Joint account holder last name (If applicable)
1. Client information
2. New client information
Last name First Name
Address
(street # and name, apartment #) (not only a P.O. Box number) City Province Postal code
Home number
Cell number
3. Deposit Agent or Dealer/Advisor changes
The undersigned authorizes execution of the change(s) noted above. I/We authorize B2B Bank to:
1. Provide copies of statements and/or to provide account balance information to my/our new Deposit Agent or Dealer/Advisor set out in Section 3 if
applicable.
2. Update my/our B2B Bank accounts with the personal information last provided by me/us pertaining to my/our legal name, personal address (residential
and mailing), phone/cell/fax number(s) and email address.
3. Share updates to my/our personal information authorized in the above noted and Dealer/Advisor information with afliates of B2B Bank to update their
records if I/we have a B2B Bank investment loan associated with an investment account held at an afliate of B2B Bank.
Non-Financial Account Changes
Fax to: 416.947.9476 or 1.866.941.7711
199 Bay Street, Suite 600
PO Box 279 STN Commerce Court
Toronto ON M5L 0A2
4. Client authorization
Client signature Joint client signature (if applicable) Date (mm/dd/yyyy)Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
ONLY one method required
Copy by fax
Original by mail/courier
Page 1 of 1 618-03-107E (01/14/2019)
E-mail address
Signature guarantee
B2B Bank Client Account number:
Last name First name
First name
Initial
Initial
Change mailing address Change home address
Social Insurance Number (SIN) Birth date (mm/dd/yyyy)
Beneciary name Relationship
Beneciary name Relationship
Beneciary %
Beneciary %
( ) ( )
I/We wish to change my Dealer/Advisor
on my/our B2B Bank account
New Dealer name
New Advisor address
City Province
Telephone number
New Advisor name
Postal code
Fax numberNew Advisor email
from: to:
( )( )
Change beneciary Add beneciary
Agent/Advisor signature
Dealer x-reference number:
I conrm that I am duly licensed to distribute the product the Client wishes to purchase in the jurisdiction where the Client resides. By signing this form, you
attest that the assets being received have been reviewed and that your dealer is properly registered/licensed to offer, advise on and supervise these assets.
Dealer #
Advisor #
BRANCH #
DEPOSIT AGENT # DEALER #
ADVISOR #
DEALER #
ADVISOR #
DEALER #
ADVISOR #
Primary client
Joint client
(For name change please include a notarized or true copy of the original relevant legal document.)
Change applies to:
Both Primary Client and Joint Client
New Deposit Agent name
I/We wish to change my Deposit Agent on
my/our B2B Bank/Laurentian Bank account
to:
Instructions on how to complete this form
Method of transmission
Indicate whether this form is being submitted by fax, or if the original
form is being mailed or couriered to B2B Bank. Please note that
B2B Bank is not responsible for duplicate transactions if the request
is sent more than once.
Account number
Provide the Client’s B2B Bank Client account number.
Section 1: Client and account identication
Provide the information requested regarding the Client’s name.
Section 2: Client information changes
Name change
Complete this section to correct an input error. In the case of a legal
name change, a notarized or true copy of the relevant legal document
must be attached to this form. If the Client signature has changed,
the Client must sign the form using the new name that appears on the
legal document.
Address change
To process an address change, indicate the new address in the
appropriate space. Indicate if the change is for primary client, joint
client or both. Indicate the type of address change (mailing or home).
Please include full street address not just a P.O. Box number.
Telephone/Fax number change
Indicate the change in the appropriate space and provide the new
telephone number, including area code.
SIN/Birth date change
Complete this section to correct an input error.
Beneciary change/addition
Provide the name and relationship of the beneciary. In the case of
multiple beneciaries, indicate the percentage that is to be designated
to each beneciary. The Client must authorize the beneciary change
by signing this form and the signature must be witnessed by someone
other than the beneciary.
Other non-nancial changes
Outline the changes by completing the Other non-nancial
changes section.
Section 3: Deposit Agent or Dealer/Advisor changes
This section of the form is used to inform B2B Bank of a change in
Deposit Agent or Dealer/Advisor. In the case of an Investment Loan, it
can be used to authorize the Advisor to buy, sell and trade investments
in a B2B Bank account for the Client. Provide all requested information
Note that signatures from both the Client and the Agent/Advisor are
required to authorize a deposit agent or dealer / advisor change.
Section 4: Client authorization
In addition to the date, the Client signature is required on this form.
