Issuer Name:

Type of Eligible Security Offered:

WARNING!

BUYER BEWARE: This investment is risky.

Don’t invest unless you can afford to lose all the money you pay for this investment.

1. Risk acknowledgement

Risk of loss – Do you understand that this is a risky investment and that you may lose all the money you pay for this investment?

No income – Do you understand that you may not earn any income, such as dividends or interest, on this investment? 

Liquidity risk – Do you understand that you may never be able to sell this investment?

Lack of information – Do you understand that you may not be provided with any ongoing information about the issuer and/or this investment?

2. No approval and no advice Instruction: Delete “and no advice” if the funding portal is operated by a registered dealer.

No approval – Do you understand that this investment has not been reviewed or approved in any way by a securities regulatory authority or regulator?

No advice – Do you understand that you will not receive advice about your investment?  Instruction: Delete this row if the funding portal is operated by a registered dealer.

3. Limited legal rights

Limited legal rights – Do you understand that you will not have the same rights as if you purchased under a prospectus or through a stock exchange?

If you want to know more, you may need to seek professional legal advice.

4. Purchaser’s acknowledgement

Investment risks – Have you read this form and do you understand the risks of making this investment?

Offering document – Has an offering document relating to this investment been made available to you on the funding portal?

The offering document contains important information about this investment. If you have not read the offering document or if you do not understand the information in it, you should not invest. You should retain a copy of the offering document for your records.

Have you read and do you understand the information in the offering document?

First and last name:

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.

5. Additional information

▪   You have two days to cancel your purchase by sending a notice to the funding portal at: Instruction: Provide email address where purchasers can send their notice. Describe any other manner for purchasers to cancel their purchase.

▪   If you want more information about your local securities regulation, go to www.securities-administrators.ca. Securities regulators do not provide advice on investment.

▪   To check if the funding portal is operated by a registered dealer, go to www.aretheyregistered.ca.  Instruction: Delete if the funding portal is not operated by a registered dealer.