Form 36 - Insider report [F - Rescinded]
| Published Date: | 1998-07-24 |
|---|---|
| Effective Date: | 1998-07-22 |
| Rescinded Date: | 2001-04-26 |
FORM 36
INSIDER REPORT
Securities Act
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Where freedom of information legislation is in force in the jurisdiction where this from is filed: The personal
information requested on this form is collected under the authority of and used for the purpose of administering the provincial securities Acts , Bank Act, Cooperative Credit Associations Act, Insurance Companies Act, Trust and Loan Companies Act and Canada Business Corporations Act. Under the CBCA the information provided satisfies the disclosure requirements of section 127. While the federal Privacy Act protects personal information provided, it also permits public disclosure pursuant to section 266 of the CBCA. All information contained in this form will be made available to the public. Federally, this information will be stored in personal information bank number CCA/P-PU-092. If you have questions about how the freedom of information legislation applies to the personal information collected on this form, contact the Supervisor, Insiders Department at (604) 899-6548 or write the Supervisor, 200-865 Hornby Street, Vancouver, B.C. V6Z 2H4. Toll free in British Columbia (1-800-373-6393).
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BOX 1. NAME OF REPORTING ISSUER (BLOCK LETTERS)
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BOX 2. INSIDER DATA
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RELATIONSHIPS(S) TO REPORTING ISSUER DAY MONTH YEAR
DATE OF LAST
[__] [__] [__] [__] REPORT FILED ____________________
OR
CHANGE IN IF INITIAL REPORT, DAY MONTH YEAR
RELATIONSHIP DATE ON WHICH YOU
FROM LAST REPORT [__] YES [__] NO BECAME AN INSIDER ____________________
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BOX 3. NAME, ADDRESS AND TELEPHONE NUMBER OF THE INSIDER (BLOCK LETTERS)
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FAMILY NAME OR CORPORATE NAME
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GIVEN NAMES
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NO. STREET APT
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CITY
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PROV POSTAL CODE
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BUSINESS TELEPHONE NUMBER
[__ __ __] - [__ __ __] - [__ __ __ __ ]
CHANGE IN NAME,
BUSINESS FAX NUMBER ADDRESS OR
TELEPHONE NUMBER
[__ __ __] - [__ __ __] - [__ __ __ __ ] FROM LAST REPORT [__] YES [__] NO
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BOX 4. JURISDICTION(S) WHERE THE ISSUER IS A REPORTING ISSUER OR THE
EQUIVALENT
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[] ALBERTA [] NEWFOUNDLAND
[] BRITISH COLUMBIA [] NOVA SCOTIA
[] FEDERAL [] ONTARIO
[] BANK ACT
[] CCAA [] QUEBEC
[] ICA
[] TLCA [] SASKATCHEWAN
[] CBCA
[] UNITED STATES
[] MANITOBA [] NASDAQ
[] SEC
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BOX 5. INSIDER HOLDINGS AND CHANGES (IF INITIAL REPORT COMPLETE COLUMNS (A),
(D), (E) AND (F) ONLY. SEE ALSO INSTRUCTIONS TO BOX 5)
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(A) (B)
DESIGNATION OF CLASS OF SECURITIES BALANCE OF CLASS OF SECURITIES ON LAST REPORT
[___________________________] [__________________________]
[___________________________] [__________________________]
[___________________________] [__________________________]
[___________________________] [__________________________]
[___________________________] [__________________________]
[___________________________] [__________________________]
[___________________________] [__________________________]
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(C)
TRANSACTIONS
DATE NATURE NUMBER/ NUMBER/ UNIT PRICE/ $US
DAY MONTH YEAR VALUE VALUE EXERCISE PRICE
ACQUIRED DISPOSED OF
[__ __] [__ __] [__ __] [__ __] [_________] [_________] [_________]__] [__]
[__ __] [__ __] [__ __] [__ __] [_________] [_________] [_________]__] [__]
[__ __] [__ __] [__ __] [__ __] [_________] [_________] [_________]__] [__]
[__ __] [__ __] [__ __] [__ __] [_________] [_________] [_________]__] [__]
[__ __] [__ __] [__ __] [__ __] [_________] [_________] [_________]__] [__]
[__ __] [__ __] [__ __] [__ __] [_________] [_________] [_________]__] [__]
[__ __] [__ __] [__ __] [__ __] [_________] [_________] [_________]__] [__]
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(D) (E) (F)
PRESENT BALANCE DIRECT/INDIRECT IDENTIFY THE REGISTERED
OF CLASS OF OWNERSHIP/CONTROL HOLDER WHERE OWNERSHIP
SECURTIES HELD OR DIRECTION IS INDIRECT OR WHERE CONTROL
OR DIRECTION IS EXERCISED
[______________] [___] [______________________]
[________________] [___] [______________________]
[________________] [___] [______________________]
[________________] [___] [______________________]
[________________] [___] [______________________]
[________________] [___] [______________________]
[________________] [___] [_____________________]
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BOX 6. REMARKS
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The undersigned certifies that the information given in this report is true and complete in every respect. It is an offence to file a report that, at the time and in the light of the circumstances in which it is made, contains a misrepresentation.
