General Intake Forms

Please complete this general intake form for new and existing clients.

Should you have any questions about our Privacy Policy please click here.

Politically Exposed Foreign Person Addendum

Fintrac Legislations mandates under Guideline 6E, section 7.2 dated July 2010, that an Advisor must take reasonable measures to determine whether you are dealing with a Politically Exposed Foreign Person within 14 days of opening the account.

Advisors are expected to ensure that their clients fully understand the definition of Politically Exposed Foreign Person as outlined below, before answering it on the investment application.

POLITICALLY EXPOSED FOREIGN PERSON DETERMINATION AND RELATED RECORDS

A politically exposed foreign person is an individual who holds or has ever held one of the following offices or positions in or on behalf of a foreign country:

• a head of state of government;

• a member of the executive council of government or a member of legislature;

• a deputy minister (or equivalent);

• an ambassador or an ambassadors’ attache or counselor;

• a military general (or higher rank);

• a president of a state-owned company of bank;

• a head of a government agency;

• a judge; or

• a leader or president of a political party in a legislature.

A politically exposed foreign person also includes the following family members of the individual described above:

• mother or father;

• child;

• spouse or common-law partner;

• spouse’s or common-law partner’s mother or father; and

• brother, sister, half-brother, or half-sister (that is, any other child of the individual’s mother or father)

The above questions have been read and explained to me. By signing below, I attest to the fact that I am not a Politically Exposed Foreign Person.

Guidelines to Respond to Requests for Information

1. Under the Federal Privacy Act of Canada, an individual has the right to ask for access to his or her personal information.

   a) Requests should be made in writing.

   b) The written request should contain enough information to allow VFC to make a reasonable effort to locate the information.

   c) The applicant may ask to see the information or receive a copy of it and they do not have to say why they are asking for the information.

2. VFC must respond to the applicant within 45 calendar days of receiving the request.

3. Unless VFC has no such record, or it can refuse access under The Privacy Act, VFC must:

   a) Give the individual access to his or her personal information

   b) Tell the individual what the information has been or is being used for, and

   c) Tell him or her to whom, and in what situations, the information is being or has been disclosed by VFC.

Note: VFC may not have a record of the persons or organizations that they have disclosed personal information to before January 2004. If this is the case, VFC should tell the individual to whom, or to what organization, it may have disclosed the information.

4. Persons who can request personal information are:

a) The individual that the information is about

b) His or her authorized representative

Individuals may request records that contain personal information about them.

Guidelines to Requests for Corrections to Personal Information

Under the Federal Privacy Act, Villeneuve Financial Consulting LTD. has a responsibility to ensure that the personal information they hold is accurate, complete, and up-to-date as is necessary for the purposes for which it is to be used. An individual who believes that his or her personal information has a mistake in it, or is missing some information, may ask the organization to correct it.

A request for the correction must give enough information so that an organization that makes a reasonable effort can find the information. Requests should be made in writing and a fee cannot be charged for correction of information.

Written request for information or correction of information should be directed to the Privacy Officer of Villeneuve Financial Consulting Ltd.:

Guy Villeneuve

Privacy Officer

Villeneuve Financial Consulting Ltd.

272 Larch Street

Sudbury, ON P3B 1M1

Proceeds of Crime (money laundering) and Terrorist Financing Act (PCMLTFA)

The Financial Transactions and Reports Analysis Centre of Canada (FINTRAC), Canada’s financial intelligence unit, was created in 2000. It is an independent agency, reporting to the Minister of Finance, who is accountable to Parliament for the activities of the Centre. It was established and operates within the ambit of the Proceeds of Crime (money laundering) and Terrorist Financing Act (PCMLTFRA) and it’s Regulations.

The Mandate of the Financial Transactions and Reports Analysis Centre of Canada

The mandate is to facilitate the detection, prevention, and deterrence of money laundering and the financing of terrorist activities while ensuring the protection of personal information under their control. They fulfill their mandate through the following activities:

• Receiving financial transaction reports and voluntary information on money laundering and terrorist financing in accordance with the legislation and regulations and safeguarding personal information under it’s control;

• Ensuring compliance of reporting entities with the legislation and regulations;

• Producing financial intelligence relevant to money laundering, terrorist activity financing, and threats to the security of Canada investigations;

• Researching and analyzing data from a variety of information sources that shed light on trends and patterns in money laundering and terrorist financing;

• Maintaining a registry of money services businesses in Canada;

• Enhancing public awareness and understanding of money laundering and terrorist activity financing.

