Common use of For Purchasers of Securities Purchased Pursuant to a Prospectus Exemption Clause in Contracts

For Purchasers of Securities Purchased Pursuant to a Prospectus Exemption. Purchasers resident in Canada are hereby notified that: a. personal information pertaining to purchasers and details of the distribution will be delivered to the securities regulatory authority or regulator, which in- formation includes, but is not limited to: i. the legal name, residential address, telephone number and e-mail ad- dress (if available) of the purchaser; ii. details of the securities purchased, including the date of distribution, the number and type of securities and the amount paid (expressed in Can- adian dollars); and iii. the details of the exemption relied upon. (Please see Schedules 1 and 2 of Form 45-106F1 Report of Exempt Distri- bution which is available at xxx.xxx.xxx.xx.xx for full details of the informa- tion required to be delivered); b. this information is being collected by the securities regulatory authority or regulator under the authority granted in securities legislation; c. this information is being collected for the purposes of the administration and enforcement of the securities legislation of the local jurisdiction; and d. while this information will not be placed on the public file of any securities regulatory authority or regulator, freedom of information legislation may re- quire the securities regulatory authority or regulator to make this information available if requested. By submitting a subscription agreement, you authorize such indirect collection of this information by the securities regulatory authority or regulator. With the exception of subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this information should be directed to: Inquiries Offi- cer, Ontario Securities Commission, 00 Xxxxx Xxxxxx Xxxx, 00xx Xxxxx, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. For subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this informa- tion should be directed to: Information Officer, Alberta Securities Commission, Suite 000, 000 - 0xx Xxxxxx XX, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. The Subscriber agrees to indemnify the Fund and the Manager, against all losses, claims, costs, expenses and damages or liabilities which it may suffer or incur or cause arising from the reliance on the representations, warranties, certifications and covenants of the Subscriber by the Fund or the Manager, as the case may be, and the breach of any of them by the Subscriber.

For Purchasers of Securities Purchased Pursuant to a Prospectus Exemption. Purchasers resident in Canada are hereby notified that: a. personal information pertaining to purchasers and details of the distribution will be delivered to the securities regulatory authority or regulator, which in- formation includes, but is not limited to: i. the legal name, residential address, telephone number and e-mail ad- dress (if available) of the purchaser; ii. details of the securities purchased, including the date of distribution, the number and type of securities and the amount paid (expressed in Can- adian dollars); and iii. the details of the exemption relied upon. (Please see Schedules 1 and 2 of Form 45-106F1 Report of Exempt Distri- bution which is available at xxx.xxx.xxx.xx.xx for full details of the informa- tion required to be delivered); b. this information is being collected by the securities regulatory authority or regulator under the authority granted in securities legislation; c. this information is being collected for the purposes of the administration and enforcement of the securities legislation of the local jurisdiction; and d. while this information will not be placed on the public file of any securities regulatory authority or regulator, freedom of information legislation may re- quire the securities regulatory authority or regulator to make this information available if requested. By submitting a subscription agreement, you authorize such indirect collection of this information by the securities regulatory authority or regulator. With the exception of subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this information should be directed to: Inquiries Offi- cer, Ontario Securities Commission, 00 Xxxxx Xxxxxx Xxxx, 00xx Xxxxx, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. For subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this informa- tion should be directed to: Information Officer, Alberta Securities Commission, Suite 000, 000 - 0xx Xxxxxx XX, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000403) 000-0000. The Subscriber agrees to indemnify the Fund and the Manager, against all losses, claims, costs, expenses and damages or liabilities which it may suffer or incur or cause arising from the reliance on the representations, warranties, certifications and covenants of the Subscriber by the Fund or the Manager, as the case may be, and the breach of any of them by the Subscriber.

