Form 51-105F4 Notice – Issuer Ceases to be an OTC Reporting Issuer This is the form required under subsection 4(2) of Multilateral Instrument 51-105 Issuers Quoted in the U.S. Over-the-Counter Markets. This form must be completed and filed in jurisdictions other than Québec if an OTC reporting issuer has ceased to be an OTC issuer because it has a class of securities listed or quoted on an exchange or a quotation and trade reporting system specified in the definition of “OTC issuer” in section 1 of the Instrument. In Québec, an OTC reporting issuer that has a class of securities listed or quoted on an exchange or a quotation and trade reporting system specified in the definition of “OTC issuer” in section 1 of the Instrument must apply to the securities regulatory authority to have its status as an OTC reporting issuer revoked in order to cease to be an OTC issuer. The Issuer Name of Issuer: (the Issuer) Head office address: Last head office address (if different from above): Telephone number: Fax number: E-mail address: Ceasing to be an OTC Reporting Issuer The Issuer’s _____________________[describe class of securities] are listed or quoted on ___________________________ [name of exchange or quotation and trade reporting system listed in definition of OTC issuer in section 1 of Multilateral Instrument 51-105 Issuers Quoted in the U.S. Over-the-Counter Markets]. If the Issuer has ceased to be an OTC issuer, the Issuer is no longer an OTC Reporting Issuer under Multilateral Instrument 51-105 Issuers Quoted in the U.S. Over-the-Counter Markets. The Issuer [will not be / will remain] a reporting issuer in a jurisdiction of Canada.
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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