FORM 33-109F1 Notice Of End Of Individual Registration Or Permitted Individual Status (section 4.2)
WARNING - It is an offence to knowingly give false or misleading information to the regulator or the securities regulatory authority.
CERTIFICATION I, on behalf of the firm, certify to the regulator or, in Québec, the securities regulatory authority in each jurisdiction where the firm is submitting this form and to any applicable self-regulatory authority (SRO) that
I have read this form and understand all matters within this form, including the questions, and to the best of my knowledge and after reasonable inquiry, all of the information provided on this form is true and complete.
NRD format: I, the authorized firm representative, am making this submission under authority delegated by the firm. By checking this box, I certify that the firm
provided me with all of the information on this form, and makes the certification above.
Non-NRD format: By signing below, I, on behalf of the firm, make the certification above. Name of firm
Name of authorized signing officer or partner
Title of authorized signing officer or partner
Signature of authorized signing officer or partner
GENERAL INSTRUCTIONS Complete and submit this form to notify the relevant regulator(s) or, in Québec, the securities regulatory authority, or self-regulatory organization (SRO) that a registered individual or permitted
individual has left their sponsoring firm or has ceased to act in a registerable capacity or as a permitted individual.
As set out in section 1.1 of National Instrument 33-109 Registration Information, “cessation date” means the last day on which an individual had authority to act as a registered individual on behalf of their sponsoring firm or the last day on which an individual was a permitted individual of their sponsoring firm..
How to submit the form Submit this form at the National Registration Database (NRD) website in NRD format at www.nrd.ca.
If you are relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102 National Registration Database, you may submit this form in a format other than NRD format.
When to submit the form As set out in paragraph 4.2(2)(a) of National Instrument 33-109 Registration Information, you must submit the responses to Items 1, 2, 3 and 4 within 15 days of the cessation date.
If you are required to complete Item 5, you must submit those responses within 30 days of the cessation date. If you are submitting the responses to Item 5 in NRD format, after Items 1 to 4 have been submitted at NRD, use the NRD submission type called “Update/Correct Cessation Information” to complete Item 5 of this form..
Item 1 Former sponsoring firm 1. Name ________________________________________ 2. NRD number ___________________________________ Item 2 Individual 1. Name ________________________________________ 2. NRD number ___________________________________ Item 3 Business location of the cessation 1. Business location address _________________________ 2. NRD number ___________________________________ Item 4 Date and reason for termination 1. Cessation date __________________________ (YYYY/MM/DD)
The above date is the last day on which the individual had authority to act as a registered individual on behalf of the sponsoring firm, or the last day on which the individual was a permitted individual of the sponsoring firm.
Reason for cessation (check one): Resigned - voluntary Resigned - at the firm’s request
Terminated in good standing Terminated for cause Completed temporary employment contract Retired Deceased Other If “Other”, explain: _______________________________________ Item 5 Details about the cessation Complete Item 5 except if the individual is deceased. In the space below • state the reason(s) for the cessation and • provide details if the answer to any of the following questions is “Yes”. [For NRD Format only:] This information will be disclosed within 30 days of the cessation date Not applicable: individual is deceased
Answer the following questions to the best of the firm’s knowledge.
In the past 12 months:
Was the individual charged with any criminal offence?
Was the individual the subject of any investigation by any securities or financial industry regulator?
Was the individual subject to any significant internal disciplinary measures at the firm or at any affiliate of the firm related to the individual’s activity as a registrant?
Were there any written complaints, civil claims and/or arbitration notices filed against the individual or against the firm about the individual’s securities-related activities that occurred while the individual was registered or a permitted individual authorized to act on behalf of the firm?
Does the individual have any undischarged financial obligations to clients of the firm?
Has the firm or any affiliate of the firm suffered significant monetary loss or harm to its reputation as a result of the individual’s actions?
Did the firm or any affiliate of the firm investigate the individual relating to possible material violations of fiduciary duties, regulatory requirements or the compliance policies and procedures of the firm or any affiliate of the firm? 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 activity.
Did the individual repeatedly or materially fail to follow compliance policies and procedures of the firm or any affiliate of the firm?
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?
Reasons/Details: _______________________________________________________________ Item 6 [REPEALED] Item 7 [REPEALED] Item 8 [REPEALED]
Schedule A [REPEALED]