Appendix A Notice of Intention to Rely on Exemption in s. 2.2 Issuer information 1. State the full name, address and telephone number of the mutual fund that distributed or intends to distribute the security. 2. State whether the mutual fund is or is not a reporting issuer and, if reporting, each of the jurisdictions in which it is reporting. 3. List each jurisdiction where the mutual fund is, or intends to distribute mutual fund securities in reliance on the exemption for capital accumulation plans and deliver the notice to the relevant securities regulatory authority listed in the attached Schedule. Certificate On behalf of the mutual fund, I certify that the statements made in this report are true. Date: ________________________________________ _____________________________________________ Name of mutual fund (please print) _____________________________________________ Print name and position of person signing _____________________________________________ e-mail address of person signing _____________________________________________ Signature
- 2 -Schedule to Appendix A Instruction: Prior to relying on the exemption, you must file this notice with the securities regulatory authority in each jurisdiction in which the mutual fund is currently providing services to a capital accumulation plan, or where they intend to provide services to a capital accumulation plan. If you subsequently intend to provide services to a capital accumulation plan located in a new province, you must file a notice in that province. Notice - Collection and use of personal information The securities regulatory authorities collect the personal information required under this notice for the purposes of the administration and enforcement of the securities legislation. Freedom of information legislation in certain jurisdictions may require the securities regulatory authority to make this information available if requested. As a result, the public may be able to obtain access to the information. If you have any questions about the collection and use of this information, contact the securities regulatory authorities in the jurisdictions where the mutual fund files this form, at the address(es) set out below. British Columbia Securities Commission P.O. Box 10142, Pacific Centre 701 West Georgia Street Vancouver, BC V7Y 1L2 Telephone: (604) 899-6854 Toll free in British Columbia and Alberta 1-800-373-6393 Facsimile: (604) 899-6506 Attention: Exempt Distributions Alberta Securities Commission 4th Floor, 300 – 5th Avenue SW Calgary, AB T2P 3C4 Telephone: (403) 297-6454 Facsimile: (403) 297-6156 Saskatchewan Financial Services Commission 6th Floor 1919 Saskatchewan Drive Regina, SK S4P 3V7 Telephone: (306) 787-5879 Facsimile: (306) 787-5899 The Manitoba Securities Commission 500-400 St. Mary Avenue Winnipeg, MB R3C 4K5 Telephone: (204) 945-2548 Facsimile: (204) 945-0330
- 3 -Ontario Securities Commission 20 Queen Street West Suite 1900, Box 55 Toronto, ON M5H 3S8 Telephone: (416) 593-3682 Facsimile: (416) 593-8252 Public official contact regarding indirect collection of information: Administrative Assistant to the Director of Corporate Finance Telephone: (416) 593-8086 Autorité des marchés financiers 800, Square Victoria, 22 e étage C.P. 246, Tour de la Bourse Montréal (Québec) H4Z 1G3 Telephone: (514) 395-0337 or 1-877-525-0337 Facsimile: (514) 864-3681 New Brunswick Securities Commission 133 Prince William Street, Suite 606 Saint John, NB E2L 2B5 Telephone: (506) 658-3060 Facsimile: (506) 658-3059 Nova Scotia Securities Commission 2nd Floor, Joseph Howe Building 1690 Hollis Street Halifax, NS B3J 3J9 Telephone: (902) 424-7768 Facsimile: (902) 424-4625 Prince Edward Island Securities Office 95 Rochford Street, P.O. Box 2000 Charlottetown, PE C1A 7N8 Telephone: (902) 368-4569 Facsimile: (902) 368-5283 Securities Commission of Newfoundland and Labrador P.O. Box 8700 2nd Floor, West Block Confederation Building St. John's, Newfoundland and Labrador A1B 4J6 Telephone: (709) 729-4189 Facsimile: (709) 729-6187 Government of Yukon Department of Community Services Law Centre, 3 rd Floor 2130 Second Avenue Whitehorse, YT Y1A 5H6 Telephone: (867) 667-5314 Facsimile: (867) 393-6251
- 4 -Government of the Northwest Territories Department of Justice Securities Registry 1st Floor Stuart M. Hodgson Building 5009 – 49th Street Yellowknife, NT X1A 2L9 Telephone: (867) 920-3318 Facsimile: (867) 873-0243 Government of Nunavut Department of Justice Legal Registries Division P.O. Box 1000 – Station 570 1st Floor, Brown Building Iqaluit, NU X0A 0H0 Telephone: (867) 975-6190 Facsimile: (867) 975-6194
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.