 Registration Information).

Name

Type of Permitted

Individual

NRD number, if

applicable

 
 

 
 

 
 

 
 

 
 

(f) by replacing Item 3.12 with the following:

3.12 Ownership chart

Attach a chart showing the firm’s structure and ownership. Include all parents, specified affiliates and specified subsidiaries. Indicate which of the parents, specified affiliates and specified subsidiaries are registered under securities legislation in any jurisdiction of Canada and provide their NRD number.

Include the name of the person or company, and class, type, amount and percentage ownership of the firm’s voting securities. ,

(g) in Item 4.6 by replacing the table after the sentence "If yes, provide the following information for each registration or licence:" with the following:

Name of entity

Type of licence or registration

Licence number

Regulator/organization

Date of registration (yyyy/mm/dd)
 

Expiry date, if applicable (yyyy/mm/dd)
 

Jurisdiction

(h) in Item 5.13 (b), by replacing "an interim financial report" with "interim financial information (as set out in section 12.11 of NI 31-103)",

(i) by repealing Part 9,

(j) in Schedule A in the contact information for British Columbia, by replacing "Freedom of Information Officer" with "Registration staff" and adding "E-mail: Registration@bcsc.bc.ca" at the end,

(k) in Schedule A in the contact information for Saskatchewan, by deleting "Deputy" and adding "E-mail: registrationfcaa@gov.sk.ca" at the end,

(l) in Schedule A in the contact information for Nova Scotia, by replacing "Deputy Director, Capital Markets" with "Registration",

(m) in Schedule A in the contact information for Yukon, by adding "Office of the Yukon" before "Superintendent of Securities" and replacing "(867) 667-5314" with "(867) 667-5466",

(n) in Schedule A in the contact information for Northwest Territories, by deleting "Deputy",

(o) in Schedule B, by replacing point 7 with the following:

7. Until six years after the Firm ceases to be registered, the Firm must file a new executed Submission to jurisdiction and appointment of agent for service in this form

a. no later than the 15th day after the date this Submission to jurisdiction and appointment of agent for service is terminated, and

b. no later than the 15th day after any change in the name or address of the Agent for Service. , and

(p) in Schedule C, by replacing "CICA Handbook" with "CPA Canada Handbook".

16. Form 33-109F7 is amended

(a) by adding the following immediately before the heading "General instructions":

WARNING – It is an offence to knowingly give false or misleading information to the regulator or the securities regulatory authority.

CERTIFICATION

Individual

I, the individual, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where I am submitting this form and to any applicable self-regulatory organization (SRO) that

I consent to and authorize the collection, directly and indirectly, of personal information by each regulator, securities regulatory authority and SRO and to the use of my personal information as set out in Item 10.

Firm

I, on behalf of the firm, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where the firm is submitting this form and to any applicable SRO that

NRD format:

☐    I, the authorized firm representative, am making this submission under authority delegated by the firm and the individual identified in this form. By checking this box, I certify that

(a) the firm provided me with all of the information on this form and makes the firm certification above,

(b) the individual provided the firm with all of the information on this form and makes the individual certification above, and

(c) the individual provided the above consent and authorization for the collection and use of the individual’s personal information.

Non-NRD format:

Individual

By signing below, I, the individual, make the above individual certification and provide my consent and authorization for the collection, directly and indirectly, and use of my personal information.

Signature of individual__________________________________________

Date signed _____________________

              (YYYY/MM/DD)

Firm

By signing below, I, on behalf of the firm, make the firm certification above.

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)

(b) by replacing the text between the heading "General instructions" and "Terms" with the following:

Complete and submit this form to the relevant regulator(s) or, in Québec, the securities regulatory authority, or self-regulatory organization (SRO) if

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 individual may reinstate the individual’s registration or permitted individual status by submitting this form. This form must not be used unless all of the following apply:

1. this form is submitted on or before the 90th day after the cessation date of the individual’s employment, partnership or agency relationship with the individual’s former sponsoring firm;

2. the information in the individual’s Form 33-109F4 was up-to-date as of the cessation date of the individual’s employment, partnership or agency relationship with the individual’s former sponsoring firm;

3. if this form is submitted on or after June 6, 2023, on the date this form is submitted, the individual’s information in the National Registration Database does not state "there is no response to this question" for any item of the individual’s Form 33-109F4;

4. there have been no changes to the information previously submitted in respect of the following items of the individual’s Form 33-109F4 since the individual left the individual’s former sponsoring firm:

