In accordance with Section 7(3)(c.1)(ii) PIPEDA Act (2000) we are required to collect certain information for the purposes of Client Identification and Verification. Please fill out the following information in full.

Client Information

Personal Information

Email Address(es)

Home Address & Contact Information

Please provide your home address and contact information. This MUST match what is on the Proof of Residency & Address you submit below.


Must be current and NOT expired.
Must be less than three months old

Employment Information

Your current employment information.
Please do not use Director or Officer in this field.

Authorized Contact for This Company

Individual authorized to provide and give instructions on behalf of the organization.

Billing or Accounting Contact

Where are the invoices being sent?


If answering Yes to any questions, please provide details below


I hereby declare that the information provided on this form is a true and accurate representation of myself.


1. I declare that I am requesting your services for lawful purposes and the moneys and/or other assets now or to be introduced to you do not emanate from any activity which is unlawful in my country of origin or in Canada and specifically that none of the assets were derived from any of the activities characterized as criminal by any applicable legislation against money laundering or terrorist financing. I acknowledge that if you at any time discover that the declarations made herein is untrue, you will disclose full details of your dealings with me, including names, addresses, telephone and facsimile numbers and electronic mail address to the appropriate government authorities.

2. I declare that the information given herein is true and accurate.

3. I undertake to provide you with all information that you require concerning the company and its affairs immediately upon request.

4. I confirm that if you are required by any lawful authority to determine the source of funds and/or assets I will provide you with any necessary information and explanations to establish that the funds are from a lawful activity, and that funds and/or assets are free from any encumbrance or restraint imposed by any court or any third party.

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