Common use of Name of Transferor Clause in Contracts

Name of Transferor. REASON FOR TRANSFER – For US Residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). Gift Estate Private Sale Other (or no change in ownership) Date of Event (Date of gift, death or sale): Value per Warrant on the date of event: CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLY

Name of Transferor. REASON FOR TRANSFER – For US Residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). Gift Estate Private Sale Other (or no change in ownership) Date of Event (Date of gift, death or sale): Value per Warrant on the date of event: CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLY

Name of Transferor. REASON FOR TRANSFER – For US Residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). Gift in ownership) Estate Private Sale Other (or no change in ownership) Date of Event (Date of gift, death or sale): Value per Warrant on the date of event: CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLYCAD OR

Name of Transferor. REASON FOR TRANSFER – For US Residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). Gift ownership) Estate Private Sale Other (or no change in ownership) Date of Event (Date of gift, death or sale): Value per Warrant on the date of event: CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLY

Name of Transferor. REASON FOR TRANSFER – For US Residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). Gift Estate Private Sale Other (or no change in ownership) Date of Event (Date of gift, death or sale): Value per Warrant on the date of event: CAD OR USD CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLY

Name of Transferor. REASON FOR TRANSFER – For US Residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). Gift Estate Private Sale Other (or no change in ownership) Date of Event (Date of gift, death or sale): Value per Warrant on the date of event: CAD OR USD CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLY

Name of Transferor. REASON FOR TRANSFER – For US Residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). Gift Estate Private Sale Other (or no change in ownership) Date of Event (Date of gift, death or sale): Value per Warrant on the date of event: CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLY

Name of Transferor. REASON FOR TRANSFER – For US Residents only (where the individual(s) or corporation receiving the securities is a US resident). Please select only one (see instructions below). Gift ownership) Estate Private Sale Other (or no change in ownership) Date of Event (Date of gift, death or sale): Value per Warrant Right on the date of event: CAD OR USD CERTAIN REQUIREMENTS RELATING TO TRANSFERS – READ CAREFULLY