Know Your Client

Personal Information

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.

State / Province / Region

Valid Government Issued Photo ID Must be current and NOT expired.

Attach Government Issued ID

Proof of Residency & Address Must be less than three months old

Attach Proof of Residency & Address

Employment Information

Your current employment information.

Occupation Please do not use Director or Officer in this field.

State / Province / Region

Company Email Address

Authorized Contact for This Company

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

State / Province / Region

Billing or Accounting Contact

Where are the invoices being sent?

Invoice/Billing Address

State / Province / Region

If answering Yes to any questions, please provide details below

If yes, please provide details

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.

Your data has been submitted successfully. Thank you!

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.