Fillable WORTHLESS SECURITIES REMOVAL ALL ACCOUNT TYPES

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WORTHLESS SECURITIES REMOVAL ALL ACCOUNT TYPES

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Worthless securities removal form Page 1 of 1
Last modified: March 9, 2017
TRDE015EN
WORTHLESS SECURITIES REMOVAL
ALL ACCOUNT TYPES
YOUR QUESTRADE ACCOUNT
(eight digits, numbers only)
You can ask us to remove worthless securities/shares from your account when they are subject to a cease-trade order and cannot be
sold, the issuer goes bankrupt, or the shares/securities are delisted from an exchange. Questions? Call us at 1.888.783.7866.
ACCOUNT HOLDER(S) INFORMATION
FIRST NAME OF ACCOUNT HOLDER(S) (please print)
LAST NAME OF ACCOUNT HOLDER(S) (please print)
1.
2.
SECURITIES TO REMOVE
SYMBOL
SECURITY DESCRIPTION (name of issuer, class and series of securities)
QUANTITY
SECURITY CODE OR
CUSIP (optional)
SIGNATURE(S)
For joint accounts, both account holders must sign. By signing this form, I authorize Questrade to remove the securities listed above
from my account. I agree that the information provided is correct. I acknowledge that there is no longer a market for the securities
listed above and cannot be sold. I also acknowledge that the fair market value of these securities is $0.00. I agree that Questrade can
take all steps necessary to transfer and assign these securities. I further acknowledge that I am no longer the owner of the securities
once they have been removed from my account and won’t be able get the securities or their equivalent value returned to my account. I
also acknowledge that Questrade is relying on the accuracy of the information I have provided about these securities. I agree to
indemnify and hold harmless Questrade and each of their respective officers, employees, affiliates, associates, agents, and assigns from
and against all claims, demands, actions, suits, or other proceedings, and from all losses, damages, expenses (legal fees and
disbursements), taxes, penalties, and all other liabilities, directly or indirectly as a result of the removal of these securities from my account.
SIGNATURE(S)
DATE (dd/mm/yyyy)
1.
2.
UPLOAD AND MAILING INSTRUCTIONS
Upload this completed and signed form to us or mail to:
Questrade, Inc.
5700 Yonge Street, Suite 1900
Toronto, ON M2M 4K2
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WORTHLESS SECURITIES REMOVAL ALL ACCOUNT TYPES

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Completed 7 May 2021

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