FORM 35-101F2
FORM OF SUBMISSION TO JURISDICTION AND
APPOINTMENT OF AGENT FOR SERVICE OF PROCESS
BY AGENTS OF THE BROKER-DEALER

Instructions: Complete this form for each of the jurisdictions in which agents of the broker-dealer seek the conditional exemption from registration in National Instrument 35-101 (the "exemption"). Insert the name of the jurisdiction at each "·".

1.           Name of the broker-dealer (the "Broker-Dealer");

2.           Jurisdiction of incorporation of the Broker-Dealer;

3.           Name(s) and address(es) of agent(s) of the Broker-Dealer filing this form (the "Broker-Dealer Agents");

4.           Name of agent for service of process (the "Agent for Service");

5.           Address for service of process on the Agent for Service in ·;

6.           Each Broker-Dealer Agent designates and appoints the Agent for Service at the address of the Agent for Service stated above as its agent upon whom may be served a notice, pleading, subpoena, summons or other process in any action, investigation or administrative, criminal, quasi-criminal or other proceeding (a "Proceeding") arising out of or relating to or concerning the Broker-Dealer Agent's activities in · under the exemption, and irrevocably waives any right to raise as a defence in any such proceeding any alleged lack of jurisdiction to bring such Proceeding.

7.           Each Broker-Dealer Agent irrevocably and unconditionally submits to the non-exclusive jurisdiction of the judicial, quasi-judicial and administrative tribunals of · and any administrative proceeding in ·, in any Proceeding arising out of or related to or concerning the Broker-Dealer Agent's activities in · under the exemption.

8.           Until the earlier of (i) the termination of a Broker-Dealer Agent’s position as an agent of the Broker-Dealer and (ii) six years after the Broker-Dealer ceases to use the exemption, the Broker-Dealer Agent shall file:

a.           new Submission to Jurisdiction and Appointment of Agent for Service of Process in this form at least 30 days prior to termination for any reason of this Submission to Jurisdiction and Appointment of Agent for Service of Process; and

b.           an amended Submission to Jurisdiction and Appointment of Agent for Service of Process at least 30 days before any change in the name or above address of the Agent for Service.

9.           This Submission to Jurisdiction and Appointment of Agent for Service of Process is governed by and construed in accordance with the laws of ·.

 

Dated:                                                                                                                      

(Signature of Broker-Dealer Agent)

 

 

Dated:                                                                                                                      

(Signature of Broker-Dealer Agent)

 

 

Dated:                                                                                                                      

(Signature of Broker-Dealer Agent)

 

 

Dated:                                                                                                                      

(Signature of Broker-Dealer Agent)

 

 

Acceptance

The undersigned accepts the appointment as agent for service of process on __________ (Insert name(s) of Broker-Dealer Agent(s)) pursuant to the terms and conditions of the foregoing Submission to Jurisdiction and Appointment of Agent for Service of Process.

 

Dated:                                                                                                                      

(Signature of Agent for Service or Authorized Signatory)

 

 

                                                                             

(Name and Title of Authorized Signatory)