Who Does this Apply To?

Anti-money laundering and anti-terrorist financing legislation and regulations apply to all financial advisors. The Proceeds of Crime (Money Laundering) and Terrorist Financing Act consists of a reporting and identification regime to which financial advisors must subscribe.

Key Items Impacting Financial Advisors

Attempted Suspicious Transactions

The regulations integrate the concept of an “attempted transaction” (not just a completed transaction) into the anti-money laundering and terrorist financing regime, which constitutes a significant change in the way reportable activities are defined. Reports of these transactions must be filed with the Financial Transactions and Reports Analysis Centre of Canada - FINTRAC.

Information on Directors and Partners of Corporations

Financial entities, securities dealers, life insurance companies, life insurance brokers, and agents will have to take reasonable measures to obtain information on directors or partners of a corporation or other entities or on personals that own or control 25 percent or more of that corporation or entity.

Politically Exposed Foreign Persons

Financial entities, securities dealers, life insurance companies, life insurance brokers and agents would have to determine whether purchases of insurance, account holders or persons sending large electronic fund transfers or making large payments are politically exposed foreign person (individuals who hold a prescribed list of positions in a foreign state).

Reporting Requirements

Advisors must report to the Financial Transactions and Report Analysis Centre of Canada (FINTAC):

• Suspicious transactions or attempted suspicious transactions

• Known or suspected terrorist property in your possession or control, and

• Cash transactions of $10,000 or more.

Record-Keeping Requirements

• Large Cash Transaction Records

• Client Information Records

For more information, please visit the website of the Financial Transactions and Reports Analysis Centre of Canada https://www.fintrac.gc.ca/fintrac-canafe/1-eng.asp.

Consent to Electronic Delivery of Documents

To: Villeneuve Financial Consulting Ltd & FundEX Investments Inc.

I/We have read and understand the “Consent to Electronic Delivery of Documents (“Consent”) and hereby consent to the electronic delivery of the documents and/or types of documents listed below that my/our Representative elects to deliver to me/us electronically, all in accordance with my/our instructions below.

1. Types of documents covered by this Consent may include, but are not limited to:

   Mutual Fund Company Prospectuses

   Mutual Fund Periodic Updates

   Annual or Semi Annual Reports

   Educational or Promotional Material

   Portfolio Summaries

   Administrative forms pertaining to my account(s)

   Transaction Data

2. My/Our Representative may email any such Documents to the email address sent out below. No separate notice of delivery is required, although my/our representative may request acknowledgement, in the form of a “read receipt”, that I/we have received and reviewed such documents. I/we agree to notify my/our representative of any change in my/our email address.

3. I/We agree to maintain a current email account on a system with sufficient capacity to retrieve and review messages from my/our representative, including large documents or attachments. I/We indemnify my/our dealer and hold my/our dealer harmless for any loss or non-delivery of documents from my/our representative or of information from any third party sender arising from this consent.

4. I/We understand that, in addition to a current version of email and internet browser software, current versions of my standard desktop software such as Microsoft Word, Excel, or Adobe Reader and will be required to view documents. It is my/our responsibility to keep all my/our programs up to date.

5. I/We may, in my/our sole discretion, contact my/our representative by telephone, regular mail or electronic mail to request and receive, at no cost, paper copies of any documents delivery electronically.

6. I/We understand that, upon my/our notification and request, my/our representative will provide a paper copy of any documents delivered electronically if electronic delivery fails.

7. I/We understand that documents posted on my/our dealers website(s) are subject to revisions and removal without notice and that, if I/we wish to retain a copy for my/our personal records, I/we need to save a copy to my/our local drive immediately and make regular, periodic backups of my/our local data to prevent loss due to hardware, software, or communications failure.

8. I/we will take reasonable measure to ensure that the privacy and confidentiality of document are maintained and will not forward documents receive from my/our representative to any third party without my/our representative’s prior consent.

   This understanding does not apply to documents of a purely promotional or marketing nature.

9. I/We understand that my/our consent may be revoked or changed, including any in the electronic mail address to which documents are delivered, at any time by notifying the deliverer of such revised or revoked consent in writing by a regular mail or electronic mail to: guy@villeneuvefinancial.com.

10. I/We understand that I/we am/are not required to consent to electronic delivery.

11. This consent applies to but is not limited to Mutual Funds & Insurance accounts with Villeneuve Financial Consulting Ltd. & FundEx Investments Inc.