AFFIDAVIT OF UNCHANGED STATUS
A
BENEFICIARY INFORMATION
Under penalties of perjury I declare that I have examined the enclosed document(s) and that the information and certifications relevant to residency status
contained therein remained the same and unchanged for the period beginning January 1, 2001 (or later account opening date) to the present and were true,
correct and complete during that period.
Beneficial owner/Authorized Officer name
(please
print) Capacity in which acting (if form is not signed by beneficial owner)
Beneficial owner/Authorized Officer signature
Date (YY/MM/DD)
1
®Registered trade-marks of Bank of Montreal, used under licence.
BMO InvestorLine Inc. is a wholly owned subsidiary of Bank of Montreal.
Member – Canadian Investor Protection Fund and Member of the Investment Industry
Regulatory Organization of Canada.
Order Execution Only Account
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