SUBSCRIPTION AGREEMENT
Exhibit 99.1
Lake Victoria Mining Company, Inc.
0000 Xxxxxxxx Xxxxx
Xxxxxxxxx, Xxxxxxxxxx 00000
Dear Sirs:
Concurrent with execution of this Agreement, the undersigned (the “Purchaser”) is purchasing _________________________________________ (_______) shares of Common Stock of Lake Victoria Mining Company, Inc. (the “Company”) at a price of $0.10 per Share (the “Subscription Price”).
Purchaser hereby confirms the subscription for and purchase of said number of shares and hereby agrees to pay herewith the Subscription Price for such Shares.
Purchaser further confirms that Xxxxx Xxxxxxx or Xxxxxx Xxxxxx solicited him/her/it to purchase the shares of Common Stock of the Company and no other person participated in such solicitation other than Xxxxx Xxxxxxx or Xxxxxx Xxxxxx.
MAKE CHECK PAYABLE TO: Lake Victoria Mining Company, Inc.
Executed this _____ day of ___________________, 2007.
______________________________________________ | ______________________________________________ | |
Signature of Purchaser | ||
______________________________________________ | ||
Address of Purchaser | ||
______________________________________________ | ||
Printed Name of Purchaser | ||
PLEASE ENSURE FUNDS ARE IN US DOLLARS | ||
X $0.10 | US$ | |
Number of Shares Purchased | Total Subscription Price | |
Form of Payment: | Cash: ___________ Check #: _____________ | Other: _____________ |
LAKE VICTORIA MINING COMPANY, INC. | ||
By: _________________________________________ | ||
Title: _________________________________________ |