Please answer all eight questions. Failure to meet the professional conduct criteria may result in cancellation of your application:

1

Suspension: Are you currently, or within the last five years have you been, the subject of disciplinary action by a regulatory organization or judicial court that resulted in a temporary suspension from:

(a) participation in the financial services markets OR

(b) association with a financial services institution?

   No

   Yes

2

Expulsion: Are you currently, or within the last five years have you been, the subject of disciplinary action by a regulatory organization or judicial court that resulted in a permanent or indefinite suspension from:

(a) participation in the financial services markets OR

(b) association with a financial services institution?

   No

   Yes

3

Prohibitions and Restrictions: In the last five years, has a regulatory organization or judicial court denied you trading privileges or prevented you from:

(a) Trading on a securities or contract market, OR

(b) Acting as a person required to be registered under a law or regulation, OR

(c) Acting as an affiliated person or employee of a financial services institution?

   No

   Yes

4

Convictions: (a) In the last five years, have you been convicted of a crime punishable by less than one year in prison or jail (or otherwise defined as a misdemeanor) involving lying, cheating, stealing or other dishonest conduct?

(b) Have you ever been convicted of a crime punishable by one year or more in prison or jail (or otherwise defined as a felony)?

If yes to (a) or (b) or both, you must provide the following information: date of the conviction, whether the crime was punishable by less than or more than one year in prison or jail, and a description of the conduct which caused the conviction.

   No

   Yes

5

Damage Claims: In the last five years, has your professional conduct, in either a direct or supervisory capacity, been the subject of litigation, arbitration, a complaint, or other claim for damages that was resolved for an amount exceeding $20,000 (US)?

   No

   Yes

6

Disciplinary Action: In the last five years have you been the subject of disciplinary action by a regulatory organization, judicial court, or financial services institution that resulted in withholding of commissions or a monetary fine in an amount exceeding $20,000 (US)?

   No

   Yes

7

Assisting in a Violation: In the last five years, has a regulatory organization or judicial court found that your conduct caused another person or financial services institution to violate a securities or commodities related law, rule or regulation?

   No

   Yes

8

Caused Suspension or Expulsion: In the last five years, has a regulatory organization or judicial court found that your conduct caused:

(a) another person to be temporarily or permanently prevented from being associated with a financial services institution or participating in the financial services markets OR

(b) a financial services institution to be temporarily or permanently prevented from participating in the financial services markets?

   No

   Yes