4 - Distribution Requirements

A. Permitted Client

You are a permitted client because:

□  You are an individual who beneficially owns financial assets, as defined in section 1.1 of National Instrument 45-106 Prospectus Exemptions, having an aggregate realizable value that, before taxes but net of any related liabilities, exceeds $5 million.

□  Other - you are a person or company that otherwise falls within the definition of a permitted client in section 1.1 of Part 1 in National Instrument 31-103 Registration Requirements, Exemptions and Ongoing Registrant Obligations. Please specify the relevant category: ____.

B. Accredited Investor

You are an accredited investor because (check all that apply):

□  Your net income before taxes was more than $200,000 in each of the 2 most recent calendar years and you expect it to be more than $200,000 in this calendar year. (You can find your net income before taxes on your personal income tax return.)

□  Your net income before taxes combined with your spouse’s was more than $300,000 in each of the 2 most recent calendar years and you expect your combined net income before taxes to be more than $300,000 in the current calendar year.

□  Either alone or with your spouse, you own more than $1 million in cash and securities, after subtracting any debt related to the cash and securities.

□  Either alone or with your spouse, you have net assets worth more than $5 million. (Your net assets are your total assets (including real estate) minus your total debt.)

□  Other - you are a person or company that otherwise falls within the definition of an accredited investor as defined in section 1.1 of National Instrument 45-106 Prospectus Exemptions and in subsection 73.3(1) of the Securities Act, R.S.O. 1990 c. S.5. Please specify the relevant category: ____.

Confirmation (if you are an accredited investor but not a permitted client)

□  I confirm that, after taking into account my investment of $__________ today in this issuer:

--  I have not invested more than $25,000 in a single crowdfunding investment, and

--  I have not invested more than $50,000 in all of the crowdfunding investments I have made in this calendar year.

C. Retail Investor

You are a retail investor if none of the statements in the previous two sections apply to you.

Confirmation (if you are a retail investor)

□  I confirm that, after taking into account my investment of $__________ today in this issuer:

--  I have not invested more than $2,500 in a single crowdfunding investment, and

--  I have not invested more than $10,000 in all of the crowdfunding investments I have made in this calendar year.

First and last name:

Date:

Electronic signature: By clicking the ‘I confirm’ button, I acknowledge that I am signing this form electronically and agree that this is the legal equivalent of my handwritten signature. I will not at any time in the future claim that my electronic signature is not legally binding.  The date of my electronic signature is the same as my acknowledgement.