CSE DEALER APPLICATION

Please complete the following application form for approval as a new Dealeror, if an existing Dealer, for updating information that was previously provided. All new applications must also include a signed copy of the CSE Dealer Agreement, which is found at the end of the form. If you have any questions please contact the exchange at 416.572.2000.

New Application / Update

Part 1General Information:

  1. Dealer Name

Please state the full legal name of the dealer applying to the CSE (“Applicant”). If this is a name change or the firm is the successor following a merger, acquisition, etc, please provide the name(s) of the predecessor firms.

  1. Description of Dealer’s Business

Please provide a general description of the Applicant’s principal business and the services offered for inclusion in the Dealer directory. (If the Applicant has a US Desk that will accept client orders from US firms please provide contact information.)

  1. Head Office Address

Please provide the complete address.

Phone Number / Fax Number
Website
Street Address
City, Province/State, Postal/Zip Code / Country
  1. Representative of Dealer

Please provide the name and contact information of the individual appointed as theApplicant’sCSE representative (“Representative”). The Representative must be a senior officer, director or partner of the Applicant.

First Name Last Name / Title
Direct Phone / Direct Fax
Email Address
Street Address (if different from Head Office)
City, Province/State, Postal/Zip Code / Country

5.Back-up CSE Representative(s)

The Dealer Representative must approve all of the dealer’s traders who wish to trade on the Trading System and all market making applications. If the CSE Dealer Representative would like to appoint one or more back-up representatives authorized to sign on the Applicant’sbehalf, please provide their name(s), telephone number(s) and email address(es) below. Please also indicate any restrictions, e.g. authorized only to approve trader applications, not market making applications, etc. (Leave blank if not assigning a back-up.)

First Name Last Name / Title
Phone Number / Fax Number
Email Address
Restrictions
First Name Last Name / Title
Phone Number / Fax Number
Email Address
Restrictions

6. Head of Trading

Please provide the name, telephone number and email address of the person designatedas head of trading.

First Name Last Name / Title
Phone Number / Fax Number
Email Address
  1. Chief Compliance Officer

Please provide the name, telephone number and email address of the person designatedas the Applicant’s compliance officer. You may also provide contact details for back-up compliance officers.

First Name Last Name (Primary) / Title
Phone Number / Fax Number
Email Address
First Name Last Name (Secondary) / Title
Phone Number / Fax Number
Email Address
  1. Technical Contact

Please provide the name, telephone number and email address of the person(s) appointed as the Applicant’s technical/operations person(s) for connectivity and technical implementation information.

First Name Last Name (Primary) / Title
Phone Number / Fax Number
Email Address
First Name Last Name (Secondary) / Title
Phone Number / Fax Number
Email Address
  1. Back Office Contact:

Please provide the name, telephone number and email address of the person(s) to whom the exchange should send fill reports, outstanding order and jitney reports.

First Name Last Name (Primary) / Title
Phone Number / Fax Number
Email Address
First Name Last Name (Secondary) / Title
Phone Number / Fax Number
Email Address
  1. Dealer TSX Trading Number (If Assigned):

11.CDS Clearing Number (CUID Code):

If the Applicant has a clearing arrangement with another firm that is not a Dealer, please request a clearing agreement from the CSE. This form must be completed by the Applicant and the clearing member.

Part 2Dealer Banking Information:

A dealer that has been approvedshall pay the set up fee,as may be amended by the CSE from time to time, and any applicable taxes, before beginning to trade on the TradingSystem. If suchfee is not received within 30 days of approval,such approvalshall lapse.

A Dealer shall pay such fees and charges as fixed by the CSE, which shall become due and payable to CNSX Markets Inc. within the payment terms specified on the invoice.

This application must be accompanied with a cheque representing the full set upfee and any applicable taxes as well as a void cheque and pre-authorized debit (PAD) or CDS Authorization for the automatic withdrawal ofmonthly access and trading fees, if applicable.

Please provide the name, telephone number and email address of the contact person responsible for accounts payable.

First Name Last Name (Primary) / Title
Phone Number / Fax Number
Email Address
First Name Last Name (Secondary) / Title
Phone Number / Fax Number
Email Address

GST/HST Registration Number:

Part 3Certification:

The Applicant hereby certifies that the foregoing statements are true and correct to the best of its knowledge and hereby undertakes to notify the CSEin writing of any material changes herein as prescribed in the Rules.

Dated at this day of

By

Print Name of Applicant
Print Name of Authorized Signatory
Title of Authorized Signatory
Signature of Authorized Signatory

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CSE DEALER AGREEMENT

This Agreement made as of the day of, 2016

Between:

CNSX Markets Inc.

220 Bay Street, 9th Floor

Toronto, OntarioM5J 2W4

(“CSE”)

-And-

Name of Dealer
Address
Address
Address
(the “Applicant”)

In consideration for being granted access to trade on the TradingSystem, the Applicant agrees to the terms set out in this Agreement.

The Applicant affirms that it has completed the CSE Dealer Application and will keep the information therein up to date. It also affirms that it is a member in good standing of the Investment Industry Regulatory Organization of Canada (“IIROC”) and is registered with the Ontario Securities Commission or other applicable Canadian securities regulatory authority. The Applicant agrees that so long as it remains a participating Dealer it will remain a member of IIROC and will remain registered under the applicable securities laws.

The Applicant acknowledges that it has received a copy of the CSE Rules and agrees to comply with all CSE Requirements, as amended from time to time. The Applicant undertakes to ensure that, as a term of their employment, all partners, directors, officers and other persons authorized to trade on the Trading System or advise on the trading of securities on the Trading System, or any other employee to the extent that such employee has the approval of a self-regulatory organization ("Approved Person") are aware of the CSE Requirements and will be made aware of any amendment or addition to the CSE Requirements.

The Applicant submits to the jurisdiction of the CSEand to the Market Regulator, including without limitation the ability of the CSEand the Market Regulator to monitor the conduct of the Applicant, its Related Persons and agents,and to enforce compliance with the CSE Requirements.

The Applicant agrees to have all Approved Personsagree, as a term of their employment, to comply with any orders or directions from the CSEor the Market Regulator, including an order or direction prohibiting the Applicant or any Related Person, including any Approved Person of the Applicant, from trading on the CSE System, subject to any right to appeal such order or direction under the CSE Requirements or applicable securities law.

The Applicant agrees to provide the CSEor the Market Regulator with any assistance reasonably requested in conducting an investigation and with information, files, data or documents reasonably requested by the CSEor the Market Regulator.

Terms used in this Agreement shall have the meaning ascribed to them in Rule 1 of the CSE Rules, unless the context otherwise requires.

This Agreement will be binding on and enure to the benefit of the parties and their respective successors and permitted assigns. The Applicant must advise the CSE as soon as practicable of any name or ownership changes and may not assign this Agreement without the prior written consentof the CSE.

This Agreement will terminate upon the termination of the Applicant as a CSE Dealer in accordance with the CSE Requirements.

Dated at this day of

By

Print Name of Applicant
Print Name of Authorized Signatory
Title of Authorized Signatory
Signature of Authorized Signatory

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