45-910F - Report of Exempt Offering [Proposed F - Lapsed]
Published Date: | 2004-06-25 |
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Rescinded Date: | 2006-05-31 |
Document(s): |
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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.
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: __________________________________
Head and registered offices:
________________________________________________________________
________________________________________________________________
Telephone: ______________________________
Fax: ____________________________________
E-mail: __________________________________
3. Details of sales:
Date sale completed | Number and class of securities sold | Price per share ($CDN) | Total dollar value raised from purchasers in BC | Total dollar value raised from purchasers in all Canadian jurisdictions other than BC | Total dollar value raised from all purchasers outside Canada | Exemption(s) relied on |
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Name and address | Compensation paid (CDN$) and number and type of securities, if any* | Exemption relied on and date, if applicable** |
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**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 completed | Purchaser's name, residential address, telephone no. and e-mail* | Number and type of securities purchased | Total purchase price (CDN $) | Exemption relied on |
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*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.