TO BE COMPLETED BY THE ISSUER Sample Clauses

TO BE COMPLETED BY THE ISSUER. 6. For more information about this investment
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TO BE COMPLETED BY THE ISSUER. 1. About your investment SECTIONS 2 TO 4 TO BE COMPLETED BY THE PURCHASER 2. Risk acknowledgement 3. Family, friend or business associate status A) You are: 1) [check all applicable boxes] 2) [check all applicable boxes] B) You are a family member of ____________________________________ [Instruction: Insert the name of the person who is your relative either directly or through his or her spouse], who holds the following position at the issuer or an affiliate of the issuer: _______________________________. You are the ____________________________ of that person or that person’s spouse. [Instruction: To qualify for this investment, you must be (a) the spouse of the person listed above or (b) the parent, grandparent, brother, sister, child or grandchild of that person or that person’s spouse.] Form 1C- 2 - Form 45-106F12 C) You are a close personal friend of _______________________________ [Instruction: Insert the name of your close personal friend], who holds the following position at the issuer or an affiliate of the issuer: _______________________________. You have known that person for _____ years. D) You are a close business associate of ______________________________ [Instruction: Insert the name of your close business associate], who holds the following position at the issuer or an affiliate of the issuer: ____________________________. You have known that person for _____ years. 4. Your name and signature
TO BE COMPLETED BY THE ISSUER. 1. About your investment SECTIONS 2 TO 4 TO BE COMPLETED BY THE PURCHASER 2. Risk acknowledgement Liquidity risk – You may not be able to sell your investment quickly – or at all. Lack of Information – You may receive little or no information about your investment. The information you receive may be limited to the information provided to you by the family member, friend or close business associate specified in Section 3 of this form.
TO BE COMPLETED BY THE ISSUER. 1. About your investment SECTION 2 TO 4 TO BE COMPLETED BY THE PURCHASER 2. Risk acknowledgement [Instruction: initial all boxes in Section 2] 3. Family, friend or business associate status [Instruction: initial one or more boxes that apply] A. You are: 4. 1. [check all applicable boxes] ¨ a director of the issuer or an affiliate of the issuer ¨ an executive officer of the issuer or an affiliate of the issuer ¨ a control person of the issuer or an affiliate of the issuer ¨ a founder of the issuer 5. OR 2. [check all applicable boxes] ¨ a person of which a majority of the voting securities are beneficially owned by, or a majority of the directors are, (i) individuals listed in (1) above and/or (ii) family members, close personal friends or close business associates of individuals listed in (1) above ¨ a trust or estate of which all of the beneficiaries or a majority of the trustees or executors are (i) individuals listed in (1) above and/or (ii) family members, close personal friends or close business associates of individuals listed in (1) above A. You are a family member of [Instruction: Insert the name of the person who is your relative either directly or through his or her spouse], who holds the following position affiliate of the issuer: . You are the of that person or that person's spouse. [Instruction: To qualify for this investment, the person listed above must be (a) your spouse or (b) your or your spouse's parent, grandparent, brother, sister, child or grandchild.] B. You are a close personal friend of [Instruction: Insert the name of your close personal friend], who holds the following position at the issuer or an affiliate of the issuer: . You have known that person for years. C. You are a close business associate of [Instruction: Insert the name of your close business associate], who holds the following position at the issuer or an affiliate of the issuer: . You have known that person for years.
TO BE COMPLETED BY THE ISSUER. 1. About your investment Type of securities: Shares of common stock of the Issuer (“Shares”) and warrants to purchase Shares Issuer: XxxXxx Pharmaceuticals, Inc. (the “Issuer”) Purchased from: the Issuer 2. Risk acknowledgement This investment is risky. Initial that you understand that: Your initials Risk of loss – You could lose your entire investment of U.S.$ [Instruction: Insert the total dollar amount of the investment.] Liquidity risk – You may not be able to sell your investment quickly – or at all. Lack of information – You may receive little or no information about your investment. Lack of advice – You will not receive advice from the salesperson about whether this investment is suitable for you unless the salesperson is registered. The salesperson is the person who meets with, or provides information to, you about making this investment. To check whether the salesperson is registered, go to xxx.xxxxxxxxxxxxxxxxx.xx. 3. Accredited investor status You must meet at least one of the following criteria to be able to make this investment. Initial the statement that applies to you. (You may initial more than one statement.) The person identified in section 6 is responsible for ensuring that you meet the definition of “accredited investor” as such term is defined in National Instrument 45-106 – Prospectus Exemptions. That person, or the salesperson identified in section 5, can help you if you have questions about whether you meet these criteria. Your initials · Your net income before taxes was more than $200,000 in each of the two most recent calendar years, and you expect it to be more than $200,000 in the current calendar year. (you can find your net income before taxes on your personal income tax return.) · Your net income before taxes combined with your spouse’s was more than $300,000 in each of the two most recent calendar years, and you expect your combined net income before taxes to be more than $300,000 in the current calendar year. · Either alone or with your spouse, you own more than $1 million in cash and securities, after subtracting any debt related to the cash and securities. · Either alone or with your spouse, you have net assets worth more than $5 million. (Your net assets are your total assets (including real estate) minus your total debt.) 4. Your name and signature By signing this form, you confirm that you have read this form and you understand the risks of making this investment as identified in this form. First and last name (please ...
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TO BE COMPLETED BY THE ISSUER. 1. About Your Investment SECTIONS 2 TO 4 TO BE COMPLETED BY THE PURCHASER 2. Risk Acknowledgement Your Initials Joint Subscriber Initials Lack of advice – You will not receive advice from the dealer/advisor; about whether this investment is suitable for you unless the dealer/advisor is registered. The dealer/advisor
TO BE COMPLETED BY THE ISSUER. 6. For more information about this investment (a) The Subscriber is a resident of a country (an “International Jurisdiction”) other than Canada or the United States and the decision to subscribe for the Purchased Shares was taken in such International Jurisdiction. (b) The delivery of the Subscription Agreement, the acceptance of it by the Company and the issuance of the Purchased Shares to the Subscriber complies with all laws applicable to the Subscriber, including the laws of such Subscriber’s jurisdiction of residence, and all other applicable laws, and will not cause the Company to become subject to, or require it to comply with, any disclosure, prospectus, filing or reporting requirements under any applicable laws of the International Jurisdiction. (c) The Subscriber is knowledgeable of, or has been independently advised as to, the application or jurisdiction of the securities laws of the International Jurisdiction that would apply to the subscription (other than the securities laws of Canada and the United States). (d) The Subscriber is purchasing the Purchased Shares pursuant to exemptions from the prospectus and registration requirements (or their equivalent) under the applicable securities laws of that International Jurisdiction or, if such is not applicable, each is permitted to purchase the Purchased Shares under the applicable securities laws of the International Jurisdiction without the need to rely on an exemption. (e) The applicable securities laws do not require the Company to register the Purchased Shares file a prospectus or similar document, or make any filings or disclosures or seek any approvals of any kind whatsoever from any regulatory authority of any kind whatsoever in the International Jurisdiction. (f) The Subscriber will, if requested by the Company, deliver to the Company a certificate or opinion of local counsel from the International Jurisdiction that will confirm the matters referred to in subparagraphs (b), (d) and (e) above to the satisfaction of the Company, acting reasonably. (g) The Subscriber will not sell, transfer or dispose of the Purchased Shares except in accordance with all applicable laws, including applicable securities laws of Canada and the United States, and the Subscriber acknowledges that the Company shall have no obligation to register any such purported sale, transfer or disposition which violates applicable Canadian or United States or other securities laws. (h) Upon execution of this Schedule B by the...
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