Form 7 - Application for amendment of registration as dealer, adviser or underwriter [F - Rescinded]
| Published Date: | 1996-07-05 |
|---|---|
| Effective Date: | 1996-09-01 |
| Rescinded Date: | 2001-03-28 |
FORM 7
Application for Amendment of Registration
as Dealer, Adviser or Underwriter
INSTRUCTIONS
- This form is the form required under Section 42 of the Securities Act.
- All applicable questions must be answered. Failure to do so may constitute a misrepresentation and may also cause delays in the processing of the application.
- This form and all attachments added thereto must be typewritten, printed legibly in ink or prepared on an approved computer-generated form. Any form or attachment completed by any other means may be considered not properly filed.
- All attachments pertaining to any question must be made exhibits to the form and each one must be so marked. All signatures must be originals. The Commissioner of Oaths before whom the application is sworn, as well as the applicant, is required to initial all attachments.
- Please attach the applicable fee.
_________________________________________________________________
Freedom of Information and Protection of Privacy Act
The personal information requested on this form is collected under the authority of and used for the purpose of administering the Securities Act. Questions about the collection of or used of this information can be directed to the Supervisor, Registration, British Columbia Securities Commission, 200-865 Hornby Street, Vancouver, British Columbia V6Z 2H4.
Telephone (604) 899-6692. Toll Free within British Columbia 1-800-373-6393.
_________________________________________________________________
_________________________________________________________________
NAME OF REGISTRANT
_________________________________________________________________
Application is made for amendment to our existing registration as:
_________________________________________________________________
under the Securities Act and the following statements of fact are made in respect thereof:
Answer "yes" or "no" to each of the questions in parts A and B. If the answer to any of the following questions is "yes", complete details must be attached by way of exhibit.
Please (x) yes or no. | |||
| A. | HAS THERE BEEN A CHANGE IN THE FOLLOWING? | YES | NO |
| 1. | The name of the applicant. | [] | [] |
| 2. | Address for service or any business address. | [] | [] |
| 3. | Partners, officers or directors and the reason for any such person's resignation, dismissal, severance or termination of employment or office. | [] | [] |
| 4. | Compliance officer(s) of the applicant. | [] | [] |
| 5. | Holders of voting securities of the applicant. | [] | [] |
| 6. | Branch offices in British Columbia. | [] | [] |
| 7. | The person in charge of any branch office in British Columbia. | [] | [] |
| 8. | Commencement or termination of the employment of a registered salesperson or registered advising employee and, in the case of termination employment by any means, the reason for termination. | [] | [] |
| 9. | Change in the name of any partner, director of officer of the applicant. | ||
| B. | HAS THERE BEEN A MATERIAL CHANGE IN THE FOLLOWING? | YES | NO |
| 1. | A charge or indictment against, or a conviction of, the applicant or a partner, director or officer of the applicant for an offence under the law. | [] | [] |
| 2. | A finding, made against the applicant or a partner, director or officer of the applicant in a civil proceeding, of fraud, theft, deceit, misrepresentation or similar conduct. | [] | [] |
| 3. | Bankruptcy of the applicant or a partner, director or officer of the applicant. | [] | [] |
| 4. | Appointment of a receiver or receiver manager to hold the assets of the applicant or a partner, director or officer of the applicant. | [] | [] |
| 5. | Other information previously filed. | [] | [] |
C. ATTACHED HERETO AND MARKED AS AN EXHIBIT TO THE
APPLICATION FOR AMENDMENT IS:
1. The name of each new partner, officer or director of }
the applicant. } This information MUST be
} provided if you have answered
2. A completed Form 4 (or Form 1-U-85) for each new }YES to A.3. or A.4.
partner, officer or director of the applicant. }
D. Attached hereto and marked as an exhibit to the application for amendment is a statement of changes which have ocurred in the financial structure and control of the applicant, which would make the information previously given by the applicant pursuant to this or any previous requirement, false or misleading.
DATED at _________________________ | _________________________ |
(Name of Applicant) |
this ________ | day of ______________________ | _________ | By _____________________________ |
(Day) | (Month) | (Year) | ( Signature of applicant, director, officer or partner) |
_______________________________ | |
(Official Capacity) |
_______________________________________________________
AFFIDAVIT
in the matter of the Securities Act
I, ___________________________, ________________________________, of ___________________
(Name in Full) | (Occupation) | (Address) |
of the _________________ | of ____________________ | in the _______________ | of___________________, | MAKE |
(City, etc.) | (Province, etc.) |
OATH (OR SOLEMNLY AFFIRM) AND SAY THAT:
1. I am the applicant (or a partner, director, or officer of the applicant) for amendment of registration and I signed the application.
2. The statements of fact made in the application for amendment of registration are true.
SWORN (OR AFFIRMED) BEFORE ME in
the _______________________ | of ______________________________ | ) |
(City, etc.) | ) | |
) | ||
) |
in the________________________ | of _______________________ | ) | |
(Province, etc.) | ) | ___________________________ | |
) | (Signature of Deponent) |
) | |||
on this __________ | day of ______________________ , | _________________. | ) |
(Month) | (Year) | ) | |
) | |||
) |
____________________________________________ | ) |
(Signature of Commissioner, of Oaths, Notary Public or | ) |
other official authorized by law to administer oaths) | ) |
It is an offence under the Securities Act to file an application containing a statement that, at the timeand in light ofthe circumstances in which it is made, is a misrepresentation.