5. at the time of cessation with the individual’s former sponsoring firm, there were no allegations against the individual, in Canada or in any foreign jurisdiction, relevant to an assessment of whether the individual is not suitable for registration or the registration is objectionable, including, for greater certainty, an allegation against the individual of any of the following:

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". ,

(c) in Item 2 by replacing section 2 with the following:

2. Check each province or territory in which you are seeking reinstatement of registration or, if you are seeking reinstatement as a permitted individual, check each province or territory where your sponsoring firm is registered:

☐   All jurisdictions
☐   Alberta
☐   British Columbia
☐   Manitoba
☐   New Brunswick
☐   Newfoundland and Labrador
☐   Northwest Territories
☐   Nova Scotia
☐   Nunavut
☐   Ontario
☐   Prince Edward Island
☐   Québec
☐   Saskatchewan
☐   Yukon ,

(d) in Item 5 by adding the following:

6. Notice regarding a business location that is a residence

For the administration of securities legislation or derivatives legislation, including commodity futures legislation, or both, the regulator or, in Québec, the securities regulatory authority may require access to the business location to review the books, records and documents of the registered firm. If applicable, the SRO may also require access to the business location for the administration of the rules of the SRO.

If the business location specified in this form is a residence, the regulator, securities regulatory authority or SRO may request consent to enter the residence.

If consent is not provided, it may affect the ability of the regulator, securities regulatory authority or SRO to access the books, records or documents of a registered firm and to determine whether securities legislation, derivatives legislation (including commodity futures legislation) or the rules of the SRO are being complied with. As a result, the regulator, securities regulatory authority or SRO may take action if it is unable to access and review the books, records or documents of a registered firm held at the business location. ,

(e) by replacing Item 7 with the following:

Item 7 – Reportable activities

Name of your new sponsoring firm:__________________________________________________________

1. Activities with your sponsoring firm

Instructions: Describe all of your roles and responsibilities with your sponsoring firm, whether these roles and responsibilities are securities-related or not (e.g., sale of securities, review of marketing materials, IT help desk, negotiation of employment contracts, sales of banking and insurance products and services). Include any other information about your position with your sponsoring firm that is relevant for the regulator or, in Québec, the securities regulatory authority to know (e.g., if your role is specialized). For example, if you are applying as an advising representative limited to client relationship management, indicate this by including the following statement in Schedule D: "Individual is seeking registration as CRM AR."

Complete a Schedule D with respect to your roles and responsibilities with your sponsoring firm.

2. Reportable outside activities

Instructions: Consider all of the activities that you participate in outside of your sponsoring firm, whether or not you receive compensation for such activities and whether or not any such activity is business-related. Activities performed for an affiliated entity are considered activities outside of your sponsoring firm. If any of the categories below describes one or more activities that you participate in, complete a separate Schedule D for each activity or entity. If multiple activities are performed for one entity, complete a single Schedule D identifying all the activities performed.

Uncompensated activities that do not fall within Categories 1 to 5 (i.e., generally activities that do not involve securities or financial services and are not a position of influence, such as being a little league soccer coach) are not reportable.

Category 1 - Activities with another registered firm

Instructions: Report activities with registered firms, other than your sponsoring firm. All activities in this category are reportable, whether or not you receive compensation for such activities. Major shareholder means a shareholder who, in total, directly or indirectly owns voting securities carrying 10 percent or more of the votes carried by all outstanding voting securities.

If you are a director, officer, employee, contractor, consultant, agent, or service provider of a registered firm other than your sponsoring firm, or are in any other equivalent position with or for that registered firm, or are a major shareholder or partner of that registered firm, complete a separate Schedule D for the registered firm.

Category 2 - Activities with an entity that receives compensation from a registered firm

If you are a director, officer, employee, contractor, consultant, or agent of a specified entity, or are in any other equivalent position with or for a specified entity, or are a shareholder or partner of a specified entity, complete a separate Schedule D for the specified entity.

For the purposes of this category, "specified entity" means an entity that receives compensation from a registered firm for activities that you provide for your sponsoring firm or another registered firm.

Category 3 - Other securities-related activities

Instructions: All activities in this category are reportable, whether or not you receive compensation for such activities. Charitable or other fundraising activities that do not involve the issuance of securities or derivatives are not reportable.

If you have been at any time in the last 7 years directly involved in raising money for an entity through the issuance of securities or derivatives or promoting the sale of an entity’s securities or derivatives outside of your activities with your sponsoring firm or another registered firm, complete a separate Schedule D for each entity for which you performed these activities.

