Securities Law

15-904F - Endorsement Of Warrant [BCF]

Published Date: 2001-04-27
Effective Date: 2001-04-26
Document(s):
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

CANADA,

PROVINCE OF

__________________________________
(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

__________________________________