TD Waterhouse Discount Brokerage Power of Attorney Form

TD Waterhouse
Discount Brokerage
Power of Attorney
To authorize another person to have full power and authority over your account
Only complete if you want another person to have authority over your account.
Application Reference #
Account #
Throughout this agreement, the words "you", "your" and "yours" mean the applicant (and any Co-applicant or other individuals with
authority over the account). The words "we", "us" and "our" mean TD Waterhouse Discount Brokerage, a division of TD Waterhouse
Canada Inc.
Scope of Power
You hereby appoint ____________________________________ (whose signature appears on the next page) to act as your agent and
attorney in fact for your accounts with us. At such time as this Power of Attorney is signed and properly witnessed, your agent will have the
power and authority to do the following for you through your accounts with us:
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buy, sell and trade stocks, bonds, and any other securities (including margin purchases and short sales*);
receive and deliver securities and to order their reception from and delivery to others either for free or against payment for your account;
order the redemption of payments from and the making of payments to others including your agent and attorney;
receive payments from or make payments to others;
receive transaction statements, and approve and confirm them;
receive all notices and demands of any kind addressed to or intended for you regarding your account transactions;
withdraw funds from your account;
transfer your account;
sign any agreements with us on your behalf necessary for your transactions;
act on your behalf in any other matter regarding your accounts with us.
(*Not permitted in your SDRSP, SDRIF or RESP)
We will not notify you if your agent performs any of the above actions since they will have the same effect as though you did them. We are
not required to send you any statements, notices, or demands concerning such actions. By signing this Power of Attorney, you are approving
all of your agent's actions regarding your accounts with us. However, you acknowledge and agree that we reserve the right to review and
reject any of your agent's transaction requests.
Ending this Power of Attorney
Each of you agrees that this Power of Attorney is binding on each of you as well as on your heirs, executors, administrators, successors and
assigns. We will continue to deal with your agent until this Power of Attorney is ended by our having received either your written notice of
revocation or proof of your death.
Written notice - You may revoke the Power of Attorney by giving a signed, written notice addressed and delivered to our office where your
account is kept.
Proofofyourdeath-This Power of Attorney will end when we have received written proof of your death (for example, when we receive a
copy of your death certificate.)
You agree to be responsible for any actions taken by your agent regarding your accounts with us until we have either received your written
notice of revocation or proof of your death. You agree to indemnify us completely from and against any action taken by your agent until
such time as we know this appointment has been ended.
PowerofAttorneyContinuingDuringMentalInfirmity
Clause 1 - Applicable only in: British Columbia, Manitoba, New Brunswick, Saskatchewan and Quebec. Initial "Yes" only if you want your
agent's authority to continue if you become mentally infirm. Two Witnesses are required if initialed "Yes" in Quebec.
You authorize this Power of Attorney to continue to be exercised if you become mentally infirm or legally incapacitated. You understand
this is permitted under certain provisions of the Power of Attorney Act and in Quebec, under the Civil Code and subject to the homologation
of this Power of Attorney by the court.
This authority will end in the following situations:
• if an order is made under the Patients' Property Act (B.C.), sections 19 and 19.1
• if a committee is appointed under the Patients' Property Act (B.C.) section 6(1) or
• if a committee is appointed for your estate in Manitoba, New Brunswick or Saskatchewan.
Yes (initial) _________
No (initial) _________
Clause 2 - Applicable only in Ontario. Initial "Yes" only if you intend for your agent's authority to continue if you become mentally infirm.
It is my intention that this document will be a continuing power of attorney for property under the Substitute Decisions Act, 1992, and may
be used during my incapacity to manage property.
Yes (initial) _________ No (initial) _________
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Order Execution Account
520130 (0311)

The signatures on this form must be witnessed by someone other than the applicant, co-applicant, agent, spouse or common-law partner of
any of these persons, or (in Ontario) the applicant's child or a person who treats the applicant as his or her child. One witness per signature is
sufficient (except in Ontario or Quebec, if you initialed "Yes" in clause 1 above, where 2 witnesses are required). A witness can witness
more than one signature. Two separate individuals must witness each signature for residents of Ontario.
Applicant X
Co-applicant X
I accept this appointment as agent and attorney.
Agent X
Date: / /
month day year
Date: / /
month day year
Witnesses
We have no reason to believe that the person whose name appears above is incapable of giving a continuing power of attorney for
property.We have signed this power of attorney in the presence of the person whose name appears above and in the presence of each other.
Witness for signature(s) of (check all that apply)
Applicant Co-applicant Agent
Date:
/ /
month day year
Witness' Signature X
Print Full Name
Address Phone: ( )
Witness for signature(s) of (check all that apply)
Applicant Co-applicant Agent
Witness' Signature X
Print Full Name
Address Phone: ( )
Witness for signature(s) of (check all that apply) Applicant Co-applicant Agent
Witness' Signature X
Print Full Name
Address Phone: ( )
Witness for signature(s) of (check all that apply) Applicant Co-applicant Agent
Witness' Signature X
Print Full Name
Address Phone: ( )
About Your Agent (To be completed for the person appointed to act as agent)
Home address
Name and address of Agent's employer
Occupation
Date of birth
Type of Business
Relationship to Account Holder
Banking information: Bank Branch Account No.
Does the agent have an existing TD Waterhouse Account? No Yes Account No.
Is Agent a Director, Senior Officer or Insider of any publicly traded company?
No Yes - Name of Company(ies)
Is Agent, as an individual or as part of a group, in a control position of a publicly traded company?
No Yes - Name of Company(ies)
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Valid Identification/Citizenship Required - For the Agent - Provide copy of one:
(U.S. Persons - W9 form (#515876) and a Waiver of Confidentiality (#591856))
Passport
Driver's License (Restriction:
QC only if client volunteers it)
Canadian Citizenship Card
Birth Certificate
(under age 21 only)
Provincial Health Insurance Card
(Restriction: ON, MB and PEI
not allowed by law;
QC only if client volunteers it)
Permanent Resident Card
Record of Landing IMM1000
(issued prior to 1/1/2004)
Confirmation of Permanent
Residence IMM5292
(issued prior to 1/1/2004)
Canadian Forces ID Card
Certificate of Indian Status
Alberta Photo ID Card
B.C. ID Card
NFLD and Labrador Photo ID Card
Nova Scotia ID Card
PEI Voluntary ID
SK Mandatory Photo ID
ID Number
Expiry Date
TD Waterhouse Discount Brokerage is a division of TD Waterhouse Canada Inc., a subsidiary of The Toronto-Dominion Bank. TD Waterhouse Canada Inc. - Member of the Canadian Investor Protection Fund.
/ The TD logo and other trade-marks are the property of The Toronto-Dominion Bank or a wholly-owned subsidiary, in Canada and/or other countries.
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