Form 2 - New Client Application Form

IDA Form 2

New Client Application Form

Account Supervision

(to be completed by Registered Representative)

Office

Account

R.R.

(1)

(a) Name

Mr.

Mrs

Miss ...............................................................................................................................................................

Phones:

Home .............................................................

(Please Print)

Home ..............................................................................................................................................................................

Business ........................................................

(Street)

Other .............................................................

Address ...........................................................................................................................................................................

Fax ................................................................

(City)

(Province)

(Postal Code)

Date of Birth ............................................... Client’s Social Insurance Number ............................................................... Client’s Citizenship ..................................................................

Type of Account Requested:

(b) Is RR registered in the Province or

Yes ..........

Cash ....................................................... RRSP/RRIF .................................... U.S. Funds ..........................................

Country in which the client resides?

No ...........

Margin .................................................... Other ...............................................

D.A.P ...................................................... Pro .................................................. CDN Funds .........................................

(2)

Special Instructions:

Hold in Account ....................................

Register And Deliver ........................................ DAP .....................................................................

Duplicate Confirmation ............................... And/Or Statement ................................

Name: ......................................................................................................................

Name: ............................................................................................................................................

Address: ...................................................................................................................

Adress: ...........................................................................................................................................

.................................................................................................................................

.......................................................................................................................................................

........................................................ Postal Code: ...................................................

........................................................ Postal Code: .........................................................................

(3)

Client’s

Name ........................................................................................

Type of Business ............................................................................................................................

Employer:

Address .....................................................................................

Client’s Occupation .........................................................................................................................

(4)

Family Information:

Spouse’ Name ..........................................................................................................

No. of Dependents ..........................................................................................................................

Occupation ...............................................................................................................

Employer ........................................................................................................................................

Type of Business ............................................................................................................................

(5)

How long have you known client? ...................................... Advertising Lead ................... Phone In ..............................................

Have you met the client face to face?

Personal Contact .................. Walk In ...........................................................

Yes .............

No

............

Referral by: ............................................................................................. (name) (if customer, give account no.) ....................................................................................................................

(6)

If yes for Questions 1, 2, or 3, provide details in (11)

1.

Will any other person or persons:

(a)

Have trading authorization in this account?

No .............

Yes ............

(b)

Guarantee this account?

No .............

Yes ............

(c)

Have a financial interest in this account?

No .............

Yes ............

2.

Do any of the signatories have any other accounts or control the trading in such accounts?

No .............

Yes ............

3.

Does client have accounts with other Brokerage firms? (Type _______________ )

No .............

Yes ............

4.

Is this account

(a) discretionary or (b) managed

(a) .............

(b)

............

Insider Information

5.

Is client a senior officer or director of a company whose shares are traded on an exchange or in the OTC markets?

No .............

Yes ............

6.

Does the client, as an individual or as part of a group, hold or control such a company? ( _____________________________ )

No .............

Yes ............

(7)

(a)

General Documents

Attached

Obtaining

(b)

Trading Authorization Documents:

Attached

Obtaining

-Client’s Agreement

......................

......................

-For an Individual’s Account

......................

.....................

-Margin Agreement

......................

......................

-For a Corporation, Partnership, Trust, etc.

......................

.....................

-Cash Agreement

......................

......................

-Discretionary Authority

......................

.....................

-Guarantee

......................

......................

-Managed Account Agreement

......................

.....................

-Other

......................

......................

(8)

INVESTMENT KNOWLEDGE

Sophisticated

....................

EST NET LIQUID ASSETS

Good

....................

(Cash and securities less loans

Limited

....................

outstanding against securities)

A .................................................................

PLUS

Poor/Nil

....................

ACCOUNT OBJECTIVES

ACCOUNT RISK FACTORS

EST NET FIXED ASSETS

B .................................................................

EQUALS

Income

............ %

Low

............ %

(Fixed assets less liabilities

Capital Gains

Medium

............ %

outstanding against fixed assets)

Short Term

............ %

High

............ %

EST TOTAL NET WORTH (A+B=C)

C ................................................................

Medium Term

............ %

100%

APPROXIMATE ANNUAL INCOME FROM ALL

Long Term

............ %

SOURCES

D ................................................................

100%

(9)

Bank Reference:

Name ........................................................................................

Bank credit check acceptable?

Yes .............

No

............

Branch .......................................................................................

Or Credit Bureau check-acceptable?

Yes .............

No

............

Refer to ......................................................................................

Above credit checks considered unnecessary

Accounts ....................................................................................

Explain in (11)

(10)

Deposit and/or Securities Received ...........................................................................................................................................................................................................................................

Initial ..................................

Buy ....................................

Solicited .............................

Amount ............................................................................................................................

Order .................................

Sell ....................................

Unsolicited .........................

Description ......................................................................................................................

(11)

R.R. Signature ..........................................................................................................

Designated Officer, Director ...........................................................................................................

or Branch Manager’s Approval

Date .........................................................................................................................

Date of Approval .............................................................................................................................

Comments: ...............................................................................................................................................................................................................................................................................

.................................................................................................................................................................................................................................................................................................