Form 33-109F1
NOTICE OF TERMINATION OF REGISTERED INDIVIDUALS
AND PERMITTED INDIVIDUALS
(section 4.2)

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.

Terms

In this form, "cessation date" (or "effective date of termination") 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, because of the end of, or a change in, the individual's employment, partnership, or agency relationship with the 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

You must submit the responses to Item 1, Item 2, Item 3 and Item 4 within 10 days of the effective date of termination.

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 Termination Information" to complete Item 5 of this form.

Item 1    Terminating firm

1.           Name _____________________

2.           NRD number _____________________

Item 2    Terminated individual

1.           Name _____________________

2.           NRD number _____________________

Item 3    Business location of the terminated individual

1.           Business location address_____________________

2.           NRD number _____________________

Item 4    Date and reason for termination

1.           Cessation date / Effective date of termination _____________________

                                                                                                (YYYY/MM/DD)

This is the last day that the individual had authority to act in a registerable capacity on behalf of the firm, or the last day that the individual was a permitted individual.

2.           Reason for termination / cessation (check one):

Resigned – voluntary                                               □

Resigned - at the firm's request                               □

Dismissed in good standing                                     □

Dismissed for cause                                                 □

Completed temporary employment contract           □

Retired                                                                      □

Deceased                                                                 □

Other                                                                         □

If "Other", explain: __________________________________________________

Item 5    Details about the termination

Complete Item 5 except where the individual is deceased. In the space below:

•             state the reason(s) for the cessation / termination 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 effective date of termination

□           Not applicable: individual is deceased

Answer the following questions to the best of the firm's knowledge.

In the past 12 months:	Yes	No
1.         Was the individual charged with any criminal offence?	□	□
2.         Was the individual the subject of any investigation by any securities or financial industry regulator?	□	□
3.         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?	□	□
4.         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?	□	□
5.         Does the individual have any undischarged financial obligations to clients of the firm?	□	□
6.         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?	□	□
7.         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 business activity.	□	□
8.         Did the individual repeatedly or materially fail to follow compliance policies and procedures of the firm or any affiliate of the firm?	□	□
9.         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    Warning

It is an offence under securities legislation and derivatives legislation, including commodity futures legislation, to give false or misleading information on this form.

Item 8    Certification

Certification - NRD format:

□         I am making this submission as agent for the firm. By checking this box, I certify that the firm provided me with all of the information on this form.

Certification - Format other than NRD format:

By signing below I certify to the regulator or, in Québec, the securities regulatory authority, in each jurisdiction where I am submitting this form for the firm, either directly or through the principal regulator, that:

•             I have read this form and understand the questions, and

•             all of the information provided on this form is true and complete.

Name of firm ________________________________________________________

Name of authorized signing officer or partner _______________________________

Title of authorized signing officer or partner ________________________________

Signature of authorized signing officer or partner ____________________________

Date signed ______________________

                            (YYYY/MM/DD)

 

 

Schedule A
[repealed]