Account Registration Information. (Account Registration) _________________________________________ (Address) _________________________________________ Delivery Instructions as set forth below: _________________________________________ (Name) _________________________________________ (Address) _________________________________________ (Telephone Number)
Account Registration Information. (Name) (Account Reference, if applicable) (Address, including Postal Code) Delivery Instructions as set forth below: (Name) (Account Reference, if applicable) (Address) (Contact Name) (Telephone Number)
Account Registration Information. (Name) (Account Reference, if applicable) (Address, including Postal Code) Delivery Instructions as set forth below: Same as registered address, or (Name) (Account Reference, if applicable) (Address) (Contact Name) (Telephone Number) Number and kind of securities of the Corporation held, if any: Each of the Corporation and the Subscriber hereby acknowledges that it has consented and requested that all documents evidencing or relating in any way to the Purchased Shares and this Subscription Agreement be drawn up in the English language only. La Société et le souscripteur reconnaissent par les présentes avoir consenti et demandé que tous les documents faisant foi ou se rapportant de quelque manière a la vente d’actions ordinaires de la société et à la présente convention de souscription soient rédigés en anglais seulement.
Account Registration Information. (Name) __________________________________________ (Account Reference, if applicable) __________________________________________ (Address, including Postal Code) __________________________________________ __________________________________________ __________________________________________ Delivery Instructions: __________________________________________ (Name) __________________________________________ (Account Reference, if applicable) __________________________________________ (Address, including Postal Code) __________________________________________ __________________________________________ (Telephone Number) __________________________________________ (Contact Name) XXXXXXX XX XXXXXX PURCHASER CERTIFICATE (Purchaser Resident in a Jurisdiction Outside of Canada) The undersigned Purchaser represents, covenants and certifies to you that:
Account Registration Information. Same as Purchaser Information or (Name) (Account Reference, if applicable) (Email Address) (Address, including Postal Code) The Purchaser acknowledges that the Agent will receive a syndication fee and commission from the Partnership of up to 6% of the Subscription Amount. THE FEDERAL IDENTIFICATION NUMBER FOR THIS TAX SHELTER IS TS-092536. THE IDENTIFICATION NUMBER ISSUED FOR THIS TAX SHELTER IS REQUIRED TO BE INCLUDED IN ANY INCOME TAX RETURN FILED BY THE INVESTOR. ISSUANCE OF THE IDENTIFICATION NUMBER IS FOR ADMINISTRATIVE PURPOSES ONLY AND DOES NOT IN ANY WAY CONFIRM THE ENTITLEMENT OF AN INVESTOR TO CLAIM ANY TAX BENEFITS ASSOCIATED WITH THE TAX SHELTER OR WITH AN INVESTMENT IN THE UNITS. Dated this day of , 2021. ) ) ) ) (Signature of Purchaser) ) ) Print Name of Signatory ) (if different from Purchaser) set forth above this day of , 2021. Per:
Account Registration Information. (Name) (Account Reference, if applicable) (Address, including Postal Code) Delivery Instructions as set forth below: (Name) (Account Reference, if applicable) (Address) (Contact Name) (Telephone Number) Number and kind of securities of the Corporation held, directly or indirectly, if any:________________________________________________________________________________________ State whether Subscriber is an Insider (as defined herein) of the Corporation: Yes FORMCHECKBOX No FORMCHECKBOX State whether Subscriber is a Registrant (as defined herein) of the Corporation: Yes FORMCHECKBOX No FORMCHECKBOX State whether Subscriber is a Related Person (as defined herein) of the Corporation: Yes FORMCHECKBOX No FORMCHECKBOX State whether Subscriber is a member of a Pro Group: Yes FORMCHECKBOX No FORMCHECKBOX
Account Registration Information. (Name) (Account Reference, if applicable) (Address, including Postal or Zip Code) Number and kind of securities of the Company held, directly or indirectly, if any: Number of Units: xUS$2.30 Aggregate Subscription Cost: (the “Subscription Amount”) (Name of Disclosed Principal) (Address of Disclosed Principal) (Account Reference, if applicable) Delivery Instructions as set forth below: (Name) (Account Reference, if applicable) (Address) (Contact Name) (Telephone Number)
Account Registration Information. (Name) (Account Reference, if applicable) (Address, including Postal Code) TSXV Corporate Placee Registration Form: The Subscriber, if not an individual and (i) holds, or will hold upon completion of the Offering (as defined herein), more than 5% of the issued and outstanding common shares of the Corporation on a Diluted or Undiluted basis (as such terms are defined herein); (ii) is, or will upon completion of the Offering be, an Insider; or (iii) is an Aggregate Pro Group (as defined herein) the Subscriber, either: [CHECK APPROPRIATE] ______ has previously filed with the TSX Venture Exchange a Form 4C, Corporate Placee Registration Form, and represents and warrants that there has been no change to any of the information in the Form 4C previously filed with the TSX Venture Exchange up to the date of this Subscription Agreement; or ______ hereby delivers to the Corporation a duly signed and completed Form 4C Corporate Placee Registration Form, in the form attached hereto as Schedule “D” for filing with the TSX Venture Exchange.
Account Registration Information. (Name) (Account Reference, if applicable) (Address, including Postal / Zip Code)
Account Registration Information. (Name) (Account Reference, if applicable) (Address, including Postal Code) (Name) (Account Reference, if applicable) (Address, including Postal Code) (Telephone Number) (Contact Name) XXXXXXX XX XXXXXX PURCHASER CERTIFICATE (Purchaser Resident in a Jurisdiction Outside of Canada) The undersigned Purchaser represents, covenants and certifies to you that:
