Skip Navigation
Securities Law

45-911F - Report of Section 18(3) Offering by Public Issuer [Proposed F - Lapsed]

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Rescinded Date: 2006-05-31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

June 25, 2004Proposed

Form 45-911F
Report of Section 18(3) Offering by Public Issuer
This is the form required under section 116(1)of the Rules for a report by
a public issuer offering securities under section 18(3) of the Securities Act.

1. Name of issuer: ___________________________________________________

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

Head and registered office(s):

________________________________________________________________

________________________________________________________________
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 Canada
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.

__________________________________________________________________________

Instructions

· The second column of the table under item 3 requires that you describe the securities being sold. If the security is convertible or exchangeable, you should also describe the type of underlying security, the terms of exercise or conversion, and any expiry date.
· The filing fee must accompany this report.