Nrd - Request For Refund Form printable pdf download

Nrd - Request For Refund Form

NRD - Request for Refund Form

Instructions and Terms

Approved refunds will be issued by cheque mailed to the Chief AFR of the firm.

Submit the completed NRD Request for Refund Form, Sections A and B, for processing to the CSA or IIROC Regulator in the jurisdiction in

which the NRD submission has been sent. Please verify that you are sending the form only to jurisdictions where that individual is registered,

and from which a refund is expected.

For multiple jurisdiction submissions, please list all the individual's applicable jurisdictions on a single form. Send the original to the

individual's lead jurisdiction, and send copies to the other applicable jurisdictions.

Please attach a copy of the Submission Fee Summary, available on NRD in the Submission History of the pertinent submission.

Pending approval, the Regulator will forward this refund application to the NRD Administrator to process any NRD fees.

SECTION A: Refund Request made bv:

Name of Chief AFR (in full):

Legal Name of Firm (name to be printed on cheque):

Firm NRD #:

Mailing Address:

City/Town:

Province/Territory:

Postal Code:

Contact Name:

Telephone No: (

)

Fax No:

E-mail address:

Signature of Chief AFR Making this Refund Request:

Date:

YOU MUST ALSO COMPLETE SECTION B ON THE FOLLOWING PAGE

Regulator For Office Use Only:

NRD Administrator - For Office Use Only:

Date Refund Form Received by Regulator: _____________ (mm/dd/yr)

Date Refund Form Received by NRD Administrator:/___ / _ (mm/dd/yr)

Certified Correct (name/signature): _____________________________

Reviewed by NRD Administrator: _______________________________

Refund Authorized (name/signature):

Business Ops. Manager Approval: ______________________________

Refund Amount: ____________________________________________

Refund dB #: __________________ Cheque #:

Docket #: _____________________ Cheque #: ___________________

Date Completed: __ / ___ / __ (mm/dd/yr)

Date Completed: __ / ___ / ____ (mm/dd/yr)

If refund rejected, provide details:

Regulator Contact (name): ____________________________________

Telephone No: ( __ ) ________________ E-mail:

Fax No: ( __) _______________________________________________

If refund rejected, provide details:

NRD Refund Request Form

Nrd - Request For Refund Form

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