Form 55-102F5
SEDI User Registration Form
An individual who intends to use SEDI to file information with the securities regulatory authority
is required to complete and submit a user registration form in SEDI format containing the
information prescribed below. The information must be entered using the online version of this
form accessible at the SEDI web site (www.sedi.ca). To access the online user registration
form, select “Register as a SEDI user” on the navigation bar at the top of the web page titled
“Welcome to SEDI”.
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, you may 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:
CSA Service Desk
Attn: SEDI Operator
12 Millennium Blvd, Suite 210
Moncton, NB E1C 0M3
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 the CSA Service Desk 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 the SEDI operator is retained by the SEDI operator 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 SEDI operator 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. The registering individual may
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:
CSA Service Desk
Attn: SEDI Operator
12 Millennium Blvd, Suite 210
Moncton, NB E1C 0M3
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):
SECTION 2 SEDI USER CLASSIFICATION
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 the
SEDI operator by facsimile, shall have the same effect as an originally executed copy delivered
to the SEDI operator.
Signature of SEDI user
Date:
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.