Report
Report
• TFSA Application
• IRS W8-BEN
• Drivers License for wai ki man
• Canadian Citizenship Card for wai ki man
HSBC InvestDirect
3381 Steeles Ave. East, Suite 300
Toronto, Ontario
M2H 3S7
HSBC InvestDirect
Before you return your completed application please ensure you have:
1. Completed all required sections and provided full information in relevant applicable sections.
2. Read the Client Terms and Conditions for important information in connection with your HSBC InvestDirect account. Please note that certain self-
regulatory organizations require access to your personal information. Please read the “Client Information Consent Agreement” section of the Client
For Tax-Free Savings Account (TFSA): If you are a U.S. citizen or have U.S. Dual Citizenship:
TFSA Form# 1090161 W9 Form for U.S. taxation purpose
For Trading Authority: If you are a Canadian Resident or a Non-Resident:
Trading Authorization Form W- 8BEN Form for [Link] purpose
For Power of Attorney:
Power of Attorney Authorization Form.
If You Are Transferring to HSBC InvestDirect From Another Institution
Non-Registered Account Transfer Form or Registered Account
Transfer Form
T2151 Form and completed/signed Pension package
RESP Transfer Form (Form A or Form B and QESI Form - where
applicable)
5. Provided verification of the identity of each Applicant, Co-Applicant and all persons authorized to trade by providing two pieces of identification, one of
which must be a government issued photo ID. Photo identification must be physically verified by HSBC branch personnel or HSBC InvestDirect office.
6. Please return completed application after HSBC branch personnel has physically verified IDs to your HSBC Bank Canada branch or mail to your
HSBC InvestDirect
*003YP3+02M*
Toronto, ON
M2H 3S7
*HSBC InvestDirect is a division of HSBC Securities (Canada) Inc. which is a wholly owned subsidiary of, but separate entity from, HSBC Bank Canada.
HSBC Securities (Canada) Inc. is a member of The Canadian Investor Protection Fund and the Investment Industry Regulatory Organization of Canada (IIROC).
1090171-E_2018-08
Client Account Application ORDER EXECUTION ACCOUNT ONLY
Account Type – Required Please refer to the Client Terms & Conditions
Investment Accounts Cash Margin Registered Accounts
Canadian & U.S. Accounts (check one) Account Types (select all that apply)
Individual ✔
✔ Tax-Free Savings Account (TFSA) – attach TFSA Form #1090161
Joint-Tenants in Common
(For Quebec Residents Only) Retirement Savings Plan (RSP)
Joint with Right of Survivorship Spousal Retirement Savings Plan (SRSP)
(Not Available to Quebec Residents) Retirement Income Fund (RIF)
Foreign Currency Cash Accounts (optional, select all that apply) Spousal Retirement Income Fund (SRIF)
HKD GBP EUR Other Life Income Fund (LIF) – attach Addendum
Locked-in Retirement Income Fund (LRIF) – attach Addendum
Margin Account Privileges (optional, select all that apply)
Prescribed Retirement Income Fund (PRIF) – attach Addendum
Options Trading Short Selling Restricted Life Income Fund (RLIF) – attach Addendum
Language of Correspondence for this Account Locked-In Retirement Account (LIRA) – attach Addendum
Restricted Locked-in Savings Plan (RLSP) – attach Addendum
✔ English French
Locked-in Retirement Savings Plan (LRSP) – attach Addendum
✔ I would like to receive marketing materials in Chinese
Applicant’s Personal Information – Required
✔ Mr. Miss Ms. Mrs. Dr. Employment Information
man wai ki Employment status:
Last Name (Legal) First Name (Legal) Middle Name (Legal) ✔ Employed Self-Employed Student
(778) 882-2813 Retired* Homemaker* Not Working*
Home Tel. # Business Tel. # (including extension)
*Retired, Not Working, or Homemaker: Provide details of most recent job .
(778) 882-2813 rickyman84@[Link]
Mobile Tel. # E-mail Address London Drugs DSC
Canada Canada Employer’s Name
If you would like us to send information about your accounts to an address other
than your home address on the previous page of this application, please indicate it
here along with an explanation.
Street Address/Concession/Rural Route/Site Apt. /Suite #
Country
Mr. Mrs. Miss Ms. Dr. * Cash & Securities less loans outstanding
** Fixed assets less liabilities outstanding against fixed assets
Bank Name
Bank Address
Yes No (If yes and the above is a non HSBC bank account, please attach a void
personal cheque)
Options
Applicant: <1 ✔ 1–5 6–10 10+
Preferred Stock
Co-Applicant: <1 1–5 6–10 10+
Short Selling ✔
No Experience
Use of this Account (select all that apply)
✔ Income Generation Saving Growth of Capital Market Speculation Other
1. Are you, your spouse or anyone you reside with employed by an IIROC Member firm, Stock Exchange or member of a Stock Yes ✔ No Yes No
Exchange?
