55-102F4 - SEDI User Registration Form [F Proposed - Lapsed]
| Published Date: | 2000-06-16 |
|---|
TO: CDS INC. Fax: (416) 365-9194
85 Richmond Street West
Toronto, Ontario M5H 2C9
Section 1 SEDI User Information
| Family Name: | Given Name: |
| Employer Name (if applicable): | |
| Address (Street name and number): | |
| City/Town: | Province/Territory/State:Postal Code/Zip Code: |
| Telephone No.: ( ) | Fax No.: ( ) |
| Internet E-mail Address: |
Section 2 SEDI User Classification
Check the appropriate box or boxes:
Insider Agent Issuer Representative
Section 3 Certification and Acknowledgement of SEDI User
The undersigned hereby certifies that the foregoing information is true in all material respects. The undersigned agrees that an executed copy of Form 55-102F4, if delivered to CDS INC. by facsimile, shall have the same effect as an originally executed copy delivered to CDS INC.
Signature of SEDI User Date: