Form 51-105F2 Notice of Promotional Activities This is thfe form required under subsection 8(1) of Multilateral Instrument 51-105 Issuers Quoted in the U.S. Over-the-Counter Markets for an OTC reporting issuer to give notice of promotional activities. Issuer Information Name of Issuer: (the Issuer) Head office address: __________________________________ __________________________________ Telephone number: __________________________________ Fax number: __________________________________ E-mail address: Notice of Promotional Activities 1. Identify each person engaged in promotional activities and provide the person’s address, telephone and fax number, and email address. If the person is not an individual, provide the name(s) of the individual(s) carrying on the activities. __________________________________________________________________ __________________________________________________________________ 2. Describe the relationship between the Issuer and each person engaged in promotional activities. __________________________________________________________________ __________________________________________________________________ 3. Include particulars of any agreement, arrangement, commitment or understanding between the Issuer and a person engaged in promotional activities. Include i. the effective date and duration of the agreement, arrangement or committment ii. the scope of activities being conducted, and iii. the compensation paid or to be paid by the Issuer, including any non-cash compensation __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
The Issuer [has / has not] issued a news release disclosing this information. If the Issuer has issued a news release, the Issuer may file it with this form. Certificate On behalf of the Issuer, I certify that the statements made in this Notice are true. Date: ____________________________ __________________________________ Name of Issuer __________________________________ Print name, title and telephone number of person signing on behalf of the Issuer __________________________________ Signature Warning: It is an offence to make a statement in this Notice that is false or misleading in a material respect, or to omit facts that make this Notice false or misleading in a material respect. 2
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