Unofficial consolidation – June 9, 2023
Note: [9 June 2023] - The following is a consolidation of Form 45-102F1. It incorporates the amendments to this document that came into effect on September 14, 2005, September 28, 2009, May 1, 2011, June 9, 2023, local amendments in Nova Scotia and Yukon as described in CSA Staff Notice 11-320 and local amendments in Ontario as described in CSA Notice 11-330 and local amendments in Nunavut and New Brunswick as described in CSA Staff Notice 11-335. This consolidation is provided for your convenience and should not be relied on as authoritative.
Form 45-102F1
Notice of Intention to Distribute Securities under Section 2.8 of NI 45-102 Resale of Securities
Reporting issuer
1. Name of reporting issuer:
Selling security holder
2. Your name:
3. The offices or positions you hold in the reporting issuer:
4. Are you selling securities as a lender, pledgee, mortgagee or other encumbrancer?
5. Number and class of securities of the reporting issuer you beneficially own:
Distribution
6. Number and class of securities you propose to sell:
7. Will you sell the securities privately or on an exchange or market? If on an exchange or market, provide the name.
It is an offence to submit information that, in a material respect and in light of the circumstances in which it is submitted, is misleading or untrue.
I certify that
(1) I have no knowledge of a material fact or material change with respect to the issuer of the securities that has not been generally disclosed; and
(2) the information given in this form is true and complete.
Date ...................................... ............................................…
Your name (Selling security holder)
.........................................…..
Your signature (or if a company, the signature of your authorized signatory)
...............................................
Name of your authorized signatory
INSTRUCTION:
File this form with the securities regulatory authority or regulator in each jurisdiction where you sell securities and with the Canadian exchange on which the securities are listed. If the securities are being sold on an exchange, the form should be filed in every jurisdiction across Canada.
Notice to selling security holders - collection and use of personal information
The personal information required in this form is collected for and used by the listed securities regulatory authorities or regulators to administer and enforce securities legislation in their jurisdictions. This form is publicly available by authority of National Instrument 45-102 and the securities legislation in each of the jurisdictions. The personal information collected will not be used or disclosed other than for the stated purposes without first obtaining your consent.
Corporate filers should seek the consent of any individuals whose personal information appears in this form before filing this form.
If you have questions about the collection and use of your personal information, or the personal information of your authorized signatory, contact any of the securities regulatory authorities or regulators listed below.
British Columbia Securities Commission
P.O. Box 10142, Pacific Centre 701 West Georgia Street Vancouver, BC V7Y 1L2
Attention: Assistant Manager, Financial Reporting Telephone: (604) 899-6805 or (800) 373-6393 (in B.C.)
Facsimile: (604) 899-6506
Alberta Securities Commission Suite 600, 250 – 5th Street SW Calgary, AB T2P 0R4 Attention: Information Officer Telephone: (403) 297-6454
Facsimile: (403) 297-6156
Saskatchewan Financial Services Commission Securities Division
601 - 1919 Saskatchewan Drive Regina, SK S4P 4H2
Attention: Deputy Director, Legal/Registration Telephone: (306) 787-5879
Facsimile: (306) 787-5899
Ontario Securities Commission
20 Queen Street West 22nd Floor
Toronto, Ontario M5H 3S8 Telephone: (416) 593-8314
Toll free in Canada: 1-877-785-1555 Facsimile: (416) 593-8122
Public official contact regarding collection of personal information: Inquiries Officer
Autorité des marchés financiers
Tour de la Bourse 800 square Victoria
C.P. 246, 22e étage Montréal, Québec H4Z 1G3
Attention: Responsable de l’accès à l’information Telephone : (514) 395-0337
Toll Free : 1-877-525-0337
Facsimile: (514) 873-6155 (For filing purposes only) Facsimile: (514) 864-6381 (For privacy requests only) www.lautorite.qc.ca
New Brunswick Securities Commission
85 Charlotte Street, Suite 300
Saint John, New Brunswick E2L 2J2 Telephone: (506) 658-3060
Toll Free in New Brunswick 1-866-933-2222 Facsimile: (506) 658-3059
Nova Scotia Securities Commission
Suite 400, 5251 Duke Street Halifax, Nova Scotia B3J 1P3 Attention: Corporate Finance Telephone: (902) 424-7768
Facsimile: (902) 424-4625
Prince Edward Island Securities Office
95 Rochford Street, 4th Floor Shaw Building
P.O. Box 2000
Charlottetown, Prince Edward Island C1A 7N8 Telephone: (902) 368-4569
Facsimile: (902) 368-5283
Government of Newfoundland and Labrador
Financial Services Regulation Division
P.O. Box 8700
2nd Floor, West Block Confederation Building Prince Philip Drive
St. John’s, NFLD A1B 4J6
Attention: Director of Securities Telephone: (709) 729-4189
Facsimile: (709) 729-6187
Government of Yukon
Office of the Yukon Superintendent of Securities Government of Yukon Department of Community Services 307 Black Street, 1st Floor
PO Box 2703 (C-6)
Whitehorse, Yukon Y1A 2C6 Telephone: (867) 667-5466
Facsimile: (867) 393-6251 http://www.community.gov.yk.ca/corp/securities_about.html
Government of Northwest Territories
Department of Justice Securities Registry
1st Floor, Stuart M. Hodgson Building 5009 – 49th Street
Yellowknife, Northwest Territories X1A 2L9 Telephone: (867) 920-3318
Facsimile: (867) 873-0243
Department of Justice, Nunavut
Legal Registries Division
P.O. Box 1000, Station 570 1st Floor, Brown Building Iqaluit, NT X0A 0H0
Attention: Superintendent of Securities Telephone: (867) 975-6590
Facsimile: (867) 975-6194