Consolidated Statutes and Regulations
Consolidated Statutes
Consolidated Regulations
Annual Statutes and Regulations
Annual Statutes
Annual Regulations
Additional information
Québec Official Publisher
What’s new?
Information note
Policy of the Minister of Justice
Laws: Amendments
Laws: Provisions not in force
Laws: Provisions brought into force
Annual Statutes: PDF versions since 1996
Regulations: Amendments
Annual Regulations: PDF versions since 1996
Court Decisions
D-9.2, r. 18 - Regulation respecting information to be provided to consumers
Schedule
Disposition versions
Schedule 3
(s. 4)
NOTICE OF SPECIFIC CONSENT
You are free to grant or refuse this consent
Section 92 of the Act respecting the distribution of financial products and services (chapter D-9.2)
_________________________________________________________________________________
| |
| WHAT YOU MUST KNOW: |
| |
| · At this date, we hold certain information relating to you. |
| |
| · We require your consent to allow some of our representatives to have access |
| to this information. |
| |
| · These representatives will also have access to any update of the information |
| done during the period of validity of the consent. |
| |
| · These representatives will use the information available in order to solicit |
| you for the purchase of new financial products and services. |
| |
| · By granting your consent, you also authorize us to keep your insurance |
| records with your records. |
| |
| YOU ARE FREE TO SET THE PERIOD OF VALIDITY OF YOUR CONSENT |
| |
| · If you grant consent for an undetermined period of time, you may at any time |
| terminate it by revoking it. At the end of this form, you will find a |
| revocation notice model that you may use for this purpose, or as a basis for |
| preparing your own notice. |
| |
| · If you wish to grant consent for a limited period of time, you may do so by |
| determining this period yourself. This form provides, in the "specific |
| consent" section, a place where you may write down the period of validity |
| desired. |
| |
| THE ACT RESPECTING THE DISTRIBUTION OF FINANCIAL PRODUCTS AND |
| SERVICES GIVES YOU IMPORTANT RIGHTS. |
| |
| Without this specific consent, the firm may not use this information for a |
| purpose other than the purpose for which it was collected. The firm cannot |
| compel you to give your consent or refuse to do business with you if you |
| refuse to give it. Section 94 of the Act protects you. For further |
| information, contact the Autorité des marchés financiers at: (418) 525-0337 or |
| 1-877-525-0337. |
|_________________________________________________________________________________|
| |
| WHAT YOU MUST KNOW: |
| |
| · At this date, we hold certain information relating to you. |
| |
| · We require your consent to allow some of our representatives to have access |
| to this information. |
| |
| · These representatives will also have access to any update of the information |
| done during the period of validity of the consent. |
| |
| · These representatives will use the information available in order to solicit |
| you for the purchase of new financial products and services. |
| |
| · By granting your consent, you also authorize us to keep your insurance |
| records with your records. |
| |
| YOU ARE FREE TO SET THE PERIOD OF VALIDITY OF YOUR CONSENT |
| |
| · If you grant consent for an undetermined period of time, you may at any time |
| terminate it by revoking it. At the end of this form, you will find a |
| revocation notice model that you may use for this purpose, or as a basis for |
| preparing your own notice. |
| |
| · If you wish to grant consent for a limited period of time, you may do so by |
| determining this period yourself. This form provides, in the "specific |
| consent" section, a place where you may write down the period of validity |
| desired. |
| |
| THE ACT RESPECTING THE DISTRIBUTION OF FINANCIAL PRODUCTS AND |
| SERVICES GIVES YOU IMPORTANT RIGHTS. |
| |
| Without this specific consent, the firm may not use this information for a |
| purpose other than the purpose for which it was collected. The firm cannot |
| compel you to give your consent or refuse to do business with you if you |
| refuse to give it. Section 94 of the Act protects you. For further |
| information, contact the Autorité des marchés financiers at: (418) 525-0337 or |
| 1-877-525-0337. |
|_________________________________________________________________________________|
The information we hold pertaining to you, at this date, was collected as part of:
(purposes of the file)
Here are the required categories of information that we would like one of our representatives to use and the products and services he may offer you. For a fuller description of each category, you may refer to the back of this sheet.
