33-109F3 - Business Location Other than Head Office [F - Lapsed]
Published Date: | 2003-02-07 |
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Effective Date: | 2003-02-21 |
FORM 33-109F3
BUSINESS LOCATIONS OTHER THAN HEAD OFFICE
Enter the following information using the online version of this submission at the NRD web site (). If the NRD filer is relying on the temporary hardship exemption in MI 31-102 this form is required to be delivered to the regulator in paper format.
Please select one box:
This form is being submitted to notify the regulator of the opening of this business location. Complete the entire form.
This form is being submitted to notify the regulator of the closing of this business location. Complete the entire form.
This form is being submitted to notify the regulator of the change of information previously submitted in respect of this business location. Complete the entire form and describe the information that has changed (for example, “telephone number” or “type of business location”):
1. Type of business location
_____________________ branch
_____________________ sub-branch
2. Supervisor or branch manager
NRD number of the designated supervisor or branch manager: ______________________________________________________________________
Name of designated supervisor or branch manager: ______________________________________________________________________________
3. Business location information
Business address: _____________________________________
Telephone number: ( ) __________________________
Facsimile number: ( ) ___________________________
Mailing address (if different from business address): ___________________________________________________________________________
Notice of Collection and Use of Personal Information
The personal information required under this form is collected on behalf of and used by the securities regulatory authorities set out below for the administration and enforcement of certain provisions of the securities legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and Labrador, Northwest Territories, Yukon Territory, and Nunavut.
If you have any questions about the collection and use of this information, you may contact the securities regulatory authority in any jurisdiction in which the required information is filed, at the address or telephone number provided in Schedule “A”.
WARNING:
It is an offence to submit information that, in a material respect and at the time and in the light of the circumstances in which it is submitted, is misleading or untrue.
CERTIFICATION
The following certification is to be used when submitting this form in NRD format:
I am making this submission as agent for the NRD filer. By checking this box I certify that all statements of fact in this submission were provided to me by the NRD filer.
The following certification is to be used when submitting this form in paper format:
I, the undersigned, certify that I have read and that I understand the questions in this notice and the Warning set out above. I also certify that all statements of fact made in the answers to the questions are true.
___________________________________________________________________
Signature of authorized officer or partner Date
________________________________________________
Firm name
SCHEDULE “A” Notice and collection and use of personal information |
Contact Information |
Alberta Alberta Securities Commission, British Columbia British Columbia Securities Commission |
Manitoba The Manitoba Securities Commission New Brunswick Securities Administration Branch |
Newfoundland and Labrador Securities Commission of Newfoundland and Labrador Nova Scotia Securities Commission |
Northwest Territories Government of the Northwest Territories Legal Registries Division |
Ontario Ontario Securities Commission Prince Edward Island Securities Registry |
Québec Commission des valeurs mobilières du Québec Saskatchewan Saskatchewan Securities Commission |
Yukon Department of Community Services Yukon |