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Securities Law

45-910F - Report of Exempt Offering [Proposed F - Lapsed]

Published Date: 2004-06-25
Rescinded Date: 2006-05-31
Document(s):

June 25, 2004Proposed

 
Form 45-910F
Report of Exempt Offering
This is the form required under section 112ofthe Rules for a report of exempt offering.

1. Issuer:

a. Name: _____________________________________________________

b. Former name (if changed since last report): ________________________

2. Issuer contact information:
Contact person (name and title): ______________________________________

Head and registered offices:

________________________________________________________________

________________________________________________________________

Telephone: ______________________________

Fax: ____________________________________

E-mail: __________________________________

3. Details of sales:

Date sale completedNumber and class of securities soldPrice per share ($CDN)Total dollar value raised from purchasers in BCTotal dollar value raised from purchasers in all Canadian jurisdictions other than BCTotal dollar value raised from all purchasers outside CanadaExemption(s) relied on
1.
2.
3.
4.
4. Commissions and finders’ fees - provide the following for each person who is compensated in connection with the sale(s):

Name and addressCompensation paid (CDN$) and number and type of securities, if any*Exemption relied on and date, if applicable**
*Include discounts, commissions or other similar amounts directly related to the sale, but not payments for incidental services, e.g. clerical, printing, legal or accounting services.

**Complete this column if compensation is paid in securities.

_________________________________________________________________________

Instruction

The filing fee must accompany this report.




Private Placement Schedule

Provide the information set out in the table on a separate page for each offering. The information in this schedule will not be placed on the public file.

Date sale completedPurchaser's name, residential address, telephone no. and e-mail*Number and type of securities purchasedTotal purchase price (CDN $)Exemption relied on

*Required for any sales under the following sections of the Rules: sections 50 [Trade to or through a dealer] (if the trade is to the dealer as consideration for its services in connection with a distribution), 56(h) [Trade for property], 58 [Trade to accredited investor], 59 [Trade for $150,000], or 60 [Trade under an offering memorandum] and section 75[Exempt trade under other Canadian securities laws], or if the issuer is using an exemption similar to those above.