15-904F Endorsement Of Warrant [BCF]

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15-904F [F] September 18 2013
BCF 15-904F April 26, 2001
Published: 2001-04-27
Effective: 2001-04-26

This is the form required under section 156 (1) of the Securities Act.

BC FORM 15-904F (Previously Form 40)

Securities Act

Endorsement Of Warrant



(territorial division)

Pursuant to subsection __________________________________ Securities Act and pursuant to application this day made to me, I hereby authorize the execution of this warrant within the said

(territorial jurisdiction)

Dated this _______________________________ day of _______________________________ 19 ___,

at __________________________________ in the Province of British Columbia.

A Justice of the Peace in and for
the Province of