If yes, please state the name of the firm and provide a compliance letter(s) :
2. Are you, your spouse, or anyone you reside with, the CEO, CFO, COO or a Director of a publicly traded company (“a reporting Yes ✔ No Yes No
issuer”)?
3. Are you, your spouse, or anyone you reside with, the CEO, COO or CFO of a major subsidiary of a reporting issuer? (Major Yes ✔ No Yes No
subsidiary is defined as a subsidiary of an issuer whose assets or revenue comprise 30% of the consolidated assets or
revenue of the issuer)
4. Are you, your spouse, or anyone you reside with a Significant Shareholder of a reporting issuer? In other words, do you, Yes ✔ No Yes No
your spouse or anyone you reside with hold more than 10% of the voting rights of the issuer’s outstanding voting securities,
including any convertible securities that are convertible within 60 days that would put you over the 10% limit?
5. Are you, your spouse, or anyone you reside with, a control person (holding more than 20%) in a reporting issuer’s outstanding Yes ✔ No Yes No
voting securities?
6. Are you, your spouse, or anyone you reside with, a director or CEO, COO or CFO of a management company that provides Yes ✔ No Yes No
significant management or administrative services to a reporting issuer or a major subsidiary of a reporting issuer?
7. Even if questions 2 to 6 above do not apply, do you, your spouse or anyone you reside with, receive or have access to material Yes ✔ No Yes No
non-public information of a reporting issuer given the nature of the employment (i.e. finance, technology)?
8. Do you, your spouse, or anyone you reside with, exercise “significant power or influence” over the decisions of a reporting Yes ✔ No Yes No
issuer?
9. Name any reporting issuers (including symbols) to which a “Yes” answer applies on questions 2 to 8 above:
10. Other than the applicant or co-applicant, will the account be used for the benefit of a third party or someone else? Yes ✔ No
11. For the new account(s) that you are applying for in this application, will any other person(s) other than the Applicant(s)
be granted:
i) trading authority in this account? Yes ✔ No If “yes”, please complete the Trading Authorization Form
ii) power of attorney over this account? Yes ✔ No If “yes”, please complete the Power of Attorney Form
*003YP3+05P*
12. Are you (or any members of your immediate family) currently, or have you (or any members of your immediate family) in the Yes ✔ No Yes No
past, been employed in any of the following positions: (If yes, please check all applicable boxes and list the details of the individuals):
If answered yes to question 12, please indicate the details of the person(s) below:
Person Full Name Relationship to the account holder(s) Length in Position (From/To)
Description
(continued)
Note: The account to be charged must belong to the Applicant or Co-Applicant of this registered account.
In this section, the words “I”, “me”, and “my” mean the Applicant’s Spouse
Will your spouse be a contributor? Yes No Please complete section below
Mr. Mrs. Miss Ms. Dr.
First Name (Legal) Middle Name (Legal) Last Name (Legal) SIN
I request that this Plan be established to allow contributions to be made by me in addition to contributions made by my spouse. I am aware that any contributions I make
to the Plan now or in the future constitute irrevocable gifts to my spouse and request that they be accepted on that basis. I am aware that any withdrawals from the Plan,
including any amounts I have contributed, may be taxable to me under the Income Tax Act.
RIF and LIF Payments – Required for RIF and LIF accounts only
Payment Frequency
For my RIF LRIF LIF
Frequency (select one): Annually Semi-Annually Quarterly Monthly
First Payment Date (mm/dd/yyyy): (day 1-28 of the month only)
Name of Bank (Bank must be a member of the Canadian Payments Association) Branch Address
Payment Type
Minimum Amount Elected Amount (Indicate annual amount: $ ) Maximum (for LIF/LRIF only)
Election to use Spouse’s Age (Complete only if Applicant wishes to use spouse’s age to determine the amount of payments.)
I elect to use the age of my spouse to determine the period payments under the RIF.
First Name (Legal) Middle Name (Legal) Last Name (Legal)
waive notification of the aforementioned transactions and ratify any and all such transactions made for my HSBC InvestDirect Account. This direction is a continuing one and
shall remain in full force and effect unless revoked by me by written notice addressed and delivered to you, but such revocations shall not affect any liability resulting from,
or the waiver of liability relating to, transactions initiated prior to such revocation.
For RIF, complete either the Beneficiary Designation section or Designation of Successor Annuitant section below.
Designation of Successor Annuitant – RIF Only (required if Beneficiary not designated below)
With respect to this RIF and pursuant to the provisions of the Income Tax Act (Canada) and Part III, paragraph 4 of the HBSC InvestDirect Self-Directed RSP/RIF Terms and
Conditions, I designate my spouse or common law partner as successor annuitant of the RIF in the event of my death prior to the maturity of this RIF. I reserve the right to
change this designation.
