45-902F - Report Of Exempt Distribution [BCF - Rescinded]
| Published Date: | 2002-04-03 |
|---|---|
| Effective Date: | 2002-04-03 |
| Rescinded Date: | 2003-06-20 |
BC FORM 45-902F (Formerly Form 20)
Securities Act
Report Of Exempt Distribution
1. State the full name, address and telephone number of the issuer of the security distributed.
2. State whether the issuer is or is not a reporting issuer and, if reporting, the jurisdictions in which it is reporting.
3. State whether the issuer is listed or quoted on any stock exchange or trading or quotation system and, if so, which stock exchange or trading or quotation system.
4. Describe the type of security and the aggregate number distributed. If the security is convertible or exchangeable, describe the type of underlying security, the terms of exercise or conversion and any expiry date.
5. Provide the following information for each type of security distributed. Consult Multilateral Instrument 45-102 Resale of Securities to determine what restricted or seasoning period applies to the security.
| Full name of purchaser and municipality and jurisdiction of residence | Number of securities purchased | Date of distribution | Price per security / total purchase price (Canadian $) | Exemption relied on | Length of any restricted or seasoning period |
6. Disclose the following information in a schedule to the Form 45-902F. The information in the schedule is not available to the public.
| Full name and residential address of purchaser | Telephone number and e-mail address of purchaser | Type of security and number purchased | Exemption relied on |
7. State the total dollar value (Canadian $) of the securities distributed by the issuer to purchasers resident in British Columbia. This total dollar value must be used for calculating the fee payable for filing this report with the British Columbia Securities Commission.
8. Provide the following information for each person who is being compensated in connection with the distribution(s) of the security. When disclosing compensation paid or to be paid, include discounts, commissions or other fees or payments of a similar nature directly related to the distribution. Do not include payments for services incidental to the trade, such as clerical, printing, legal or accounting services.
| Name and address of person being compensated | Compensation paid (number and type of security and/or cash amount (Canadian $) | Price per share (Canadian $) |
The undersigned hereby certifies that the statements made in this report and in any schedule to this report are true and correct.
DATED at _____________________this _________day of ____________ 20________
_____________________________________________
Name of issuer (please print)
_____________________________________________
Signature of authorized signatory
_____________________________________________
Name and office of authorized signatory
(please print)
IT IS AN OFFENCE FOR A PERSON TO MAKE A STATEMENT IN A RECORD REQUIRED TO BE FILED OR PROVIDED UNDER THE SECURITIES ACT OR SECURITIES RULES THAT, AT THE TIME AND IN LIGHT OF THE CIRCUMSTANCES UNDER WHICH IT IS MADE, IS A MISREPRESENTATION.
INSTRUCTION:
File this report with the British Columbia Securities Commission on or before the 10th day after the distribution of the security with a completed Fee Checklist and the required fee. In order to determine the fee payable, consult item 19 of section 22 of the Securities Regulation, R.B.C. Reg. 196/197, as amended. For calculating the fee payable, use the total dollar value of the securities distributed in British Columbia set out in item 7 of this report. Cheques should be made payable to the “British Columbia Securities Commission”.
For further information and guidance on preparing and filing this report, please refer to FAQs at www.bcsc.bc.ca.
Notice - Collection and use of personal information
The personal information required under this form is collected on behalf of and used by the British Columbia Securities Commission for the purposes of the administration and enforcement of the Securities Act. All of the information required under this form, except for the information contained in the schedule required under section 6, is made available to the public under the Securities Act. If you have any questions about the collection and use of information, contact the British Columbia Securities Commission, P.O. Box 10142, Pacific Centre, 701 West Georgia Street, Vancouver, B.C., V7Y 1L2. Telephone 604-899-6854. Toll free in British Columbia and Alberta 1-800-373-6393.