12-602F - Application For Exempt Purchaser Status [BCF - Rescinded]
| Published Date: | 2002-04-03 |
|---|---|
| Effective Date: | 2002-04-03 |
| Rescinded Date: | 2005-09-14 |
| Document(s): |
|
This is the form required under section 88 of the Securities Rules for an application for exempt purchaser status under sections 45 (2) (4) and 74 (2) (3) of the Securities Act.
BC FORM 12-602F (Previously Form 11)
Securities Act
APPLICATION FOR EXEMPT PURCHASER STATUS
1. State the name, address for service and telephone number of the applicant.
_____________________________________________________________________________
_____________________________________________________________________________
2. State the jurisdiction and date of incorporation, organization or continuation of the applicant (if applicable) and provide a copy of the applicant's charter, license or constating documents (if applicable).
_____________________________________________________________________________
_____________________________________________________________________________
3. State the relevant facts and the reasons why the applicant should be designated as an exempt purchaser.
_____________________________________________________________________________
_____________________________________________________________________________
The statements made in this application are true.
Dated at __________________________ on ____________.
(city and country) (date)
_____________________________
Name of applicant
(please print)
___________________________________ ___________________________________
Signature of authorized signatory Signature of authorized signatory
___________________________________ ___________________________________
Name and title of authorized signatory Name and title of authorized signatory
(please print)(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.
If the space provided for any answer is insufficient, additional sheets may be used. Each sheet must be cross referenced to the relevant section of the application and signed by the person who signs the application.