33-109F1 - Notice of Termination [F - Lapsed]
| Published Date: | 2003-02-07 |
|---|---|
| Effective Date: | 2003-02-21 |
| Document(s): |
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FORM 33-109F1
NOTICE OF TERMINATION
Enter the following information using the online version of this submission at the NRD web site (www.nrd.ca). 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.
1. Individual
Name of individual:
NRD number of individual:
2. Business location
Address of business location:
NRD number of business location:
3. Termination
Effective date of termination:Indicate whether the individual:• was dismissed for cause
• was dismissed in good standing
• resigned in good standing
• is deceased
Include details regarding any:
• unresolved client complaints:
• internal discipline matters:
• restrictions for violation of regulatory requirements:
• financial obligations the individual has to clients:
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:
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 CommissionP.O. Box 10142, Pacific Centre 701 West Georgia Street Vancouver, BC V7Y 1L2 Attention: Freedom of Information Officer Telephone: (604) 899-6500 or (800) 373-6393 (in BC) |
Manitoba The Manitoba Securities Commission 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 Securities Registry |
| Québec Commission des valeurs mobilières du Québec Saskatchewan Saskatchewan Securities Commission800 B1920 Broad Street Regina, SK S4P 3V7 Attention: Director Telephone: (306) 787-5842 |
Yukon Department of Community Services Yukon |