Common use of TO BE COMPLETED BY THE REGISTRANT Clause in Contracts

TO BE COMPLETED BY THE REGISTRANT. 2. Registrant information [Instruction: this section must only be completed if a subscriber has received advice from a portfolio manager, investment dealer or exempt market dealer concerning his or her investment.] First and last name of registrant (please print): Registered as: [Instruction: indicate whether registered as a dealing representative or advising representative] Telephone: Email: Name of firm: [Instruction: indicate whether registered as an exempt market dealer, investment dealer or portfolio manager.] Date: SCHEDULE B ELIGIBLE INVESTOR QUESTIONNAIRE (Manitoba Residents - Offering Memorandum Required) The undersigned, as a purchaser of Shares (the “Shares”) of AP CAPITAL MORTGAGE INVESTMENT CORPORATION (the “Corporation”), has represented to the Corporation that the undersigned is an “eligible investor” as defined in section 1.1 of National Instrument 45-106 Prospectus Exemptions. The undersigned has indicated below the categories which it, he or she satisfies to qualify as an “eligible investor”. The undersigned understands that the Corporation is relying on this information in determining to sell securities to the undersigned in a manner exempt from the prospectus requirements of applicable securities laws. The undersigned represents and warrants that it, he or she is [check the applicable item]:

Appears in 3 contracts

Samples: Subscription Agreement, Subscription Agreement, Subscription Agreement

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TO BE COMPLETED BY THE REGISTRANT. 2. Registrant information [Instruction: this section must only be completed if a subscriber has received advice from a portfolio manager, investment dealer or exempt market dealer concerning his or her investment.] First and last name of registrant (please print): Registered as: [Instruction: indicate whether registered as a dealing representative or advising representative] Telephone: Email: Name of firm: [Instruction: indicate whether registered as an exempt market dealer, investment dealer or portfolio manager.] Date: SCHEDULE B ELIGIBLE INVESTOR QUESTIONNAIRE (Manitoba Residents - Offering Memorandum Required) The undersigned, as a purchaser of Shares (the “Shares”) of AP CAPITAL MORTGAGE INVESTMENT CORPORATION Capital Mortgage Investment Corporation (the “Corporation”), has represented to the Corporation that the undersigned is an “eligible investor” as defined in section 1.1 of National Instrument 45-106 Prospectus Exemptions. The undersigned has indicated below the categories which it, he or she satisfies to qualify as an “eligible investor”. The undersigned understands that the Corporation is relying on this information in determining to sell securities to the undersigned in a manner exempt from the prospectus requirements of applicable securities laws. The undersigned represents and warrants that it, he or she is [check the applicable item]:

Appears in 2 contracts

Samples: Subscription Agreement, Subscription Agreement

TO BE COMPLETED BY THE REGISTRANT. 2. Registrant information [Instruction: this section must only be completed if a subscriber has received advice from a portfolio manager, investment dealer or exempt market dealer concerning his or her investment.] First and last name of registrant (please print): Registered as: [Instruction: indicate whether registered as a dealing representative or advising representative] Telephone: Email: Name of firm: [Instruction: indicate whether registered as an exempt market dealer, investment dealer or portfolio manager.] Date: SCHEDULE B ELIGIBLE INVESTOR QUESTIONNAIRE (Manitoba Residents - Offering Memorandum Required) The undersigned, as a purchaser of Shares (the “Shares”) of AP CAPITAL MORTGAGE INVESTMENT CORPORATION Capital Mortgage Investment Corporation (the “Corporation”), has represented to the Corporation that the undersigned is an “eligible investor” as defined in section 1.1 of National Instrument 45-106 Prospectus Exemptions. The undersigned has indicated below the categories which it, he or she satisfies to qualify as an “eligible investor”. The undersigned understands that the Corporation is relying on this information in determining to sell securities to the undersigned in a manner exempt from the prospectus requirements of applicable securities laws. The undersigned represents and warrants that it, he or she is [check the applicable item]:

Appears in 2 contracts

Samples: Subscription Agreement, Subscription Agreement

TO BE COMPLETED BY THE REGISTRANT. 2. Registrant information [Instruction: this section must only be completed if a subscriber has received advice from a portfolio manager, investment dealer or exempt market dealer concerning his or her investment.] First and last name of registrant (please print): Registered as: [Instruction: indicate whether registered as a dealing representative or advising representative] Telephone: Email: Name of firm: [Instruction: indicate whether registered as an exempt market dealer, investment dealer or portfolio manager.] Date: SCHEDULE B ELIGIBLE INVESTOR QUESTIONNAIRE (Manitoba Residents - Offering Memorandum Required) The undersigned, as a purchaser of Shares (the “Shares”) of AP CAPITAL MORTGAGE INVESTMENT CORPORATION Capital Mortgage Investment Corporation (the “Corporation”), has represented to the Corporation that the undersigned is an “eligible investor” as defined in section 1.1 of National Instrument 45-106 Prospectus Exemptions. The undersigned has indicated below the categories which it, he or she satisfies to qualify as an “eligible investor”. The undersigned understands that the Corporation is relying on this information in determining to sell securities to the undersigned in a manner exempt from the prospectus requirements of applicable securities laws. The undersigned represents and warrants that it, he or she is [check the applicable item]:: □ □

Appears in 1 contract

Samples: Subscription Agreement

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TO BE COMPLETED BY THE REGISTRANT. 2. Registrant information [Instruction: this section must only be completed if a subscriber has received advice from a portfolio manager, investment dealer or exempt market dealer concerning his or her investment.] First and last name of registrant (please print): Registered as: [Instruction: indicate whether registered as a dealing representative or advising representative] Telephone: Email: Name of firm: [Instruction: indicate whether registered as an exempt market dealer, investment dealer or portfolio manager.] Date: SCHEDULE B ELIGIBLE INVESTOR QUESTIONNAIRE (Manitoba Residents - Offering Memorandum Required) The undersigned, as a purchaser of Shares Trust Units (the “SharesUnits”) of AP CAPITAL MORTGAGE INVESTMENT CORPORATION REIT (the “CorporationTrust”), has represented to the Corporation Trust that the undersigned is an “eligible investor” as defined in section 1.1 of National Instrument 45-106 Prospectus Exemptions. The undersigned has indicated below the categories which it, he or she satisfies to qualify as an “eligible investor”. The undersigned understands that the Corporation Trust is relying on this information in determining to sell securities to the undersigned in a manner exempt from the prospectus requirements of applicable securities laws. The undersigned represents and warrants that it, he or she is [check the applicable item]:

Appears in 1 contract

Samples: Subscription Agreement

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