Fillable TRADING AUTHORIZATION - SUPPLEMENTAL FORM (RBC Direct Investing)

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TRADING AUTHORIZATION - SUPPLEMENTAL FORM (RBC Direct Investing)

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E-FORM 4578 (06/2017)
RBC Direct Investing Inc.
TRADING AUTHORIZATION - SUPPLEMENTAL FORM
* Account Holder Information
Account Name:
Account Number:
* Required Information. Must be completed by the individual appointed to trade on
the account. (Supporting documents may be required.)
*Name * First Name
Middle Initial
* Last Name
*Home Address * No. and Street
P.O. Boxes, General Delivery or c/o addresses are not
accepted
Apt./Ste. * City
* Province * Postal Code
*Phone Number (Residential / Cell)
(
) -
/ ( ) -
Email address
*Date Of Birth
mm dd yyyy
*You are completing this form as:
Trading Officer Trustee
Executor Court Appointed Authority
General Power of Attorney Other
If you have selected “Trading
Officer”, please specify:
a) Your relationship to the Beneficial Owner(s)/Signing
Officer(s) of the Entity:
b) Are you charging a fee?
Yes No
c) Do you have financial interest in the account?
Yes No
d) Are you registered/licensed to provide financial advice in the
province where the client/account holder resides?
Yes No
Page 1 of 3
Employment Information
*Employment Details
* Occupation
* Type of Business
* Employer/School name
* No. and Street
P.O. Boxes, General Delivery or c/o addresses are not
accepted
Apt./Ste. * City
* Province/State * Postal Code/Zip Code
Business Phone Number
( ) -
Extension
Banking Information (Bank reference information is used to verify your identification as required by Anti-
Money Laundering legislation.)
*Account Details
* Name of Canadian Financial Institution
* Transit Number * Account Number
Spouse’s Information (Required by Securities Regulations)
*Are you married or living common-
law?
Yes No
If yes, please complete the following:
*Spouse's Name
* First Name Middle Initial
* Last Name
*Spouse's Employment Details
* Occupation
* Type of Business
* Employer/School name
Page 2 of 3
Additional Information
*1 Are you or your spouse/partner a director, senior officer, 10% shareholder or more, or insider of any reporting issuer?
You:
Yes No
If yes, please indicate the name of issuer(s):
Spouse/Partner:
Yes No Not Applicable
If yes, please indicate the name of issuer(s):
*2 Do you or your spouse/partner, as individuals or in combination with others, control (directly or indirectly) more than 20% of the voting securities of
any reporting issuer?
Yes No
If yes, please indicate the name of issuer(s):
*3 Are you a partner, director, officer or employee of a Member firm of the Investment Industry Regulatory Organization of Canada or are you a relative
of any such individual living in the same household?
Yes No
If yes, please list the name of the Member firm and attach the required
authorization letter from the Member firm:
*4 Do you hold or have trading authority on any other accounts with RBC Direct Investing Inc. ?
Yes No
If Yes, please provide the account number(s) :
5 Provide your 16-digit RBC Royal Bank
®
Client Card number to link it to the RBC Direct Investing Inc. account.
If I answered « yes » to either question 1 or 2, I am aware of my obligation to report purchases or sales and possible restrictions on trading of these
securities according to applicable securities legislation.
We are required to collect and confirm the foregoing personal information during the course of our relationship to fulfill our legal, regulatory and self-
regulatory obligations in Canada and in some cases, abroad. We may obtain this information from a variety of sources, including from credit reporting
agencies and other financial institutions, as is necessary. You acknowledge receipt of notice that from time to time reports about you may be
obtained by us from credit reporting agencies.
I acknowledge that I have read and understood the "Operation of Account Agreement" and agree to be bound by all terms and conditions. I hereby
authorize RBC Direct Investing
®
to review the personal information I have provided on this form and update my RBC Direct Investing account(s) and
client information with the foregoing information, as necessary.
Date
Signature of Individual Appointed to Trade on the Account
RBC Direct Investing Inc. and Royal Bank of Canada are separate corporate entities which are affiliated. RBC Direct Investing Inc. is a wholly owned subsidiary of
Royal Bank of Canada and is a Member of the Investment Industry Regulatory Organization of Canada and the Canadian Investor Protection Fund. Royal Bank of
Canada and certain of its issuers are related to RBC Direct Investing Inc. RBC Direct Investing Inc. does not provide investment advice or recommendations
regarding the purchase or sale of any securities. Investors are responsible for their own investment decisions. RBC Direct Investing is a business name used by
RBC Direct Investing Inc. ® / ™ Trademark(s) of Royal Bank of Canada. RBC and Royal Bank are registered trademarks of Royal Bank of Canada. Used under
licence. © Royal Bank of Canada 2017. All rights reserved.
Page 3 of 3
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TRADING AUTHORIZATION - SUPPLEMENTAL FORM (RBC Direct Investing)

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Completed 27 August 2020

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