Form 7Z - Uniform termination notice (BC) [F - Rescinded]

This is a form required under sections 28(1)(b) and (c) and 28(2)(a) and (b) of the Securities Act.

FORM 7Z

UNIFORM TERMINATION
NOTICE (B.C.)

___________________________________________________________

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 or use of this information can be directed to the Supervisor, Registration, British Columbia Securities Commission, 1100 - 865 Hornby Street, Vancouver, British Columbia, V6Z 2H4. Telephone (604) 660-4833. Toll Free within British Columbia 1-800-373-6393.

___________________________________________________________

Instructions

Registered dealers, underwriters and advisers must file a Uniform Termination Notice (B.C.) where there is termination of employment of a registered salesperson or advising employee or termination of employment or office of a partner, director or officer. References to "employee" in this form should be read to include "partner, director or officer" and "employment" to include "office".

DATE OF TERMINATION: _______________________________________

NAME OF EMPLOYEE: _________________________________________

NAME OF EMPLOYER: _________________________________________

ADDRESS WHERE EMPLOYED: (If branch office, so state) _______________________

___________________________________________________________

RESIDENTIAL ADDRESS: ______________________________________

___________________________________________________________

TELEPHONE NO.: ____________________________________________

___________________________________________________________

PARTICULARS OF DISCONTINUANCE:

o UNSOLICITED (voluntary)                 o DISMISSED FOR CAUSE

o SOLICITED BY EMPLOYER              o OTHER (explain) __________________

_____________________________________________________________

1. State reasons for discontinuance:
   
   _______________________________________________________
   
   _______________________________________________________
   
   
2. (a) To the best of the employer's knowledge, have there been any changes in the information given in questions 13 through 18 of the Uniform Application for Registration/Approval previously filed by the employee?
   
   _______________________________________________________
   
   _______________________________________________________
   (i) any investigation, disciplinary action or proceeding?
   
   _______________________________________________________
   
   _______________________________________________________
   
   
   (ii) any offences under the law?
   
   _______________________________________________________
   
   _______________________________________________________
   
   (iii) any civil proceedings?
   
   _______________________________________________________
   
   _______________________________________________________
   
   (v) any judgments, garnishments or out-of-court settlements with clients?
   
   _______________________________________________________
   
   _______________________________________________________
   
   (b) Is the employee now, or at anytime during employment with the employer, ever been the subject of:
   
   (i) unresolved client complaints?
   
   _______________________________________________________
   
   _______________________________________________________
   
   (ii) internal discipline or restrictions for violations of regulatory requirements?
   
   _______________________________________________________
   
   _______________________________________________________
   
   
   (c) Is the employer in possession of any information that would suggest that the employee has engaged in any conduct that contravenes regulatory requirements or is inconsistent with dealing fairly, honestly and in good faith with clients?
   
   _______________________________________________________
   
   (d) If "yes" to any of the above give full particulars:
   
   _______________________________________________________
   
   
3. (a) Are employee's accounts, or those controlled by the employee, fully secured, margined or paid?
   
   _______________________________________________________
   
   (b) Are clients' accounts fully margined, secured or paid?
   
   _______________________________________________________
   
   (i) If "No", indicate total number of unmargined or bad debt accounts in excess of $5,000.00 and set out amounts of each account (including those written off or charged to the employee in the past 12 months):
   
   _______________________________________________________
   
   _______________________________________________________
   
   (ii) In the opinion of the employer, were unmargined or unsecured client accounts the result of bad business or credit practices on the part of the employee?
   
   _______________________________________________________
   
   Provide particulars:
   
   _______________________________________________________
   
   _______________________________________________________
   
   
4. (a) Has the employee seen this form?
   
   _______________________________________________________
   
   (b) If the employee's signature is not obtained, state the reasons:
   
   _______________________________________________________
   
   _______________________________________________________
   

I am satisfied that the information in this Uniform Termination Notice (B.C.) reflects the knowledge of the employee's supervisors and the employer's management.

_________________________________ ________________________________
Date                                                                      Signature of Authorized Person
 

_________________________________ _________________________________
Position Held                                                      Name of Authorized Person (Please Print)

I have reviewed this Uniform Termination Notice (B.C.) and do/do not agree with the information contained therein

Provide particulars for not agreeing _______________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

__________________________________ ________________________________
Date                                                                        Signature of Employee