Personal Information Form And Authorization Of Indirect Collection, Use And Disclosure Of Personal Information Page 3

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Form 51-105F3B
Personal Information Form
and Authorization of Indirect Collection,
Use and Disclosure of Personal Information
Schedule 2
Securities Regulatory Authorities
British Columbia Securities Commission
P.O. Box 10142, Pacific Centre
701 West Georgia Street
Vancouver, British Columbia V7Y 1L2
Telephone: 604-899-6500
Toll free in British Columbia and Alberta 1-800-373-6393
Facsimile: 604-899-6506
Alberta Securities Commission
th
Suite 600, 250 – 5
Street SW
Calgary, Alberta T2P 3C4
Telephone: 403-297-6454
Facsimile: 403-297-6156
Saskatchewan Financial Services Commission
Suite 601 - 1919 Saskatchewan Drive
Regina, Saskatchewan S4P 4H2
Telephone: 306-787-5879
Facsimile: 306-787-5899
The Manitoba Securities Commission
500 – 400 St Mary Avenue
Winnipeg, Manitoba R3C 4K5
Telephone: 204-945-2548
Toll free in Manitoba 1-800-655-5244
Facsimile: 204-945-0330
Autorité des marchés financiers
e
800, Square Victoria, 22
étage
C.P. 246, Tour de la Bourse
Montréal, Québec H4Z 1G3
Telephone: 514-395-0337
or 1-877-525-0337
Facsimile: 514-873-6155 (For delivery purposes only)
Facsimile: 514-864-6381 (For privacy requests only)
New Brunswick Securities Commission
85 Charlotte Street, Suite 300
Saint John, New Brunswick E2L 2J2
Telephone: 506-658-3060
Toll Free in New Brunswick 1-866-933-2222
Facsimile: 506-658-3059
Nova Scotia Securities Commission
nd
2
Floor, Joseph Howe Building
1690 Hollis Street
Halifax, Nova Scotia B3J 3J9
3

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