Registration Instructions. If the certificate(s) representing the securities are to be registered in other than the name of the Subscriber. Name: _____________________________________ Address: ______________________________________ (Xxxxxx Xxxxxxx) _____________________________________ _____________________________________ (City and Province / State) _____________________________________ (Country and Postal / Zip Code) Delivery Instructions: If the certificate(s) representing the securities are to be delivered to someone other than the Subscriber. Name: _____________________________________ Contact Name: _________________________________ Telephone No.: _________________________________ Address: ______________________________________ (Xxxxxx Xxxxxxx) _____________________________________ _____________________________________ (City and Province / State) _____________________________________ (Country and Postal / Zip Code)
Appears in 4 contracts
Samples: Private Placement Subscription Agreement (Kirkland Lake Gold Inc), Subscription Agreement (Kirkland Lake Gold Inc), Kirkland Lake Gold Inc
