55-102F1 - Insider Profile [F Proposed - Lapsed]

An insider profile filed in SEDI format shall contain the following information:

1. Insider’s full name
Provide the full legal name of the insider.  Do not use initials, nicknames or abbreviations.  If the insider is an individual, complete the “Insider’s Family Name” and the “Insider’s Given Name” fields.  Otherwise, complete the “Insider’s Company Name” field.

2. Name of insider’s representative (if applicable)
If the insider is not an individual, provide the full legal name of a representative of the insider.

3. Insider’s address
If the insider is an individual, provide the insider’s principal residential address.  Otherwise, provide the business address where the insider’s representative (provided in item 2 above) is employed.  In each case, include the municipality, province or territory and postal code, as applicable.  In the case of U.S. residents, state and zip code must be provided.

4. Insider’s telephone number
Provide a daytime telephone number for the insider (if the insider is an individual) or for the insider’s representative (if the insider is not an individual).

5. Insider’s facsimile number
If available, provide a facsimile number for the insider (if the insider is an individual) or for the insider’s representative (if the insider is not an individual).

6. Insider’s e-mail address
If available, provide an e-mail address for the insider (if the insider is an individual) or for the insider’s representative (if the insider is not an individual).

7. Name of reporting issuer
Provide the name of the reporting issuer(s) in respect of which the insider is required to file insider reports in SEDI format.  Select the name of each reporting issuer to be added from the list of all SEDAR reporting issuers provided for this purpose.  Where the profiled insider has ceased to be an insider of a reporting issuer listed in the insider profile, delete the name of the reporting issuer from the insider profile and complete item 10 below.

8. Insider’s relationship to reporting issuer
For each reporting issuer disclosed under item 7 above, indicate all of the insider’s relationships to that reporting issuer by selecting from the list of relationship types provided.

9. Date on which insider became an insider
If the insider has not previously filed an insider report in respect of a reporting issuer disclosed under item 7 above, provide the date on which the insider became an insider.

10. Date on which insider ceased to be an insider
If the insider has ceased to be an insider of a reporting issuer disclosed previously under item 7 above, provide the date on which this occurred.

Optional Information

An insider profile filed in SEDI format may, at the option of the insider, contain the following information:

11. Correspondence in English or French (Quebec residents only)
If the insider is an individual resident in Quebec, the insider may choose to receive any correspondence from the securities regulatory authority in Quebec in English.  If no choice is made, any correspondence from the securities regulatory authority in Quebec shall be in French.

12. List of registered holders of securities
A list of registered holders of securities owned indirectly or over which control or direction is exercised by the insider may be created in the insider’s profile.  Any entry in this list may then be selected when an insider report is prepared in SEDI format and registered holder information is required.  The full legal name of the registered holder should be provided in each case.

Certification

The insider or the insider’s agent must certify that the information is true and complete in every respect.  In the case of an agent, the certification is based on the agent’s best knowledge, information and belief but the insider is still responsible for ensuring that the information filed by the agent is true and complete.  It is an offence to file information that, at the time and in the light of the circumstances in which it is given, contains a misrepresentation.

Notice - Collection and Use of Personal Information

The personal information prescribed by this form is collected on behalf of and used by the Securities Commissions set out below for purposes of the administration and enforcement of the insider trading provisions of the securities legislation in Alberta, British Columbia, Manitoba, Newfoundland, Nova Scotia, Ontario, Quebec and Saskatchewan.  All of the information prescribed by this form, except the name of an insider’s representative (if the insider is not an individual) and an insider’s (or its representative’s) address (excluding municipality, province, territory, state and/or country), telephone number(s), facsimile number(s), e-mail address and language preference (if applicable), is made public pursuant to National Instrument 55-102 and Companion Policy 55-102CP and the securities legislation in each of the jurisdictions indicated above.  If you have any questions about the collection and use of this information, contact the Securities Commission(s) in the jurisdiction(s) in which the form is filed, at the address(es) set out below. 

Alberta Securities Commission
4th  Floor, 300-4th Avenue S.W.
Calgary, AB   T2P 3C4
Attention: Information Officer
Telephone: (403) 297-6454
Facsimile: (403) 297-6156

British Columbia Securities Commission
200- 865 Hornby Street
Vancouver, BC   V6Z 2H4
Attention: Supervisor, Insider Reporting
Telephone: (604) 899-6548 or
(800) 373-6393 (in B.C.)
Facsimile: (604) 899-6760
 
Manitoba Securities Commission
1130-405 Broadway
Winnipeg, MB  R3C 3L6
Attention: Assistant Counsel
Telephone: (204) 945-3625
Facsimile: (204) 945-4508

Securities Commission of Newfoundland
P.O. Box 8700
2nd Floor, West Block
Confederation Building
75 O’Leary Avenue
St. John’s, NFLD  A1B 4J6
Attention: Director of Securities
Telephone: (709) 729-4189
Facsimile: (709) 729-6187
 
Nova Scotia Securities Commission
2nd Floor, Joseph Howe Building
1690 Hollis Street
P.O. Box 458
Halifax, NS  B3J 3J9
Attention: FOI Officer
Telephone: (902) 424-7768
Facsimile: (902) 424-4625 

Ontario Securities Commission
Suite 1903, Box 55
20 Queen Street West
Toronto, ON
M5H 3S8
Attention: FOI Coordinator
Telephone: (416) 593-8314
Facsimile: (416) 593-8122
 
Commission des valeurs mobilières du Québec
Stock Exchange Tower
P.O. Box 246, 22nd Floor
800 Victoria Square
Montréal, PQ   H4Z 1G3
Attention: The Person in Charge of Access to Documents or of Protection of Personal Information
Telephone: (514) 940-2150 or
(800) 361-5072 (in Quebec)
Facsimile: (514) 864-6381

Saskatchewan Securities Commission
800-1920 Board Street
Regina, SK  S4P 3V7
Attention: Deputy Director, Registration
Telephone: (306) 787-5842
Facsimile: (306) 787-5899