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Rescinded Date: | 2006-05-31 |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
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.
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):
________________________________________________________________
________________________________________________________________
Head and registered office(s):
________________________________________________________________
________________________________________________________________
Telephone: _______________________________________________________
Fax: ____________________________________________________________
E-mail: __________________________________________________________
3. Details of sales:Date sale completed | Number and class of securities sold | Price per share ($CDN) | Total dollar value raised from purchasers in BC | Total dollar value raised from purchasers in all Canadian jurisdictions other than BC | Total dollar value raised from all purchasers outside Canada |
1. | ![]() | ![]() | ![]() | ![]() | ![]() |
2. | ![]() | ![]() | ![]() | ![]() | ![]() |
3. | ![]() | ![]() | ![]() | ![]() | ![]() |
4. | ![]() | ![]() | ![]() | ![]() | ![]() |
Name and address | Compensation paid (CDN$) and number and type of securities, if any* | Exemption relied on and date, if applicable** |
![]() | ![]() | ![]() |
**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.