Fillable Material change form Applicant information Information about you (Bank of Montreal)

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Material change form Applicant information Information about you (Bank of Montreal)

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The Material change form Applicant information Information about you (Bank of Montreal) form is 4 pages long and contains:

  • 1 signature
  • 6 check-boxes
  • 118 other fields

Country of origin: CANADA
File type: PDF

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Material change form
Account #1 Account #2 Account #3 Account #4
Applicant information
Information about you
u
u
u
u
u
u
u
u
u
Legal name and personal information (the name displayed on your supporting government photo identification)
Mr. Miss Mrs. Ms. Dr.
Last name First name Middle initial
Social Insurance Number Date of birth
(DD-MMM-YYYY)
Preferred name (if other than your legal name) (optional)
Last name First name Middle initial
Contact information
Primary residential street address (a P.O. box or C/O will not be accepted) Suite/Apt. no.
City Province Postal code
Home phone Primary email
Residency for tax purposes
(choose ONE only)
Canada (include province below) U.S. (include state below) Other (include country below)
Citizenship
(complete only those that apply)
Country Dual citizenship country Taxpayer Identification Number
Preferred language
English French
Marital status
Single Common law Married Separated Divorced Widowed
Dependen
ts
No Y
es
(if yes, how many?)
Employment status
Employed Self-employed Unemployed Retired Homemaker Student
Employer/Business name (if employed or self-employed only) Nature of business
Address of employer/business Suite/Apt. no.
City Province/State Postal code Country
Occupation
Page 1 of 4 (11/15)
Material change form
Applicant information (continued)
Information about your finances
u u
u
Annual income
A. Employment/Business A $
B. Investments + B $
C. Other
(describe) + C $
D. Total annual income (A+B+C=D) = D $
Net worth
A. Estimated net liquid assets
(cash and securities less loans)
A $
B. Estimated net fixed assets
(fixed assets less liabilities)
+ B $
C. Estimated total net worth (A+B=C) = C $
Investments and accounts
Please specify how your wealth was accumulated or obtained:
(check all that apply)
Savings of employment income Inheritance Real estate investment
Other (please specify)
Investment in securities Gifts
Are you borrowing money for the purpose of investing?
No Yes
Information about your spouse
NOTE: This information is required if your marital status is married, common law, or separated.
Spouse’s last name First name Middle initial
Employment status: Employed Self-employed Unemployed Retired Homemaker Student
Spouse’s employer Nature of business Occupation
Alternative mailing address
NOTE: Unless otherwise indicated, all mailings will be sent to your primary residential street address.
Street address Suite/Apt. no.
City Province Postal code
Page 2 of 4 (11/15)
Material change form
Applicant information (continued)
Regulatory disclosure information
u
u
u
u
u
Relationships
Are you a partner, director, officer or employee of a member dealer of the
Investment Industry Regulatory Organization of Canada (IIROC) or related to
any such individual and living in the same household?
No Yes
If you have more Insider, Significant Shareholder, or Control relationships, please contact us at 1-844-895-3721.
Insider relationships
Are you or your spouse 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 do you or your
spouse (individually, or as part of a group) own more than 10% of the voting
rights attached to all voting securities?
No Yes
(if yes, please complete company information below)
Company name Trading symbol Company name Trading symbol
If yes, are you a reporting insider under Canadian securities legislation?
No Yes
(if yes, please complete company information below)
Company name Trading symbol Company name Trading symbol
Significant shareholder relationships
Do you or your spouse hold, separately or in combination with other persons,
more than 20% of the outstanding voting securities of a publicly traded
(exchange or over-the-counter) company or affiliate of such a company?
No Yes
(if yes, please complete company information below)
Company name Trading symbol Company name Trading symbol
Control relationships
Do you or your spouse hold, separately or in combination with other persons,
a controlling interest (more than 20% of the outstanding voting securities) in
a publicly traded (exchange or over-the-counter) company or affiliate of such a
company (individually, or as part of a group)?
No Yes (if yes, please complete company information below)
Company name Trading symbol Company name Trading symbol
Other information about your account
Will anyone have power of attorney over your account?
No Yes (if yes, a Power of Attorney Filing Record form must be completed)
Will your account(s) be used by, or on behalf of, any third party
or will anyone else have a financial interest in this account?
No Yes
Page 3 of 4 (11/15)
Material change form
Client agreements and signatures
I certify that the information on this form is true and complete; the information on this form shall supersede information previously provided; and the
terms and conditions of my BMO SmartFolio Investment Management Agreement remain in effect.
Client signature
SIGN
HERE
Date (
DD-MMM-YYYY)
BMO Wealth Management is the brand name for a business group consisting of Bank of Montreal and certain of its affiliates, including BMO Nesbitt Burns Inc., in providing
wealth management products and services. “BMO (M-design)”, “BMO” and “BMO (M-design) Wealth Management” are registered trademarks of Bank of Montreal, used
under license. “Nesbitt Burns” and “SmartFolio” are trademarks of BMO Nesbitt Burns Inc. BMO Nesbitt Burns Inc. is a wholly owned subsidiary of Bank of Montreal.
BMO Nesbitt Burns Inc. is a Member-Canadian Investor Protection Fund. Member of the Investment Industry Regulatory Organization of Canada.
Page 4 of 4 (11/15)
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Material change form Applicant information Information about you (Bank of Montreal)

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Completed 11 March 2021

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