Directors and officers of reporting issuers and of entities that have been at any time in the last 7 years raising money through the issuance of securities or derivatives are considered to be directly involved in raising money for that entity.

Category 4 - Provision of financial or finance-related services

Instructions: All activities in this category are reportable, whether or not you receive compensation for such activities. For example, volunteer activities pertaining to your securities or financial services knowledge must be reported under this category. Also report if you are the owner or management of an entity that provides these services. Major shareholder means a shareholder who, in total, directly or indirectly owns voting securities carrying 10 percent or more of the votes carried by all outstanding voting securities.

Complete a separate Schedule D for each activity, as applicable, if you

Also complete a separate Schedule D for each activity, as applicable, if you are a director or officer, or are in any other equivalent position with or for, or are a major shareholder or active partner of, an entity that provides one or more of the services in the above list.

Category 5 - Positions of influence

Instructions: All positions of influence (e.g., medical doctor, leader in a religious organization) are reportable, whether or not you receive compensation for such activities. Guidance: see also section 13.4.3 of National Instrument 31-103 Registration Requirements, Exemptions and Ongoing Registrant Obligations and the Companion Policy to National Instrument 31-103 Registration Requirements, Exemptions and Ongoing Registrant Obligations.

Complete a separate Schedule D for each position of influence that you are in. ,

(f) in Item 9 by replacing section 2 with the following:

2. Check the box below - I am eligible to file this Form 33-109F7 - only if you satisfy all of the following conditions:

(a) the information in your Form 33-109F4 was up-to-date when you left your sponsoring firm;

(b) there are no changes to any of the disclosure items under Item 9.1 above;

(c) if this form is submitted on or after June 6, 2023, on the date this form is submitted, your information in the National Registration Database does not state "there is no response to this question" for any item of Form 33-109F4;

(d) at the time of cessation with your former sponsoring firm, there was no allegation against you, in Canada or in any foreign jurisdiction, relevant to an assessment of whether you are not suitable for registration or your registration is objectionable, including, for greater certainty, any allegations against you of

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 reinstatement by completing on NRD a Form 33-109F4 by making the NRD submission entitled "Reactivation of Registration". If you are submitting 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. ,

(g) by replacing Item 10 with the following:

Item 10 – Submission to jurisdiction and notice and consent for collection and use of personal information

1. Submission to jurisdiction

By submitting this form, you agree to be subject to the securities legislation or derivatives legislation (including commodity futures legislation) or both of each jurisdiction of Canada, and to the bylaws, regulations, rules, rulings and policies (collectively referred to as "rules" in this form) of the SROs to which you have submitted this form. This includes the jurisdiction of any tribunals or any proceedings that relate to your activities as a registrant or a partner, director or officer of a registrant under that securities legislation or derivatives legislation or both or as an approved person under SRO rules.

2. Notice of collection and use of personal information

Your personal information is collected by, or on behalf of, each securities regulatory authority and SRO set out in Schedule F. Any of the securities regulatory authorities or SROs set out in Schedule F may contact governmental or regulatory authorities, private bodies or agencies, individuals, corporations, employers, and other organizations, in Canada and in other countries, for information about you.

This personal information is being collected under the authority of the applicable securities legislation, derivatives legislation (including commodity futures legislation) or both of the securities regulatory authorities and under the SRO rules of an SRO set out in Schedule F. The collection, use and disclosure are done in accordance with applicable freedom of information and privacy legislation.

The principal purpose of this collection by the securities regulatory authorities is to administer, enforce, carry out their duties or exercise their powers under their respective securities legislation, derivatives legislation (including commodity futures legislation) or both, and by the SROs to administer and enforce the rules of the SROs.

The information submitted by you in this form with your consent, or collected indirectly with your authorization, may be collected

If you have any questions about the collection, use and disclosure of this information, contact the securities regulatory authority or SRO in any jurisdiction in which the required information is submitted. See Schedule F for details.

Certain information, such as your name(s) (including aliases, trade names or some past names), your sponsoring firm, and other relevant registration information, will be listed in a publicly available registry of registered individuals and, if applicable, on the Disciplined List.

Certain securities regulatory authorities may provide to or receive from certain entities information under separate provisions of their securities legislation or derivatives legislation (including commodity futures legislation) or both, and SROs may provide or receive information under the rules of the SROs. This consent and notice does not limit the authority, powers, obligations or rights conferred on any of the securities regulatory authorities by legislation or regulations in effect in their jurisdiction.

