TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
1. About your investment SECTIONS 2 TO 4 TO BE COMPLETED BY THE SUBSCRIBER
2. Risk acknowledgement
3. Accredited investor status
4. Your name and signature SECTION 5 TO BE COMPLETED BY THE SALESPERSON
5. Salesperson information
TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
1. About your investment SECTIONS 2 TO 4 TO BE COMPLETED BY THE PURCHASER
2. Risk acknowledgement
TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
1. About your investment
2. Risk acknowledgement
3. Accredited investor status
4. Your name and signature
TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
6. For more information about this investment
1. it is not resident in Canada;
2. it is acquiring the Shares for its own account, for investment purposes only and not with a view to any resale, distribution or other disposition of the Shares in violation of the United States securities laws;
3. it (i) has adequate net worth and means of providing for its current financial needs and possible personal contingencies, (ii) has no need for liquidity in this investment, and (iii) is able to bear the economic risks of an investment in the Shares for an indefinite period of time;
4. if the Subscriber is an individual (that is, a natural person and not a corporation, partnership, trust or other entity), then it satisfies one or more of the categories indicated below (please place an “X” on the appropriate lines): __________ a natural person whose individual net worth, or joint net worth with that person’s spouse, exceeds US$1,000,000. For purposes of this category, “net worth” means the excess of total assets at fair market value (including personal and real property, but excluding the estimated fair market value of a person’s primary home) over total liabilities. Total liabilities excludes any mortgage on the primary home in an amount of up to the home’s estimated fair market value as long as the mortgage was incurred more than 60 days before the Shares are purchased, but includes (i) any mortgage amount in excess of the home’s fair market value and (ii) any mortgage amount that was borrowed during the 60 day period before the Closing Date for the purpose of investing in the Shares, __________ a natural person who had an individual income in excess of US$200,000 in each of the two most recent years, or joint income with their spouse in excess of US$300,000 in each of those years, and has a reasonable expectation of reaching the same income level in the current year, or __________ a director or executive officer of the Issuer;
5. if the Subscriber is a corporation, partnership, trust or other entity), then it satisfies one or more of the categories indicated below (please place an “X” on the appropriate lines): __________ an organization described in Section 501(c)(3) of the United States Internal Revenue Code, a corporation, a Massachusetts or similar business trust or partnership, not formed for the specific purpose of acquiring the Shares, with total assets in excess of US$5,000,000,
TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
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.
TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
6. For more information about this investment
1. it is not resident in Canada;
2. it is acquiring the Shares for its own account, for investment purposes only and not with a view to any resale, distribution or other disposition of the Shares in violation of the United States securities laws;
3. it
TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
1. About your investment
2. Risk acknowledgement
TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
1. About your investment SECTIONS 2 TO 4 TO BE COMPLETED BY THE PURCHASER
2. Risk acknowledgement This investment is risky. Initial that you understand that: Your initials Risk of loss - You could lose your entire investment of $___________ . [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
4. Your name and signature
TO BE COMPLETED BY THE ISSUER OR SELLING. SECURITY HOLDER
6. For more information about this investment
