33-109F1 - Notice of Termination [F - Rescinded]
Published Date: | 2007-05-15 |
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Rescinded Date: | 2009-09-28 |
Document(s): |
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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 NI 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:
I, the undersigned, certify that I have read and that I understand the questions in the notice and the Warning set out above. I also certify that all statements of fact made in the answers to the questions are true
SCHEDULE “A” Notice and collection and use of personal information | ||
Contact Information | ||
| Alberta
AlbertaSecurities Commission, 4th Floor, 300 B 5th Avenue S.W. Calgary, AB T2P 3C4 Attention: Information Officer Telephone: (403) 297-6454 | British Columbia
British ColumbiaSecurities Commission P.O. Box10142, 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 1130-405 Broadway Winnipeg, MB R3C 3L6 Attention: Director - Legal Telephone: (204) 945-4508
| New Brunswick
Securities Administration Branch PO Box5001 606, 133 Prince William Street Saint John, NB E2L 4Y9 Attention: Deputy Administrator, Capital Markets Telephone: (506) 658-3021 | |
Newfoundland and Labrador
Securities Commission of Newfoundland and Labrador P.O. Box8700, 2nd Floor, West Block ConfederationBuilding St. John's, NF A1B 4J6 Attention: Director of Securities Tel: (709) 729-4189
| Nova Scotia
Nova ScotiaSecurities Commission 2nd Floor, Joseph Howe Building 1690 Hollis Street P.O. Box458 Halifax, NS B3J 3J9 Attention: FOI Officer Telephone: (902) 424-7768 | |
Northwest Territories
Government of the Northwest Territories P.O. Box1320 Yellowknife, NWT X1A 2L9 Attention: Deputy Registrar of Securities Telephone: (867) 920-8984
| Nunavut
Legal Registries Division Department of Justice Government of Nunavut P.O. Box1000Station 570 Iqaluit, NU X0A 0H0 Attention: Deputy Registrar of Securities Telephone: (867) 975-6190 | |
Ontario
OntarioSecurities Commission Suite1903, Box 55 20 Queen Street West Toronto, ON M5H 3S8 Attention: FOI Coordinator Telephone: (416) 593-8314
| Prince Edward Island
Securities Registry Office of the Attorney General B Consumer, Corporate and Insurance Services Division P.O. Box2000 Charlottetown, PE C1A 7N8 Attention: Deputy Registrar of Securities Telephone: (902) 368-4569 | |
Québec
Commission des valeurs mobilières du Québec StockExchange Tower P.O. Box246, 22nd Floor 800 Victoria Square Montréal, PQ H4Z 1G3 Attention: Responsable de l’accès à l’information Telephone: (514) 940-2150 or (800) 361-5072 (in Québec) | Saskatchewan
SaskatchewanSecurities Commission 800 B1920 Broad Street Regina, SK S4P 3V7 Attention: Director Telephone: (306) 787-5842 | |
Yukon
Department of Community Services Yukon P.O. Box2703 Whitehorse, YU Y1A 2C6 Attention: Registrar of Securities Telephone: (867) 667-5225 |