Please authorize each category of information requested.
_________________________________________________________________________________
| | | | |
| Required information | For which products | Client’s | |
| category to be | and services?2 | Authorization3 | Initials4 |
| accessed1 | | | |
|________________________|______________________|__________________|______________|
| | | | |
| To be filled by the | To be filled by the | □ Yes □ No | |
| distributor | distributor | | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| |
| Instructions for the firm (duplication not required): |
| |
| |
| 1. The firm must describe each category on the reverse side of this sheet. |
| |
| 2. The firm must specify the nature of the products and services it wishes |
| to offer the client. Each information category must be associated with |
| a specific purpose. Where a category serves several purposes, the firm |
| must repeat it for each purpose. |
| |
| 3. The client may give his or her authorization by telephone, provided both |
| parties can identify each other. In such case, this form shall serve as a |
| script for the officer, who will also read the detailed description of each |
| category to the client. The firm must fill out this form and send it to |
| the client within 10 days of obtaining the verbal consent. |
| |
| 4. If in electronic form, the initials may be replaced by a confirmation |
| window. However, the notice of consent must be made available to the |
| client by any means allowing the reading or printing thereof. |
|_________________________________________________________________________________|
| | | | |
| Required information | For which products | Client’s | |
| category to be | and services?2 | Authorization3 | Initials4 |
| accessed1 | | | |
|________________________|______________________|__________________|______________|
| | | | |
| To be filled by the | To be filled by the | □ Yes □ No | |
| distributor | distributor | | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| | | | |
| | | □ Yes □ No | |
|________________________|______________________|__________________|______________|
| |
| Instructions for the firm (duplication not required): |
| |
| |
| 1. The firm must describe each category on the reverse side of this sheet. |
| |
| 2. The firm must specify the nature of the products and services it wishes |
| to offer the client. Each information category must be associated with |
| a specific purpose. Where a category serves several purposes, the firm |
| must repeat it for each purpose. |
| |
| 3. The client may give his or her authorization by telephone, provided both |
| parties can identify each other. In such case, this form shall serve as a |
| script for the officer, who will also read the detailed description of each |
| category to the client. The firm must fill out this form and send it to |
| the client within 10 days of obtaining the verbal consent. |
| |
| 4. If in electronic form, the initials may be replaced by a confirmation |
| window. However, the notice of consent must be made available to the |
| client by any means allowing the reading or printing thereof. |
|_________________________________________________________________________________|
In accordance with the Act respecting the protection of personal information in the private sector (chapter P-39.1), you may request access to the information that we hold pertaining to you.
SPECIFIC CONSENT
Having read the above, I, the undersigned,__________(name of client)__________ consent to use of the information the firm held by the firm for the purposes indicated above. This authorization will be valid until revoked or for the following period:
______________________________________________
DD/MM/YY (to be filled out by the client)
I may revoke this consent at any time by sending a notice. I may use the attached model notice for this purpose or as a basis for preparing my own notice.
____________________________________________ ___________________________________________
(signature of client) (date of signature of the consent)
(client identification, address, folio or contract no., etc.)
-----------------------------------------------------------------------------------------------------------------------------------------
I HEREBY REVOKE THE SPECIFIC CONSENT GIVEN TO THE FIRM BY THE FOLLOWING NOTICE
To: ___________________________________________
(name of firm)
______________________________________________
(address of firm)
On: ___________________________________________
I, the undersigned, __________(name of client)__________ hereby notify you that
I am canceling the specific consent authorizing the communication of my personal information for new purposes.
Consent given to you on: ______________________________________________________________________
(date of consent)
____________________________________________ _____________________________________________
(name of client) (signature of client)
(client identification, address, folio or contract no., etc.)