For Purchasers of Securities Purchased Pursuant to a Prospectus Exemption. Purchasers resident in Canada are hereby notified that: a. personal information pertaining to purchasers and details of the distribution will be delivered to the securities regulatory authority or regulator, which in- formation includes, but is not limited to: i. the legal name, residential address, telephone number and e-mail ad- dress (if available) of the purchaser; ii. details of the securities purchased, including the date of distribution, the number and type of securities and the amount paid (expressed in Can- adian dollars); and iii. the details of the exemption relied upon. Subscription Agreement and Application Form Portland India Select Business Portfolio inc. 12 PIC1011-E(12/10) CANADIAN INVESTORS SUBSCRIPTION INSTRUCTIONS AND AGREEMENT Subscription Agreement and Application Form Portland India Select Business Portfolio inc. 12 (Please see Schedules 1 and 2 of Form 45-106F1 Report of Exempt Distri- bution which is available at xxx.xxx.xxx.xx.xx for full details of the informa- tion required to be delivered); b. this information is being collected by the securities regulatory authority or regulator under the authority granted in securities legislation; c. this information is being collected for the purposes of the administration and enforcement of the securities legislation of the local jurisdiction; and d. while this information will not be placed on the public file of any securities regulatory authority or regulator, freedom of information legislation may re- quire the securities regulatory authority or regulator to make this information available if requested. By submitting a subscription agreement, you authorize such indirect collection of this information by the securities regulatory authority or regulator. With the exception of subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this information should be directed to: Inquiries Offi- cer, Ontario Securities Commission, 00 Xxxxx Xxxxxx Xxxx, 00xx Xxxxx, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. For subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this informa- tion should be directed to: Information Officer, Alberta Securities Commission, Suite 000, 000 - 0xx Xxxxxx XX, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. The Subscriber agrees to indemnify the Fund and the Manager, against all losses, claims, costs, expenses and damages or liabilities which it may suffer or incur or cause arising from the reliance on the representations, warranties, certifications and covenants of the Subscriber by the Fund or the Manager, as the case may be, and the breach of any of them by the Subscriber.

For Purchasers of Securities Purchased Pursuant to a Prospectus Exemption. Purchasers resident in Canada are hereby notified that: a. personal information pertaining to purchasers and details of the distribution will be delivered to the securities regulatory authority or regulator, which in- formation includes, but is not limited to: i. the legal name, residential address, telephone number and e-mail ad- dress (if available) of the purchaser; ii. details of the securities purchased, including the date of distribution, the number and type of securities and the amount paid (expressed in Can- adian dollars); and iii. the details of the exemption relied upon. (Please see Schedules 1 and 2 of Form 45-106F1 Report of Exempt Distri- bution which is available at xxx.xxx.xxx.xx.xx for full details of the informa- tion required to be delivered); ; PORTLAND INDIA SELECT BUSINESS PORTFOLIO INC. 12 PIC1011-E(12/10) CANADIAN INVESTORS b. this information is being collected by the securities regulatory authority or regulator under the authority granted in securities legislation; c. this information is being collected for the purposes of the administration and enforcement of the securities legislation of the local jurisdiction; and d. while this information will not be placed on the public file of any securities regulatory authority or regulator, freedom of information legislation may re- quire the securities regulatory authority or regulator to make this information available if requested. By submitting a subscription agreement, you authorize such indirect collection of this information by the securities regulatory authority or regulator. With the exception of subscribers of Portland Focused Plus Fund LP, questions Questions about such indirect collection of this information should be directed to: Inquiries Offi- cerInquir- ies Officer, Ontario Securities Commission, 00 Xxxxx Xxxxxx Xxxx, 00xx Xxxxx, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. For subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this informa- tion should be directed to: Information Officer, Alberta Securities Commission, Suite 000, 000 - 0xx Xxxxxx XX, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. The Subscriber agrees to indemnify the Fund and the Manager, against all losses, claims, costs, expenses and damages or liabilities which it may suffer or incur or cause arising from the reliance on the representations, warrantieswarran- ties, certifications and covenants of the Subscriber by the Fund or the ManagerMan- ager, as the case may be, and the breach of any of them by the Subscriber.

