ATTESTATION OF IDENTITY VERIFICATION

ATTESTATION OF IDENTITY VERIFICATION
(To be completed and returned by the commissioner of oaths or the guarantor)
I, the undersigned, confirm that I am engaged in one of the professions listed in Schedule A. I certify that I
have met with the individuals whose information appears below in order to ascertain their identity. In so
doing, I have seen the original of the following identity document (please check one box):
Birth certificate …,
Driver’s licence …,
Provincial health insurance card (except for Prince Edward Island, Manitoba and Ontario) …,
Passport …,
Other similar document (from acceptable documents listed in Schedule A – specify below) …
______________________________________________________________________
I therefore attest that:
(i)
(ii)
(iii)
The individuals who signed the documents required by NBCN and the Introducing Broker
___________________________________ (if applicable) are those I have identified herein;
The original of the identity documents used by the undersigned to verify the identity of these
individuals (photocopies of which are attached) are valid and have not expired;
The photocopies of these identity documents are true and exact copies of the originals.
Name of person identified
Date of birth
Occupation
Address
Identity document
Type:
Number:
Place of issuance:
Dated and signed at ______________________________ on __________________________.
_______________________________________
[Signature]
_______________________________________
[Name of guarantor / commissioner of oaths in
block letters]
_______________________________________
[Profession]
_______________________________________
[Membership number and name of professional
order]
NBCN-216 06/08
______________________________________
[Name of employer]
_______________________________________
[Address of employer]
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SCHEDULE A
Instructions to the commissioner of oaths in Canada or guarantor regarding identity verification
In order to comply with Canadian anti-money laundering and terrorist financing laws and regulations,
NBCN and the Introducing Broker (if applicable) must obtain a written attestation from a commissioner of
oaths in Canada or a guarantor in Canada confirming that he/she has met with and ascertained the
identity of each individual authorized to give instructions. The names of these individuals appear on the
documentation from NBCN and the Introducing Broker (if applicable) which they must sign as part of their
business relationship with them. This attestation must be completed by a commissioner of oaths in
Canada or a guarantor and returned with legible photocopies of the identity documents used to verify the
identity of the individuals concerned (provided the use of such documents is not prohibited by law). The
attestation and photocopies of the identity documents required and any other documentation required by
NBCN and the Introducing Broker (if applicable) must be returned to immediately.
A guarantor is engaged in one of the following professions in Canada:
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dentist;
medical doctor;
chiropractor;
judge;
magistrate;
lawyer;
notary (in Quebec);
notary public;
optometrist;
pharmacist;
professional accountant (APA [Accredited Public Accountant], CA [Chartered Accountant], CGA
[Certified General Accountant], CMA [Certified Management Accountant], PA [Public Accountant]
or RPA [Registered Public Accountant]);
professional engineer (P.Eng. [Professional Engineer, in a province other than Quebec] or Eng.
[Engineer, in Quebec]); or
veterinarian.
List of acceptable identity documents
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Birth certificate issued in Canada
Driver’s licence issued in Canada
Provincial or territorial health insurance
card, except for those issued in Ontario,
Prince Edward Island and Manitoba
(these provinces do not allow the card to
be used for identification purposes)
Canadian passport
Passport from a foreign country
Canadian citizenship certificate
Certificate of naturalization in the form of
a document or a card (excluding a
commemorative document)
IMM 1442 form issued by Citizenship
and Immigration Canada (CIC)
IMM 1000 form issued by CIC (for
permanent residents prior to June 28,
2002)
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Permanent resident card or IMM 5292
(Confirmation of permanent residence
from CIC)
Certificate of Indian Status issued by the
Government of Canada
Old Age Security card issued by the
Government of Canada
Identity card or document issued by one
of the following authorities and bearing
the photo and signature of the individual
being identified:
- Insurance Corporation of British
Columbia
- Alberta Registries
- Saskatchewan Government
Insurance
- Department of Service of Nova
Scotia and Municipal Relations
- Department of Transportation
and Public Works of the
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province of Prince Edward
Island
Service New Brunswick
Department of Government
Services and Lands of the
province of Newfoundland and
Labrador
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Government of the Northwest
Territories Department of
Transportation
Department of Community
Government and Transportation
of the territory of Nunavut
NOTE: For non-Canadian citizens, the following documents are considered equivalent to those
mentioned above and will be accepted. However, a passport and identity card bearing a photo and the
signature of the individual being identified are preferred.
ƒ Passport issued by the country of origin
ƒ Birth certificate issued by the country of origin
ƒ Driver’s licence issued by the country of origin
ƒ Equivalent of a health insurance card issued by the country of origin
ƒ Citizenship certificate issued by the country of origin
ƒ Green Card issued by the United States