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] 2 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: 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 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) 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 3 - province of Prince Edward Island Service New Brunswick Department of Government Services and Lands of the province of Newfoundland and Labrador - 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. Passport issued by the country of origin Birth certificate issued by the country of origin Driver’s licence issued by the country of origin Equivalent of a health insurance card issued by the country of origin Citizenship certificate issued by the country of origin Green Card issued by the United States
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