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BOX 7. SIGNATURE
________________________________________________________
NAME (BLOCK LETTERS) SIGNATURE
[______________________] [________________________________]
DAY MONTH YEAR
DATE OF THE REPORT [__ __] [__ __] [__ __]
ATTACHMENT [__] YES [__] NO
This form is used as a uniform report for the insider reporting requirements under all provincial securities Acts, Bank Act, Cooperative Credit Associations Act, Insurance Companies Act, Trust and Loan Companies Act and Canada Business Corporations Act. The terminology used is generic to accommodate the various Acts.
CORRESPONDENCE [__] ENGLISH [__] FRENCH
KEEP A COPY FOR YOUR FILE VERSION FRANCAISE DISPONIBLE SUR DEMANDE
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INSTRUCTIONS
Insider Reports in English and French are available from the Manitoba, Ontario, Quebec and federal jurisdictions. If you are a corporate insider in the province of Quebec, you will receive correspondence in French. Individuals in the province of Quebec will receive, upon request, correspondence in English.
Where an insider of a reporting issuer does not own or have control or direction over securities of the reporting issuer, or where an insider's ownership or direction or control over securities of the reporting issuer remains unchanged from the last report filed, a report is not required. Insider reports are not required to be filed in New Brunswick, the Northwest Territories, Prince Edward Island or the Yukon.
"Reporting issuer" has the same meaning as the words "distributing bank" as defined in subsection 265 (1) of the Bank Act; "distributing association" as defined in subsection 260 (1) of the Cooperative Credit Associations Act (CCAA); and "distributing company" as defined in subsection 288 (1) of the Insurance Companies Act (ICA) or subsection 270 (1) of the Trust and Loan Companies Act (TLCA); "distributing corporation" as defined in subsection 126 (1) of the Canada Business Corporations Act (CBCA).
"Debt securities" wherever it appears herein, has the same meaning as "debt obligation" as defined in subsection 2 (1) of the CBCA.
BOX 1 Name of the reporting issuer
Provide the full legal name of the reporting issuer. Use a separate report for each reporting issuer.
BOX 2 Insider data
Indicate all of your relationship(s) to the reporting issuer using the following codes:
Reporting issuer that has acquired securities issued by itself (or by any of its
affiliates - CBCA) 1
Subsidiary of the reporting issuer 2
Security holder who beneficially owns or who exercises control or direction over
more than 10% of the securities of the reporting issuer (Bank Act, CCAA, ICA,
TLCA, CBCA and Quebec Securities Act - 10% of a class of shares) to which are
attached voting rights or an unlimited right to a share of the profits and to its assets
in case of winding up 3
Director of a reporting issuer 4
Senior officer of a reporting issuer 5
Director or senior officer of a security holder referred to in 3 6
Director or senior officer of an affiliate (Bank Act, CCAA, ICA, TLCA and CBCA)
or of a subsidiary of the reporting issuer, other than in 4, 5 and 6 7
Deemed insider under the Bank Act, CCAA, ICA, TLCA and CBCA 8
If you have filed a report before, indicated whether your relationship to the reporting issuer has changed.
