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. TERMS AND CONDITIONS OF SUBSCRIPTION FOR COMMON SHARES
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) XXXXXXXX X XXXXXXX XX XXXXXX PURCHASER CERTIFICATE (Purchaser Resident in a Jurisdiction Outside of Canada) TO: Western Magnesium Corporation (the “Company”) RE: Private Placement (the “Offering”) of Convertible Debenture of the Company (the “Purchased Securities”) 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) IMPORTANT NOTE: The General Partner may reject subscriptions which are not properly completed including, in particular, failure to provide the Purchaser’s social insurance or corporation account number. 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. Print Name of Purchaser ) ) ) ) (Signature of Purchaser) ) ) Print Name of Signatory ) (if different from Purchaser) Acceptance: CORDILLERA MINERALS 2021 FLOW-THROUGH LIMITED PARTNERSHIP accepts the subscription set forth above this day of , 2021. CORDILLERA MINERALS 2021 FLOW-THROUGH LIMITED PARTNERSHIP by its General Partner, CORDILLERA MINERALS 2021 MANAGEMENT LTD. Per: Authorized Signatory Subscription Agreement – Cordillera 2021 1. INTERPRETATION 1
Account Registration Information. (Name) ____________________________________________________________ (Account Reference, if applicable) ____________________________________________________________ ____________________________________________________________ (Address, including Postal or Zip Code) Delivery Instructions: ____________________________________________________________ (Name) ____________________________________________________________ (Account Reference, if applicable) ____________________________________________________________ ____________________________________________________________ (Address, including Postal or Zip Code) ____________________________________________________________ (Telephone Number) (Fax Number) ____________________________________________________________ (Contact Name) It is anticipated that the Unit Shares purchased hereunder will be deposited electronically with The Depository Trust Corporation (“DTC”) system or through participants, including CDS Clearing and Depository Services Inc. (“CDS”) through its book-based system administered by CDS on the Closing Date (as defined herein). In such case, the Subscriber (as defined herein) understands and acknowledges that securities purchased hereunder will be registered in the name of Cede & Co. (DTC’s nominee), CDS, or its nominee, and held by, or on behalf of, DTC or CDS and the Subscriber will not be entitled to receive definitive certificates or other instruments from the Company or DTC or CDS representing their interest in the securities purchased hereunder. The Subscriber will receive only a customer confirmation from the registered dealer who is a DTC or CDS participant and from or through whom the securities hereunder are purchased against payment of the Purchase Price. It is also anticipated that the Warrants and Additional Warrants will be delivered Warrants will only be delivered in certificated form (such as via Computershare’s Quickcert system) or on a non-certificated basis under a Direct Registration System (DRS) maintained by the Warrant Agent, and the books and records shall bear a notation that the Warrants were sold in reliance upon Regulation A. APPENDIX A An accredited investor includes the following categories of investor:
Account Registration Information. To sign up to use our Services, we collect: First and last name; Company name; Company website; Company email; Telephone number; and Country.
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 Special Warrants: xUS$3.25 Aggregate Subscription Cost: (the “Subscription Amount”) Please complete if purchasing as Agents or trustee for a principal (beneficial purchaser) (a “Disclosed Principal”) and not purchasing as trustee or Agents for accounts fully managed by it. (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) TERMS AND CONDITIONS OF SUBSCRIPTION FOR SPECIAL WARRANTS
Account Registration Information. (Name) ______________________________________________________ (Account Reference, if applicable) ______________________________________________________ ______________________________________________________ (Address, including Postal or Zip Code) Delivery Instructions: ______________________________________ (Name) ______________________________________ (Account Reference, if applicable) ______________________________________ ______________________________________ (Address, including Postal or Zip Code) ______________________________________ (Telephone Number) (Fax Number) ______________________________________ (Contact Name) APPENDIX A An accredited investor includes the following categories of investor:
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 Return by: June 15, 2023 Return as directed by the Corporation
