SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below.
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below Number of Units: (Name of Subscriber) Unit Price: X $3.85 Account Reference (if applicable): Aggregate Subscription Price: By: (the “Subscription Price”) Authorized Signature (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Name of Principal) (Subscriber’s Address, including State) (Principal’s Address) (Telephone Number) (Email Address)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print ALL information (other than signatures), as applicable, in the space provided below (Name of Subscriber): Number of Common Shares: x $0.45 Account Reference (if applicable): = Aggregate Subscription Price: By: (the "Subscription Price") Authorized Signature (Official Capacity or Title – if the Subscriber is not an individual) If the Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: (Name of individual whose signature appears above if different than the name of the subscriber printed above.) (Name of Principal) (Subscriber's Address, including Municipality and Province) (Principal's Address) S.I.N. or Taxation Account of Subscriber (Telephone Number) (Email Address) Account Registration Information: Delivery Instructions as set forth below: (Name) (Name) (Account Reference, if applicable) (Address, including Zip Code) (Address, including Postal Code) (Account Reference, if applicable) (Contact Name) (Telephone Number) Number and kind of securities of the Corporation held, directly or indirectly, if any: 1. State whether Subscriber is an Insider (as such term is hereinafter defined) of the Corporation: Yes ¨ No ¨
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Aggregate Subscription Price: (the “Subscription Amount”) Number of Units: x $0.20 (Name of Disclosed Principal) (Residential Address of Disclosed Principal) (Telephone Number of Disclosed Principal) (Account Reference, if applicable) Please print all information (other than signatures), as applicable, in the space provided below Subscriber Information and Signature (Name of Subscriber) Account Reference (if applicable): By: Authorized Signature (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Subscriber’s Residential Address, including Municipality and Province) (Address continued) (Subscriber’s Telephone Number) (Subscriber’s Email Address) **see Section 1.1 - “Definitions” in the attached Terms and Conditions for defined terms. (Name) (Account Reference, if applicable) (Address, including Postal Code) (Address continued)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below. Please also ensure all Schedules (as applicable) are completed and executed.
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print ALL information (other than signatures), as applicable, in the space provided below (Name of Subscriber): Number of Flow-Through Shares: x $0.30 Account Reference (if applicable): = Aggregate Subscription Price: By: (the "Subscription Price") Authorized Signature (Official Capacity or Title – if the Subscriber is not an individual) If the Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: (Name of individual whose signature appears above if different than the name of the subscriber printed above.) (Name of Principal) (Subscriber’s Address, including Municipality and Province) (Principal’s Address) S.I.N. or Taxation Account of Subscriber (Telephone Number) (Email Address)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print ALL information (other than signatures), as applicable, in the space provided below (Name of Subscriber):_________________________________ Number of Units:__________________________________x U.S.$1.00 Account Reference (if applicable):________________________________ = Aggregate Subscription Price:________________________________ (the "Subscription Price") By:_______________________________________________________ Authorized Signature (Official Capacity or Title – if the Subscriber is not an individual) If the Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, and in each case satisfying the criteria set forth in National Instrument 45-106, complete the following: (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Name of Principal) (Subscriber's Residential Address) (Principal's Residential Address) (Subscriber's Telephone Number) (Email Address) (Principal's Telephone Number)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below The Subscriber hereby provides the Corporation the following registration instructions in connection with the settlement of the Units being purchased hereunder and hereby directs the Corporation to issue and register the Units as follows. ____ (Name of Subscriber) By: __ (Authorized Signature) (Official Capacity or Title - please print) (Please print name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Subscriber’s Address including Postal Code) (Subscriber’s Address including Postal Code) _____________________ (Telephone Number) (Email Address) Number of $0.05 Units to be purchased:_________________ Aggregate Subscription amount $_ __________________ If the Subscriber is signing as agent for a principal, unless it is deemed to be purchasing as principal under NI 45-106 (as defined herein), complete the following and ensure that the applicable Exhibit(s) are completed on behalf of such principal: (Name of Principal) (Principal’s Address including Postal Code) Register the Offered Shares Exactly as set forth below: _______________________________________________ (Name) (Account reference, if applicable) (Address) (Address) Deliver the Offered Shares as set forth below: ___________________________________________ (Name) (Account reference, if applicable) (Contact Name) (Address)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print ALL information (other than signatures), as applicable, in the space provided below (Name of Subscriber) Account Reference (if applicable): By: Authorized Signature (Name of individual whose signature appears above if different than the name of the subscriber printed above) (Subscriber’s Address) (Telephone Number) (Email Address) Number of Units: ___________ x $0.20 Aggregate Subscription Amount:
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print ALL information (other than signatures), as applicable, in the space provided below (Name of Subscriber): By: Authorized Signatory (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Subscriber’s Address, including Municipality and Province) (Telephone Number) (Email Address) Insider o Registrant o Please indicate if you are an Insider of the Corporation or a Registrant in British Columbia. (See pages 3 and 4 for definitions) Number of Units: _________________________ x $0.20 = (the “Subscription Amount”)
