First Name
Middle Initial
Last Name
Street Address
Address (cont.)
City
Province
Postal Code
Home Phone
Work Phone
Email Address
Gender	MaleFemale
Please indicate if you owned shares/units in:	IG Funds Yes No CI Funds Yes No Templeton Funds Yes No AGF Funds Yes No
If you answered "yes" to any of the above funds, please provide the details of your ownership, including the name of the funds, the number of shares or units, and the dates the shares/units were purchased.
Please indicate if you owned funds managed by ant of the following management companies:	AIC Limited: Yes No    AIMS Funds Management Inc.: Yes No    Clarington Funds Inc.: Yes No    Dynamic Mutual Funds: Yes No    Manulife Financial Corporation: Yes No    Guardian Group of Funds: Yes No    HSBC Asset Management (Canada) Limited: Yes No   Mackenzie Financial Corporation: Yes No    Industrial Alliance Fund Management Inc. /  BLC-Edmond de Rothschild Asset Management Inc.: Yes No    RBC Asset Management Inc.: Yes No Scotia Securities Inc. Yes No MD Management Ltd.: Yes No Talvest Fund Management: Yes No
If you owned funds managed by any of the above companies, please list the name of the funds owned, and for each of the funds owned, please indicate the approximate amount and date of purchase.