Form 7A - Application for transfer/change of status [F - Rescinded]
| Published Date: | 1996-07-05 |
|---|---|
| Effective Date: | 1996-09-01 |
| Rescinded Date: | 2001-03-28 |
FORM 7A
APPLICATION FOR TRANSFER /
CHANGE OF STATUS
FOR INTERNAL USE ONLY
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APPLICATION APPROVED BY DATE APPROVED
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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.
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APPLICANT NAME
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APPLICANT'S RESIDENTAIL ADDRESS Postal Code
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EMPLOYER NAME
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ADDRESS WHERE APPLICANT WILL BE WORKING Postal Code
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ADDRESS FOR SERVICE IN THE PROVINCE Postal Code
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APPLYING FOR REGISTRATION AS TYPE OF REGISTRATION
[] TRANSFER [] CHANGE
OF STATUS
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A. TRANSFER DATE OF TERMINATION
NAME OF PREVIOUS EMPLOYER Y M D
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B. CHANGE OF STATUS
CURRENT REGISTRATION
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1. APPLICABLE EXAMINATION WRITTEN - Attach proof of passing DATE PASSED
Y M D
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2. APPLICABLE EXAMINATION WRITTEN - Attach proof of passing DATE PASSED
Y M D
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3. APPLICABLE EXAMINATION WRITTEN - Attach proof of passing DATE PASSED
Y M D
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Have there been changes in the information given in Questions 11 through PLEASE (x) ONE
20 (see reverse) of the Uniform Application For Registration / Approval [] YES [] NO
previously filed by you and approved. If yes, attach full particulars.
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CERTIFICATION - The undersigned hereby certify that the foregoing statements are true and correct to the best of our knowledge, information and belief (after having seen the Uniform Application for Registration / Approval and all subsequent Applications for Transfer / Change of Status previously filed by the applicant) and we hereby undertake to notify the British Columbia Securities Commission in writing, of any change therein within the period prescribed by the British Columbia Securities Act or Securities Rules.
APPLICANT SIGNATURE PRINT APPLICANT'S NAME DATE SIGNED
Y M D
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SIGNATURE OF PARTNER, PRINT NAME OF PARTNER, DIRECTOR DATE SIGNED
DIRECTOR OR OFFICER OR OFFICER OF THE DEALER, ADVISOR Y M D
OR UNDERWRITER THAT EMPLOYS THE
APPLICANT
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NOTE: The following areas are addressed in the Uniform Application and constitute questions 11 through 20 respectively:
CHANGE OF NAME
PRIOR REGISTRATION OR LICENSING
REFUSAL, SUSPENSION, CANCELLLATION OR DISCIPLINARY MEASURE
SELF - REGULATORY ORGANIZATIONS
OFFENCES UNDER THE LAW
CIVIL PROCEEDINGS
BANKRUPTCY
JUDGMENT OR GARNISHMENT
SURETY BOND OR FIDELITY BOND
BUSINESS ACTIVITIES