First Name (Legal) Middle Name (Legal) Last Name (Legal) SIN
I revoke any and all beneficiary designations made in respect to this Plan, and designate the person name below as beneficiary to receive the proceeds payable
under the Plan in the event of my death. This designation will remain in effect until revoked in accordance with the terms of the HSBC InvestDirect Self-Directed
RSP/RIF Terms and Conditions.
Note: In certain provinces, the Applicant can only designate a beneficiary by including a special clause in his or her will.
Caution: Your designation of a beneficiary by means of a designation form will not be revoked or changed automatically by any future marriage or divorce. Should
you wish to change your beneficiary in the event of a future marriage or divorce, you will have to do so by means of a new designation.
Relationship to Applicant:
Note: These instructions do not apply to any specific request you give or may have given to a reporting issuer concerning the sending of interim financial
statements of the reporting issuer. In addition, in some circumstances, the instructions you give in this client response form will not apply to annual reports or
financial statements of an investment fund that are not part of proxy-related materials. An investment fund is also entitled to obtain specific instructions from you
on whether you wish to receive its annual report or financial statements, and where you provide specific instructions, the instructions in this form with respect to
financial statements will not apply.
Please read the “Client Information Consent Agreement” section of the Client Terms and Conditions booklet. I consent to the collection, use and disclosure of
Client Information in the manner and for the purposes specified in the Client Terms and Conditions. I agree HSBC InvestDirect may collect, use and share my SIN
for the additional purposes of conducting Financial Crime Risk Management Activities, and for internal audit, security, statistical, and record keeping purposes.
1. HSBC InvestDirect may collect and use my personal information and, where permitted by law, share it within the HSBC Group, to identify and inform me of
products and services provided by the HSBC Group that may be of interest to me.
2. HSBC InvestDirect may collect and use my Personal information to promote the products and services of select third parties that may be of interest to me.
✔ Yes (Default unless instructed otherwise) or No
I may at any time change my consent to the above by contacting HSBC at 1-800-760-1180. I understand that if I refuse or withdraw my consent it will not
affect my eligibility for products or services.
Each of the undersigned acknowledges that he/she have read and understand the Joint Account Agreement (contained in the Client Terms and Conditions),
and agree to the terms and conditions set forth therein.
9. For the purpose of evaluating this Agreement, HSBC InvestDirect is authorized to collect factual credit information and other personal information about
me from third parties such as credit reporting agencies and credit grantors and from income sources and personal references and to disclose to other credit
grantors and credit bureau particulars of this Agreement and subsequent credit experience, and to retain this Agreement for HSBC InvestDirect records. I
authorize other institutions with which I deal to provide HSBC InvestDirect with any such information requested.
10. I have read and agree to the section of the Client Terms & Conditions Agreement entitled “Electronic Delivery of Documents” and understand how I can opt
out of electronic delivery of documents.
for all tax consequences resulting in from including investments which are not eligible.
(d) I will furnish proof of any information, including any age and the age of my spouse when required by HSBC InvestDirect or the Trustee.
(e) Any benefits derived from this Plan will be taxable under the Applicable Tax Legislation,.
3. Description of Relationship between HSBC InvestDirect and HSBC Bank Canada: I understand that HSBC InvestDirect and HSBC Bank Canada are
separate entities.
4. Balances are not insured by the Canadian Deposit Insurance Corporation (CDIC) but are covered under the Canadian Investor Protection Fund. Certain limits
apply.
5. It is the express wish of the parties that this Agreement and any related documents be drawn up and executed in English. Les parties conviennent que la
présente convention et tous les documents s’y rattachant soient rédigés en anglais.
6. I have read and agree to the section of the Client Terms & Conditions Agreement entitled “Electronic Delivery of Documents” and understand how I can opt
out of electronic delivery of documents.
I verify that I have carefully reviewed the applicable section of the Client Terms and Conditions with respect to suitability reviews and I understand and
acknowledge that HSBC InvestDirect does not provide investment advice or recommendations regarding any of my investment decisions or securities
transactions and that HSBC InvestDirect will not be responsible for making a determination that the products and account types offered by HSBC InvestDirect
are appropriate for me. Additionally, HSBC InvestDirect will not determine my general investment needs and objectives or the suitability of any of my investment
decisions or securities transactions.
I acknowledge that I have sole responsibility for all my investment decisions and securities transactions and I understand that my orders may be sent directly to
the exchange or market without prior review by HSBC InvestDirect.
I agree to comply with all applicable rules and customs of the Investment Industry Regulatory Organization of Canada and those governing the exchanges or
markets (and their clearing houses, if any) where the orders are executed. HSBC InvestDirect, however, reserves the right to review any of my transactions prior
to the exchange or market and to reject, change or remove any order for credit reasons or non-compliance with the requirements of those exchanges, markets or
securities regulations.
