33-109F1 - Notice of Termination of Registered Individuals and Permitted Individuals [F Amendment Proposed - Lapsed]
- BCN 2008/11 - Request for Comment Proposed National Instrument 31-103 Registration Requirements, Proposed Companion Policy 31-103CP Registration Requirements, Proposed BC Instrument 33-5XX Registration Requirements, and Proposed consequential amendments to national and local instruments [BCN - Lapsed]
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 been terminated by his or her sponsoring firm.
Complete and submit this form online at the national registration database (NRD) website at www.nrd.ca. Otherwise, complete the paper version of this form if you are relying on the temporary hardship exemption in NI 31-102.
A. Information about the terminating firm
2. NRD number
B. Information about the terminated individual
2. NRD number
C. Business location of the terminated individual
2. NRD number
D. Information about the termination
1. Effective date (the first day on which the individual ceased to have authority to act in a registerable capacity on behalf of the firm or ceased to act in his/her permitted individual activity ) _______________
2. Reason for the termination (check one)
|Resigned||... requested or encouragedto do so by the firm?|
|Dismissed||… for just cause?|
|Other (provide details)|
E. Further details
(You do not have to provide the information in this Part E unless the individual resigned or was dismissed. If so, you have until 30 business days after the effective date of the termination to file your responses to the questions in this Part E - the remainder of the Form should still be filed within 5 days business days after the effective date of the termination.)
If the individual resigned or was dismissed (whether or not for just cause), explain why in the space provided and answer the following questions to the best of the firm’s knowledge.
Reasons for resignation or dismissal:
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.
|1. Was the individual charged with any criminal offence?|
|2. Was the individual the subject of any investigation by any securities or financial industry regulator?|
|3. Was the individual subject to any significant internal disciplinary measures at the firm or any affiliate of the firm related to the individual's integrity or competence as a registrant?|
|4. Were there any written complaints, civil claims and/or arbitration notices filed against the individual or against the firm concerning securities-related activities of the individual that occurred while the individual was registered or a permitted individual authorized to act on behalf of the firm?|
|5. Does the individual have any undischarged financial obligations to clients of the firm?|
|6. Has the firm or any affiliate suffered significant monetary loss or harm to its reputation as a result of the individual's actions?|
|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.|
|8. Did the individual demonstrate a pattern of failing to follow compliance policies and procedures of the firm or any affiliate?|
|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?|
|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 the individual's integrity or competence as a registrant or permitted individual?|
F. Collection and use 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 at
1-888-528-7741 or visit its website at www.cai.gouv.qc.ca.
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 important information may lead to regulatory sanctions, including a fitness for registration review or enforcement action against the firm and/or persons responsible for preparing the information in 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.
Use the following certification when submitting this form in NRD electronic format:
I am making this submission as agent for the firm. By checking this box, I certify that the firm provided me with all of the information in this form.
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 partner or officer
Title of authorized signing partner or officer
Date signed (YYYY/MM/DD)