1. Investor Information
t RRSP/REGISTERED t INVESTMENT SOCIAL INSURANCE NUMBER ACCOUNT #
LAST NAME FIRST NAME
ADDRESS APT. CITY PROVINCE POSTAL CODE
2. Dealer and Financial Advisor Information
DEALER NAME DEALER #
FINANCIAL ADVISOR NAME FINANCIAL ADVISOR #
3. Investor Acknowledgement
1. I appoint M.R.S. Securities Services Inc. (“MRSSSI”) as broker with 7. I authorize MRSSSI to sell or dispose of, in its sole discretion,
respect to all equity and fixed income purchase and sale sufficient securities in my account to pay any outstanding fees or
transactions for my account at MRSSSI. MRSSSI shall execute all debit balances which may be owing by me to MRSSSI in connection
trades on my behalf only upon my specific instructions. with the services provided by MRSSSI under this agreement and to
deduct any and all fees when due from the account.
2. I acknowledge that my Dealer has referred me to MRSSSI to execute
trades in equity and fixed income securities. 8. I agree to provide MRSSSI with written notice to withdraw or
transfer any of the cash or assets in my account.
3. I acknowledge and agree that MRSSSI may pay a referral fee to my
Dealer for referring me to MRSSSI. The referral fee will be equal to 9. I acknowledge and agree that MRSSSI may transfer, or cause to be
40% of MRSSSI commissions charged to me. MRSSSI will tell me transferred, cash or assets from my account to or between MRSSSI
how much it has paid to my Dealer on each trade confirmation. It and Multiple Retirement Services Inc. upon my instructions.
is illegal for the recipient of the fee to give advice regarding a
transaction if he or she is not licensed or registered to give such 10. I acknowledge that MRSSSI will not provide any advice to me.
advice. MRSSSI is not responsible for any advice I obtain from any other
person. I acknowledge that MRSSSI reserves the right to refuse any
4. I acknowledge that MRSSSI may act as agent or principal in any trade.
securities transactions involving my account.
11. I acknowledge that MRSSSI will only act on my instructions
5. I agree to pay the fees as published from time to time by MRSSSI. concerning the purchase or sale of securities, and that MRSSSI does
not guarantee investment results and shall not be liable for any loss
6. I acknowledge and agree that MRSSSI may change the fees from occasioned by an investment decision.
time to time upon 30 days written notice.
4. General Terms
1. All information received by MRSSSI regarding my account will be 2. This agreement shall be governed under the laws of the province of
held in strict confidence. Ontario and the federal laws of Canada applicable therein. The
parties irrevocably submit to the non-exclusive jurisdiction of the
courts of Ontario.
5. Investor Authorization
I acknowledge that I have read and understand the terms of this agreement and acknowledge receipt of a duplicate copy of this agreement.
INVESTOR SIGNATURE DATE
4812 1/00 ORIGINAL – MRSSSI • YELLOW – INVESTOR