Specify the date of the last report you filed, and if it is an initial report, the date on which you became an insider.
BOX 3 Name, address and telephone number of the insider
Provide you name, address and business telephone number.
BOX 4 Jurisdiction
Indicate each jurisdiction where the issuer is a reporting issuer.
BOX 5 Insider holdings and changes
Show direct and indirect holdings separately, both in the initial report and where a transaction is reported. Indicate only one transaction per line.
For an initial report complete only:
(A) designation of class of securities held
(D) present balance of class of securities held
(E) nature of ownership (see List of Codes)
(F) identification of the registered holder where ownership is indirect.
If you acquired or disposed of securities while an insider, complete sections (A) to (F):
(A) Indicate a designation of the securities traded that is sufficient to identify the class, including yield, series, maturity.
(B) Indicate the number of securities, or for debt securities, the aggregate nominal value, of the class held, directly and indirectly, before the transaction that is being reported.
(C) Indicate for each transaction:
- the date of the transaction (not the settlement date)
- the nature of transaction (see List of Codes)
- the number of securities acquired or disposed of, or for debt securities, the aggregate nominal value
- the unit price paid or received on the day of the transaction, excluding the commission
- if the report is in American dollars, check the space under "$ US"
List of Codes
BOX 5 (C) Nature of transaction
Acquisition or disposition carried out in the market, excluding the exercise of an option 10
Private placement (issuance from treasury) 11
Acquisition or disposition carried out privately (already issued securities) 20
Acquisition or disposition pursuant to a takeover bid or issuer bid 22
Change in the nature of ownership 25
Acquisition or disposition under a plan 30
Stock dividend 35
Acquisition or disposition of a call option 40
Acquisition or disposition of a put option 45
Expiration of an option 46
Acquisition or disposition by gift 50
Acquisition by inheritance or disposition by bequest 55
Short sale 60
Grant of warrants 65
Grants of rights 66
Exercise of warrants 70
Expiration of warrants 71
Expiration of rights 72
Excercise of rights 75
Exercise of options 76
Conversion or exchange 78
Stock split or consolidation 84
Redemption/retraction/cancellation/repurchase 85
Compensation for property 90
Compensation for services 95
Grant of options 96
Other than referred to above (please explain in Remarks) 97
Correction of information 99
(please explain in Remarks)
(D) Indicate the number of securities, or for debt securities, the aggregate nominal value, of the class held, directly and indirectly, after the transaction that is being reported.
(E) Indicate the nature of ownership, control or direction of the class of securities held using the following codes:
Direct ownership 0
Indirect ownership (identify the registered holder) 1
Control or direction (identify the registered holder) 2
(F) For securities that are indirectly held, or over which control or directions is exercised, identify the registered holder.
BOX 6 Remarks
Add any explanation necessary to make the report clearly understandable.
If space provided for any item is insufficient, additional sheets may be used. Additional sheets must refer to the appropriate Box and must be properly identified and signed.
Office staff are not permitted to alter a report.
BOX 7 Signature and filing
Sign and date the report.
File two copies of the report in each jurisdiction in which the issuer is reporting within the time limits prescribed by the applicable laws of that jurisdiction. British Columbia requires only one copy.
Manually sign one of the two copies.
Legibly print or type the name of each individual signing the report.
If the report is filed on behalf of a company, partnership, trust or other entity, legibly or type the name of that entity after the signature.
If the report is signed on behalf of an individual by an agent, there shall be filed with each jurisdiction in which the report is filed a duly completed power of attorney.
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Alberta Securities Commission | Manitoba Securities Commission | Ontario Securities Commission |
Office of the Superintendent of | Director of Securities | Commission des valeurs |
British Columbia Securities Commission | Nova Scotia Securities | Saskatchewan Securities Commission |
Director |