KYC Questionnaire

    Full Name
    Birth Date
    SIN and Marital Status
    Current Address
    Phone Number
    Income Information
    Do you have a secondary income ?

    Proposed Amount Of Investment
    Please enter your other source of amount


    Net Financial Assets

    (Total value of cash and securities minus related liabilities - Exclude Real Estate)

    Net Worth

    (Total assets minus total liabilities - Include Real Estate)

    Investment Knowledge

    Investment Objectives
    • Safety: You want to preserve the initial capital in the account, minimizing risk is of primary importance.
    • Income: You want to establish a source of income. Securities could include low and moderate quality bonds, real estate mortgages, financing funds, preferred shares, income trusts, low risk exempt products, and high yielding quality equities.
    • Growth: You want to invest in securities or funds that have upside appreciation notwithstanding that such securities can fluctuate in value. You could lose a portion of your capital.
    • Aggressive Growth: You want to invest in securities or funds that have significant upside potential but also recognize that there is significant risk and / or volatility of returns to you. You could lose a significant portion of your capital.
    (Safety + Income + Growth + Aggressive Growth must equal to a total of 100%)
    Knowledge of Alternate Investment Products

    (Subscriber is invested in other alternate investment products)


    (Subscriber needs access to his/her investments)

    Investment Time Horizon

    Intended Use of Investment in Issuer

    (Check all that apply)

    Percentage of your total investment portfolio represented by investment in Issuer

    Other Investments Held

    (Check all that apply)

    Leverage - Are you borrowing money to make your investment?

    Risk Tolerance
    Are you willing to see your investment fluctuate in value?

    If the investment fell in value would you become very concerned once these losses were in the region of

    How wealthy do you feel?

    Select your risk tolerance


    Low to Medium


    Medium to High


    Anti-Money Laundering, Terrorism Financing and Citizenship
    (a) Politically Exposed Foreign Persons

    Does individual hold or has individual ever held one of the following offices/positions in/or behalf of a foreign country:

    A head of state or government

    A member of the executive councilgovernment or member of legislature

    A deputy minister (or equivalent)

    An ambassador or an ambassador’sattaché or councillor

    A military general (or higher rank)

    A head of government agency

    A judge

    Leader or president of a political party in a legislature

    (b) Domestic Politically Exposed Person

    Does individual hold or has individual ever held, within the last 5 years — a specific office or position in or on behalf of the Canadian federal government, a Canadian provincial government, or a Canadian municipal government such as:

    Member of the Senate or House of Commons or member of a legislature

    A member of the executive councilgovernment or member of legislature

    Deputy minister or equivalent rank

    Ambassador, or attaché or counsellor of an ambassador

    Military officer with a rank of general or above

    President of a corporation that is wholly owned directly by Her Majesty in right of Canada or a province

    Head of a government agency

    Judge of an appellate court in a province, the Federal Court of Appeal or the Supreme Court of Canada

    Leader or president of a political party represented in a legislature; or mayor*

    *In line with legislation across Canada, municipal governments include cities, towns, villages and rural (county) or metropolitan municipalities.As such, a mayor is the head of a city, town, village, or rural or metropolitan municipality, regardless of the size of the population. A person ceases to be a domestic PEP 5 years after they have left office.

    (c) Head of an International Organization

    Does individual or a family member hold or have they ever held either any of the above listed offices or positions?. For the purpose of this inquiry family members, include mother or father, child, spouse, or common law partner, spouses or common law partners mother, father, brother, sister, half-brother or half-sister (that is, any other child of the individual’s mother or father)

    If the answer to any of the above questions is yes, please enter the following details
    (d)Country of Citizenship

    Are you now or have you ever been a U.S. citizen ?


    (Click the box below after reading the disclaimer to submit)