X X
Signature – Applicant Signature – Co-Applicant Date (mm/dd/yyyy)
Signatures – Required
By signing any of the signature areas, I am certifying that the information provided by me in this application is true and complete and I agree to advise HSBC InvestDirect
immediately of any material change in the information. I further certify that I am capable of evaluating and bearing the financial risk inherent in buying and selling securities and
that trading in all transactions for which approval is sought is suitable for the purposes of my investment objectives. I acknowledge and confirm that I have received, read and
consent to the Client Terms and Conditions, including the Statement of Policies and Securities Related Activities Section, Electronic Delivery of Documents Section and the
Client Information Consent Agreement Section, which includes my consent to the collection, use and disclosure of my personal information for the purposes described.
An electronic version of the Client Terms and Conditions is available at [Link]/investdirect-terms, or a paper copy may be requested by contacting
HSBC InvestDirect at 1-800-760-1180.
X X
Signature – Applicant Signature – Co-Applicant Date (mm/dd/yyyy)
X
Applicant(s) Initials
X X
Signature – Applicant Signature – Co-Applicant Date (mm/dd/yyyy)
*003YP3+09T*
Sign here if you are applying to trade options in any selected account.
I hereby apply to be granted option facilities with respect to this account. I acknowledge and confirm that I have received, read and accept the Option Trading Agreements
in the Client Terms and Conditions. I also confirm that I have received and read the applicable Risk Disclosure Document and am aware of and accept all risks associated
with the trading of options and securities.
What kind of option trades would you like to make in your Margin Account? Buy Calls/Puts Covered Writing Spreads Uncovered Writing
What kind of option trades would you like to make in your Registered Accounts? Buy Calls/Puts Covered Writing
What kind of option trades would you like to make in your Tax-Free Savings Account? Buy Calls/Puts Covered Writing
X X
Signature – Applicant Signature – Co-Applicant Date (mm/dd/yyyy)
E-mail:
HSBC /HIDC Transit Number: Number of Years with HSBC: Client EBN #
Jade Client Premier Client Advance Client Employee Account If yes, please provide employee ID
Employee Comments:
Face to Face Anti Money Laundering Verification Face to Face Anti Money Laundering Verification
Date of Verification (mm/dd/yyyy) Date of Verification (mm/dd/yyyy)
Applicant Co-applicant
ID #1 ID #1
Type of ID Verified: Type of ID Verified:
✔
Driver’s License Passport Other: Driver’s License Passport Other:
ID Number 73335541 ID Number
Place of Issuance Richmond BC Place of Issuance
Expiry Date 05/19/2023 Expiry Date
Verified by: Verified by:
HSBC Bank Other HSBC Entity HSBC Bank Other HSBC Entity
Transit Number: Transit Number:
ID #2 ID #2
Type of ID Verified: Type of ID Verified:
Driver’s License Passport ✔
Other: Canadian Citizenship Card Driver’s License Passport Other:
ID Number 7512764 ID Number
Place of Issuance Vancouver BC Place of Issuance
Expiry Date Expiry Date
Verified by: Verified by:
HSBC Bank Other HSBC Entity HSBC Bank Other HSBC Entity
Transit Number: Transit Number:
Comments:
Representative’s Name: Date: / /
Account Approval
Check if obtained: Cash Margin Short Selling TFSA RSP SRSP LRSP
RIF SRIF LIF LRIF PRIF RLIF LIRA
Buy Puts/Calls Covered Writing Next Level Review: Spreads Uncovered Writing
man wai ki
My Estate
Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United
States Tax Withholding and Reporting (Individuals)
(Rev. July 2017) a For use by individuals. Entities must use Form W-8BEN-E. OMB No. 1545-1621
Department of the Treasury Go to [Link]/FormW8BEN for instructions and the latest information.
a
Internal Revenue Service a Give this form to the withholding agent or payer. Do not send to the IRS.
City or town, state or province. Include postal code where appropriate. Country
5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions)
Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions)
9 I certify that the beneficial owner is a resident of Canada within the meaning of the income tax
treaty between the United States and that country.
10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article and paragraph
of the treaty identified on line 9 above to claim a % rate of withholding on (specify type of income):
.
Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:
• I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or
am using this form to document myself for chapter 4 purposes,
• The person named on line 1 of this form is not a U.S. person,
• The income to which this form relates is:
(a) not effectively connected with the conduct of a trade or business in the United States,
(b) effectively connected but is not subject to tax under an applicable income tax treaty, or
(c) the partner’s share of a partnership's effectively connected income,
• The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between
the United States and that country, and
• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or
any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 days
if any certification made on this form becomes incorrect.
F
Sign Here
Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)
wai ki man
Print name of signer Capacity in which acting (if form is not signed by beneficial owner)
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 7-2017)