2
TA INFORMATION
1. Are you, or your spouse/common-law partner:
a.
An insider, director or senior officer (i.e. an officer or one of the five highest paid employees) of a publicly traded (exchange or over-the-counter) company or affiliate of such a company?
Or
Individually, or as part of a group, own more than 10% of the voting rights attached to all voting securities?
Yes
No
Company Name(s):
If yes, are you a Reporting Insider under Canadian securities legislation?
Yes
No
Company Name(s):
b.
Separately or in combination with other persons, a holder of more than 20% of the outstanding voting securities of a publicly traded (exchange or over-the-counter) company
or affiliate of such a company?
Yes
No
Company Name(s):
c.
Individually, or as part of a group, a member with controlling interest in a publicly traded (exchange or over-the-counter) company or affiliate of such a company?
Yes
No
Company Name(s):
2. Do you have, or exercise authority over, any brokerage accounts with other financial institutions?
Yes Financial institution(s):
No Account Type: Account Type:
3. Do you have, or exercise authority over, any accounts with BMO InvestorLine?
Yes
No Account #1: Account #2:
Sign only if you want another person to have access to your account.
The signatures on this form must be witnessed by someone other than the applicant, co-applicant, agent, attorney, spouse or common-law partner of any of these persons. One
witness per signature is enough. A witness can witness more than one signature.
By signing below, the Applicant agrees to receive all account statements, trade confirmations, and applicable mutual fund documentation via eDocuments only.
Co-applicant’s Signature
(if applicable)
Applicant’s
Signature
TA's Acceptance
I certify that the information in this application is true and complete and I have received and agree to the terms and conditions as outlined in the Client Agreements (https://
www.bmoinvestorline.com/selfDirected/pdfs/ClientAgreements_SD_E.pdf). I also agree to advise you immediately in writing of any material change in my information.
TA’s ____________________________________________________________________________________________________
Signature
Please provide a verified photocopy of 1 piece of Federal, Provincial or Territorial government issued photo ID.
Witness Signature(s)
Name of
Witness
Witness Signature
Witness ________________________________________________________________________________________________
Address
Date
YY/MM/DD
BRANCH INFORMATION
I have verified all and included a photocopy of a valid photo ID.
Phone (area code, no., ext.)
Name of Branch Representative (please print)
PLEASE PROVIDE DETAILS if your TA answers YES to the following questions
CLIENT’S AUTHORIZATION and TA acceptance
OFFICE USE ONLY
E
F
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