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Securities Law

Form 20 - Report of exempt distribution [F - Rescinded]

Published Date: 1988-08-12
Effective Date: 1988-09-01
Rescinded Date: 1997-06-25

This is the form required under section 132 of the Securities Regulation or, where required, under an order issued under section 59 of the Securities Act.

FORM 20

Securities Act

Report of Exempt Distribution

Report of a distribution under section 55 (2) (1) to (5), (8) to (10), 11 (i), (14), (16) (i), (18), (19) or (24) to (27) of the Securities Act, S.B.C. 1985, c. 83 (the "Act"), section 117 (a), (b) or (f) to (i) of the Securities Regulation, B.C. Reg. 270/86 (the "Regulation"), or, where required, under an order issued under section 59 of the Act.

  1. Name, address and telephone number of the issuer of the security distributed (the "Issuer"):

    ___________________________________________

    ___________________________________________

  2. State whether the Issuer is an exchange issuer.

    ___________________________________________

  3. Description of the security (the "Security") and the number distributed:

    ___________________________________________

    ___________________________________________

  4. Section of the Act or Regulation under which the distribution was made:

    ___________________________________________

  5. Date of the distribution: _________________________

  6. If the distribution was to 50 or fewer persons, complete clause (a) of this item. If the distribution was to more than 50 persons, circle clause (b) of this item.

    Number of

    (a) Full Name and Address Securities Purchase

    Of Purchaser(s) Purchased Price

    ____________________________________________

    (b) The Issuer has prepared and certified a list comprising the information required by clause (a) of this section and a certified true copy of the list will be provided to the Commission upon request.

  7. State the total proceeds derived in British Columbia by the Issuer from the distribution, i.e. the total value of the securities distributed to residents of British Columbia.

    ____________________________________________

  8. State the name and address of any person acting as agent in connection with the distribution and the compensation paid or to be paid to such agent, including discounts, commissions or other fees or payments of a similar nature. If the compensation includes securities of the Issuer, note that a separate Form 20 may be required to be filed under section 132 of the Regulation.

    ____________________________________________

    ____________________________________________

    ____________________________________________

  9. If the distribution was under section 117 (a) of the Regulation, state the number of different purchasers who acquired securities of the Issuer under that exemption during the 12 month period preceding the distribution.

    ____________________________________________

  10. If the distribution was under section 117 (i) of the Regulation, state

    (a) the number of different purchasers who acquired securities of the Issuer under that exemption during the 12 month period preceding the distribution, and


    (b) the total amount paid for securities of the Issuer issued under that exemption during the 12 month period preceding the distribution.

    ____________________________________________

The undersigned hereby certifies that the statements made in this report are true and correct.

DATED at ______________________ this ____________ day of ____________, 19____.

___________________________________________

Name of Issuer

Per:_______________________________________

Signature of authorized signatory

___________________________________________

___________________________________________

Name and office of authorized signatory

 

IT IS AN OFFENCE FOR A PERSON TO MAKE A STATEMENT IN A DOCUMENT REQUIRED TO BE FILED OR FURNISHED UNDER THE SECURITIES ACT THAT, AT THE TIME AND IN THE LIGHT OF CIRCUMSTANCES UNDER WHICH IT IS MADE, IS A MISREPRESENTATION.

Instructions:

  1. In answer to item 8, it is not necessary to include payments for services incidental to the distribution such as clerical, printing, legal or accounting services.

  2. If the distribution was under section 117 (a), (b) or (i) of the Regulation or if the filing of this report was required under an order issued under section 59 of the Act, the Issuer, at the time of filing this report, must file the completed undertaking and acknowledgement of the purchaser of the securities required by section 128 of the Regulation. The required form is Form 20A.

  3. If the space provided for any answer is insufficient, additional sheets may be used. Each sheet must be cross referenced to the relevant item, properly identified and signed by the person whose signature appears on the report.

  4. File this report with the required fee and completed Fee Checklist. In order to determine the fee payable, consult section 183 of the Regulation. Cheques should be made payable to the "Minister of Finance".

 

September 1, 1988