Unofficial Consolidation: Form 33-109F3 Business Locations Other Than Head Office

 
FORM 33-109F3
BUSINESS LOCATIONS OTHER THAN HEAD OFFICE
(section 3.2) 
 

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 organization (SRO) that

• I have read this form and understand all matters within this form, including the questions,
• if the business location specified in this form is a residence, the individual conducting business from that business location has completed a Form 33-109F4 Registration of Individuals and Review of Permitted Individuals, 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, the authorized firm representative, certify that

1. the firm provided me with all of the information on this form, and
2. the firm 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_________________________________________

Date signed ______________________
(YYYY/MM/DD)

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 business location has opened or closed, or information about a business location has changed.

Check one of the following and complete the entire form:

▢ Opening this business location

▢ Closing this business location

▢ Change to the information previously submitted about this business location. Clearly specify the information that has changed.

How to submit this 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 complete and submit this form in a format other than NRD format.

Item 1             Type of business location

▢ Branch or business location

▢ Sub-branch (Mutual Fund Dealers Association of Canada members only)

Item 2             Supervisor or branch manager

Name of designated supervisor or branch manager                                                                                              

NRD number of the designated supervisor or branch manager _______________________________________

Item 3               Business location information

Business location address __________________________
(a post office box is not a valid business location address)

Mailing address (if different from business location address) ________________________________________

Telephone number (_____) __________________  

Fax number (_____) _______________________

E-mail address ____________________________

Notice regarding a business location that is a residence

For the administration of securities legislation or derivatives legislation, including commodity futures legislation, or both, the regulator or, in Québec, the securities regulatory authority may require access to the business location to review the books, records and documents of the registered firm. If applicable, the SRO may also require access to the business location for the administration of the rules of the SRO.

If the business location specified in this form is a residence, the regulator, securities regulatory authority or SRO may request consent to enter the residence.

If consent is not provided, it may affect the ability of the regulator, securities regulatory authority or SRO to access the books, records or documents of a registered firm and to determine whether securities legislation, derivatives legislation (including commodity futures legislation) or the rules of the SRO are being complied with. As a result, the regulator, securities regulatory authority or SRO may take action if it is unable to access and review the books, records or documents of a registered firm held at the business location.

Item 4             [repealed]

Item 5             [repealed]

Item 6             [repealed]

 

Schedule A
[repealed]