3. Consent to collect and use personal information

By submitting this form, you consent to and authorize the collection, directly and indirectly, of personal information by each securities regulatory authority and SRO and to the use of your personal information as set out above.

The personal information that each securities regulatory authority or SRO collects includes the following:

(h) by repealing Item 11,

(i) by repealing Item 12,

(j) in Schedule B, by replacing the text between the subheading "Approval categories" and "Additional approval categories" with the following:

[  ] Executive
[  ] Director (Industry)
[  ] Director (Non-Industry)
[  ] Supervisor
[  ] Investor
[  ] Registered Representative
[  ] Investment Representative
[  ] Portfolio Manager
[  ] Associate Portfolio Manager
[  ] Trader ,

(k) by replacing Schedule D with the following:

Schedule D
Reportable activities (Item 7)

1. Start date _____________________

                             (YYYY/MM/DD)

2. Sponsoring firm or other entity information

☐   Check here if the reportable activity is with your sponsoring firm.

If the reportable activity is with your sponsoring firm, you are not required to indicate the firm’s name and address but are required to provide the name and title of your immediate supervisor. For all other types of reportable activity, enter all of the 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 the reportable activity and your roles and responsibilities

Instructions: If you are completing this schedule in relation to your activities with your sponsoring firm, for (e) below, provide the title(s) you will use once registered, and if you are already registered, provide the title(s) you use as of the date of this filing.

(a) Describe the entity that you carry on the activity with or for, including the nature of the entity’s business.

(b) Is the entity listed on an exchange?

(c) Describe your relationship with the entity.

(d) Describe all of your roles and responsibilities relating to the activity.

____________________________________________________________________________________

(e) Provide all business title(s) and professional designation(s) you use for the activity.

____________________________________________________________________________________

4. Number of work hours per week

How many hours per week do you spend on this activity? ___________________

5. Conflicts of interest

Instructions: Complete this section if you have a reportable activity outside your sponsoring firm. Do not complete this section if your reportable activity is solely with your sponsoring firm.

Take into consideration existing and reasonably foreseeable material conflicts of interest and existing and potential client confusion.

(a) Does the activity give rise to any material conflicts of interest between the client and the sponsoring firm or you? Does the activity give rise to client confusion? If no material conflicts of interest or client confusion are expected, explain why.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

(b) Describe (i) the material conflicts of interest, and (ii) how these conflicts will be addressed in the best interest of the client.

____________________________________________________________________________________

(c) Describe (i) the client, and (ii) how the client confusion will be addressed.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

(d) Does your sponsoring firm and the entity have procedures for identifying and addressing material conflicts of interest? If so, confirm you are complying with both sets of procedures.

____________________________________________________________________________________

(e) State the name and title of the individual at your sponsoring firm who has reviewed and approved the activity.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

(l) in Schedule E, by replacing paragraphs (c), (d) and (e) with the following:

(c) If another person or entity has provided you with funds to invest in the firm, provide the name of the person or entity and state the relationship between you and that person or entity:

____________________________________________________________________________________

(d) Is the payment of the funds to be invested (or proposed to be invested) guaranteed directly or indirectly by any person or entity?

Yes  ☐      No  ☐

If "Yes", provide the name of the person or entity and state the relationship between you and that person or entity:

____________________________________________________________________________________

(e) Have you directly or indirectly given up any rights relating to these securities or this partnership interest, or do you, when you are registered or approved as a result of the review of this form, intend to give up any of these rights (including by hypothecation, pledging or depositing as collateral the securities or partnership interest with any entity or person)?

Yes  ☐      No  ☐

If "Yes", provide the name of the person or entity, state the relationship between you and that person or entity and describe the rights that have been or will be given up:

____________________________________________________________________________________

(m) in Schedule F, by replacing "Notice of" in the title with "Notice and Consent for",

(n) in Schedule F in the contact information for British Columbia, by replacing "Freedom of Information Officer" with "Registration staff" and adding "E-mail: Registration@bcsc.bc.ca" at the end,

(o) in Schedule F in the contact information for Saskatchewan, by deleting "Deputy" and adding "E-mail: registrationfcaa@gov.sk.ca" at the end,

(p) in Schedule F in the contact information for Nova Scotia, by replacing "Deputy Director, Capital Markets" with "Registration",

(q) in Schedule F in the contact information for Yukon, by adding "Office of the Yukon" before "Superintendent of Securities" and replacing "(867) 667-5314" with "(867) 667-5466", and

(r) in Schedule F in the contact information for Northwest Territories, by deleting "Deputy".


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