Securities Law

33-109F1 - Notice of termination [F Proposed - Lapsed]

Published Date: 2007-02-20
Document(s):

Concurrently Published:

Complete this form to notify the appropriate Canadian securities regulator(s) or self-regulatory organization(s) (SRO) that a registered individual or permitted person has left the sponsoring firm.

Complete the paper version of this form if you are relying on the temporary hardship exemption in MI 31-102. Otherwise, complete and submit this form online at the national registration database (NRD) website at www.nrd.ca.

If you need more space, use a separate sheet of paper, clearly identifying the section and item. Please complete and sign the form, and send it to the appropriate Canadian securities regulator(s) or SRO(s).

A. Information about the terminating firm
1. Name

2. NRD number

B. Information about the terminated individual
1. Name

2. NRD number

C. Business location of the terminated individual
1. Address

2. NRD number

D. Information about the termination
1. Effective date dd/mm/yyyy

2. Reason for the termination

(check one)  YesNo
Resigned  Square... for cause?SquareSquare
DismissedSquare... for cause?SquareSquare
Completed temporary employment contractSquare
RetiredSquare
DeceasedSquare
Other (provide details)Square
 
E. Further details
(You do not have to provide the information in this Part unless the individual resigned or was dismissed. If so, you have until 30 days after the effective date of the termination to file your responses to the questions in this Part - the remainder of the Form should still be filed within 5 days of the effective date of the termination.)

If the individual resigned or was dismissed (whether or not for cause), explain why in the
space provided and answer the following questions to the best of the firm's knowledge.

Reasons for dismissal or termination:

 

If the answer to any of the following questions is "yes", provide details (you may cross-reference the information provided immediately above if the relevant details have been set out there). Answers should be with reference to events in the past twelve months.

  YesNo
1.If the individual resigned, was the resignation solicited by the firm?SquareSquare
2.Was the individual charged with any criminal offence? SquareSquare
3.Was the individual subject to any significant internal disciplinary measures at the firm or any affiliate of the firm?SquareSquare
4.Did any investors allege they lost money because the individual acted inappropriately? Such allegations include written complaints, civil actions and arbitration notices.SquareSquare
5.Does the individual have any undischarged financial obligations to clients of the firm? Examples include accounts which are not fully secured, margined or paid and in the opinion of the firm, are the result of bad business or credit practices on the part of the individual. SquareSquare
6.Has the firm or any affiliate suffered monetary loss or harm to its reputation as a result of the individual's actions?SquareSquare
7.Did the firm or any affiliate investigate the individual in connection with possible material violations of fiduciary duties, regulatory requirements or the compliance policies and procedures of the firm or any affiliate? Examples include making unsuitable trades or investment recommendations, stealing or borrowing client money or securities, hiding losses from clients, forging client signatures, money laundering, deliberately making false representations and engaging in undisclosed outside business activity. SquareSquare
8.Did the individual demonstrate a pattern of failing to follow compliance policies and procedures of the firm or any affiliate?SquareSquare
9.Did the individual engage in discretionary management of client accounts or otherwise engage in registerable activity without appropriate registration or without the firm's authorization?SquareSquare
10.Is there any other matter relating to the individual's termination or conduct leading up to it that the firm is aware of and believes is relevant to his or her suitability for registration?SquareSquare

F. Collection of personal information
Securities regulators may collect the personal information on this form only under the requirements in securities and/or derivatives  legislation and may only use this information to administer and enforce provisions of the securities and/or derivatives legislation.

If you have any questions about the collection and use of this personal information, you can contact the securities regulator in the relevant jurisdiction. See Schedule A for details. In Québec, you can also contact the Commission d'accès à l'information du Québec at 1-888-528-7741 or visit its website at www.cai.gouv.qc.ca.

G. 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. In addition, failure to report materially significant information may lead to regulatory sanctions, including a fitness for registration review, or enforcement action against the firm and/or persons responsible for preparing this form. It should not be assumed that information is known to any securities regulatory authority merely because it is in the public domain or has previously been disclosed to one or more of them or any other regulatory body. If there is any doubt about the relevance of information, it should be included.

H. Certification

Use the following certification when submitting this form in NRD format:

Square 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 a duly authorized firm representative of the NRD filer, who has confirmed to me that he or she has read and understood the warning set out above and that the information in this form is accurate and complete to the best of his or her knowledge and belief.

Use the following certification when submitting this form in paper format:

I certify that I have read and understand the warning set out above and that the information in this form is accurate and complete to the best of my knowledge and belief.

Name of firm

Name of authorized signing officer

Title of authorized signing officer

Signature

Date signed (dd/mm/yyyy)