For Purchasers of Securities Purchased Pursuant to a Prospectus Exemption. Purchasers resident in Canada are hereby notified that: a. personal information pertaining to purchasers and details of the distribution will be delivered to the securities regulatory authority or regulator, which in- formation includes, but is not limited to: i. the legal name, residential address, telephone number and e-mail ad- dress (if available) of the purchaser; ii. details of the securities purchased, including the date of distribution, the number and type of securities and the amount paid (expressed in Can- adian dollars); and iii. the details of the exemption relied upon. (Please see Schedules 1 and 2 of Form 45-106F1 Report of Exempt Distri- bution which is available at xxx.xxx.xxx.xx.xx for full details of the informa- tion required to be delivered); b. this information is being collected by the securities regulatory authority or regulator under the authority granted in securities legislation; c. this information is being collected for the purposes of the administration and enforcement of the securities legislation of the local jurisdiction; and d. while this information will not be placed on the public file of any securities regulatory authority or regulator, freedom of information legislation may re- quire the securities regulatory authority or regulator to make this information available if requested. By submitting a subscription agreement, you authorize such indirect collection of this information by the securities regulatory authority or regulator. With the exception of subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this information should be directed to: Inquiries Offi- cer, Ontario Securities Commission, 00 Xxxxx Xxxxxx Xxxx, 00xx Xxxxx, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. For subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this informa- tion should be directed to: Information Officer, Alberta Securities Commission, Suite 000, 000 - 0xx Xxxxxx XX, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. Subscription Agreement and Application Form Portland India Select Business Portfolio inc. 12 PIC1011-E(12/10) CANADIAN INVESTORS SUBSCRIPTION INSTRUCTIONS AND AGREEMENT Subscription Agreement and Application Form Portland India Select Business Portfolio inc. 12 The Subscriber agrees to indemnify the Fund and the Manager, against all losses, claims, costs, expenses and damages or liabilities which it may suffer or incur or cause arising from the reliance on the representations, warranties, certifications and covenants of the Subscriber by the Fund or the Manager, as the case may be, and the breach of any of them by the Subscriber.

For Purchasers of Securities Purchased Pursuant to a Prospectus Exemption. Purchasers resident in Canada are hereby notified that: a. personal information pertaining to purchasers and details of the distribution will be delivered to the securities regulatory authority or regulator, which in- formation includes, but is not limited to: i. the legal name, residential address, telephone number and e-mail ad- dress (if available) of the purchaser; ii. details of the securities purchased, including the date of distribution, the number and type of securities and the amount paid (expressed in Can- adian dollars); and iii. the details of the exemption relied upon. (Please see Schedules 1 and 2 of Form 45-106F1 Report of Exempt Distri- bution which is available at xxx.xxx.xxx.xx.xx for full details of the informa- tion required to be delivered); ; Portland India Select Business Portfolio inc. 12 PIC1011-E(12/10) CANADIAN INVESTORS b. this information is being collected by the securities regulatory authority or regulator under the authority granted in securities legislation; c. this information is being collected for the purposes of the administration and enforcement of the securities legislation of the local jurisdiction; and d. while this information will not be placed on the public file of any securities regulatory authority or regulator, freedom of information legislation may re- quire the securities regulatory authority or regulator to make this information available if requested. By submitting a subscription agreement, you authorize such indirect collection of this information by the securities regulatory authority or regulator. With the exception of subscribers of Portland Focused Plus Fund LP, questions Questions about such indirect collection of this information should be directed to: Inquiries Offi- cerInquir- ies Officer, Ontario Securities Commission, 00 Xxxxx Xxxxxx Xxxx, 00xx Xxxxx, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. For subscribers of Portland Focused Plus Fund LP, questions about such indirect collection of this informa- tion should be directed to: Information Officer, Alberta Securities Commission, Suite 000, 000 - 0xx Xxxxxx XX, Xxxxxxx, Xxxxxxx X0X 0X0, Telephone: (000) 000-0000. The Subscriber agrees to indemnify the Fund and the Manager, against all losses, claims, costs, expenses and damages or liabilities which it may suffer or incur or cause arising from the reliance on the representations, warrantieswarran- ties, certifications and covenants of the Subscriber by the Fund or the ManagerMan- ager, as the case may be, and the breach of any of them by the Subscriber.