FORM 31-103F3 USE OF MOBILITY EXEMPTION
(section 2.2 [client mobility exemption – individuals])
This is to notify the securities regulatory authority that the individual named in paragraph 1 is relying on the exemption in section 2.2 [client mobility exemption – individuals] of National Instrument 31-103 Registration Requirements, Exemptions and Ongoing Registrant Obligations.
1. Individual information
Name of individual: _________________________________________________________________________
NRD number of individual: ______________
The individual is relying on the client mobility exemption in each of the following jurisdictions of Canada:
________________________________________________________________________________________
________________________________________________________________________________________
2. Firm information
Name of the individual’s sponsoring firm:
___________________________________________________________________
NRD number of firm:_________________
Dated: ____________________________________
__________________________________________
(Signature of an authorized signatory of the individual’s sponsoring firm)
__________________________________________
(Name and title of authorized signatory)