55-102F5 - SEDI User Registration Form [F - Rescinded]
| Published Date: | 2001-10-19 |
|---|---|
| Effective Date: | 2001-10-29 |
| Rescinded Date: | 2013-12-02 |
| Document(s): |
|
- This .pdf file is only for administrative ease. Before using this .pdf file, the user should first register online using the online form on the SEDI website at www.sedi.ca. The user should only use this .pdf file if the user was not able to print the online form after registering online on the SEDI website.
- To fill in the form, use the tab key to move from field to field, or use your mouse to click directly within the fields of your choice.
- Be sure to exit the last field before you print and to print the form before you close it, as you will not be able to save the filled in form.
1. Full legal name of SEDI user
Provide your family name and your given names. Use upper and lower case letters as applicable. Do not use initials, nicknames or abbreviations.
2. Name of employer and position of SEDI user
If you are acting on behalf of an employer, provide the full legal name of your employer and your position with that employer.
3. Address of SEDI user
If you are an insider, provide your principal residential address. Otherwise, provide the business address where you are employed. A post office box or other mailing address is not sufficient.
4. SEDI user’s telephone number
Provide your daytime telephone number.
5. SEDI user’s fax number
If available, provide your fax number.
6. SEDI user’s e-mail address
If available, provide your e-mail address.
7. Check the appropriate box for SEDI user classification
Indicate whether you expect to access SEDI as an insider, an agent and/or an issuer’s representative by checking the appropriate box or boxes. The type of user classification will determine the amount of functionality you will have in the SEDI application software.
8. Confidential question and answer
Provide a “confidential question” and an answer to the confidential question for use in verifying your identity if a request in your name is being made to the SEDI operator for a new password.
Certification
Prior to submitting the completed online user registration form, you must certify that the information is true in all material respects and you must agree to update the information submitted as soon as practicable following any material change in the information.
Delivery of Signed Copy to SEDI Operator
Before you may make a valid SEDI filing, you must deliver a manually signed paper copy of the completed user registration form to the SEDI operator for verification purposes. To satisfy this requirement, it is preferred that you print a copy of the online user registration form once you have certified and submitted it. You must deliver a manually signed and dated copy of the completed user registration form via prepaid mail, personal delivery or facsimile to the SEDI operator at the following address or fax number, as applicable:
CDS INC.
Attention: SEDI Administrator
85 Richmond Street West
Toronto, Ontario M5H 2C9
Facsimile: 1-866-729-8011
or, if you are resident in the province of Quebec, to the SEDI operator at the address above, or to:
CDS INC.
Attention: SEDI Administrator
600 boul. de Maisonneuve Ouest
Montreal, Quebec
H3A 3J2
or at such other address(es) or fax number(s) as may be provided on the SEDI web site (www.sedi.ca).
Questions
Questions may be directed to CDS INC. at 1-800-219-5381 or such other number as may be provided on the SEDI web site.
Notice - Collection and Use of Personal Information
The personal information that you provide on this form is used to facilitate your access to and use of the SEDI system and is not used for any other purpose. The signed copy of the completed form that you deliver to CDS INC. (the SEDI operator) is retained by CDS INC. as evidence of your registration as a SEDI user. The information you provide on this form will not be disclosed to any third party except any of the securities regulatory authorities or their authorized representatives for purposes of the administration or enforcement of securities legislation in the applicable jurisdictions. For information about the use of the information collected on this form or if you would like to obtain access to the information you have submitted, contact the CDS SEDI Administrator at the address or telephone number provided above. In Quebec, questions may also be addressed to the Commission d’accès à l’information du Québec
(1-888-528-7741, web site: www.cai.gouv.qc.ca).
SEDI User Registration Form
Note: Before an individual registering as a SEDI user may make a valid SEDI filing, the registering individual must deliver a manually signed paper copy of the completed user registration form to the SEDI operator for verification purposes. It is preferred that the registering individual print a copy of the online version using the “Print” function provided for this purpose in SEDI. The signed paper copy must be delivered by prepaid mail, personal delivery or facsimile to: CDS INC., Attention: SEDI Administrator, 85 Richmond Street West, Toronto, Ontario M5H 2C9, Facsimile: 1-866-729-8011 or, if you are resident in the province of Quebec, to the SEDI operator at the address above, or to CDS INC., Attention: SEDI Administrator, 600 boul. de Maisonneuve Ouest, Montreal, Quebec, H3A 3J2.
Section 1 SEDI User Information
| Family name: | Given names (in full): |
| Employer name and position (if applicable): |  |
| Address (street name and number, etc.): | Municipality (city, town, etc.): |
| Province, territory or state: | Country:Postal code or zip code: |
| |
| Telephone number: ( ) | Fax number (if available): ( ) |
| E-mail address (if available): | |
| Check the appropriate box or boxes: |
| Insider Agent Issuer representative |
Section 3 Certification of SEDI User
I certify that the foregoing information is true in all material respects. I agree to update the information submitted on this form in SEDI as soon as practicable following any material change in the information. I agree that an executed copy of Form 55-102F5, 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: |