Form 45-106F4 "Risk Acknowledgement" - Ontario, Canada

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Download Form 45-106F4 "Risk Acknowledgement" - Ontario, Canada

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Form 45-106F4
Risk Acknowledgement
·
I acknowledge that this is a risky investment.
·
I am investing entirely at my own risk.
·
No securities regulatory authority or regulator has evaluated or endorsed the merits of
these securities or the disclosure in the offering memorandum.
·
The person selling me these securities is not registered with a securities regulatory
authority or regulator and has no duty to tell me whether this investment is suitable for
me. [Instruction: Delete if sold by registrant]
·
I will not be able to sell these securities except in very limited circumstances. I may
never be able to sell these securities. [Instruction: Delete if issuer is reporting]
·
The securities are redeemable, but I may only be able to redeem them in limited
circumstances. [Instruction: Delete if securities are not redeemable]
·
I will not be able to sell these securities for 4 months. [Instruction: Delete if issuer is
not reporting or if the purchaser is a Manitoba resident]
·
I could lose all the money I invest.
I am investing $____________ [total consideration] in total; this includes any amount I
am obliged to pay in future. _______________ [name of issuer] will pay $_____________
[amount of fee or commission ] of this to __________________ [name of person selling
the securities] as a fee or commission.
I acknowledge that this is a risky investment and that I could lose all the money I
invest.
Date
Signature of Purchaser
Print name of Purchaser
Sign 2 copies of this document. Keep one copy for your records.
Form 45-106F4
Risk Acknowledgement
·
I acknowledge that this is a risky investment.
·
I am investing entirely at my own risk.
·
No securities regulatory authority or regulator has evaluated or endorsed the merits of
these securities or the disclosure in the offering memorandum.
·
The person selling me these securities is not registered with a securities regulatory
authority or regulator and has no duty to tell me whether this investment is suitable for
me. [Instruction: Delete if sold by registrant]
·
I will not be able to sell these securities except in very limited circumstances. I may
never be able to sell these securities. [Instruction: Delete if issuer is reporting]
·
The securities are redeemable, but I may only be able to redeem them in limited
circumstances. [Instruction: Delete if securities are not redeemable]
·
I will not be able to sell these securities for 4 months. [Instruction: Delete if issuer is
not reporting or if the purchaser is a Manitoba resident]
·
I could lose all the money I invest.
I am investing $____________ [total consideration] in total; this includes any amount I
am obliged to pay in future. _______________ [name of issuer] will pay $_____________
[amount of fee or commission ] of this to __________________ [name of person selling
the securities] as a fee or commission.
I acknowledge that this is a risky investment and that I could lose all the money I
invest.
Date
Signature of Purchaser
Print name of Purchaser
Sign 2 copies of this document. Keep one copy for your records.
You have 2 business days to cancel your purchase [Instruction: The issuer must complete this
section before giving the form to the purchaser.]
To do so, send a notice to [name of issuer] stating that you want to cancel your purchase. You
nd
must send the notice before midnight on the 2
business day after you sign the agreement to
purchase the securities. You can send the notice by fax or email or deliver it in person to [name
of issuer] at its business address. Keep a copy of the notice for your records.
Issuer Name and Address:
Fax:
E-mail:
You are buying Exempt Market Securities
They are called exempt market securities because two parts of securities law do not apply to
them. If an issuer wants to sell exempt market securities to you:
·
the issuer does not have to give you a prospectus (a document that describes the
investment in detail and gives you some legal protections), and
·
the securities do not have to be sold by an investment dealer registered with a securities
regulatory authority or regulator.
There are restrictions on your ability to resell exempt market securities. Exempt market
securities are more risky than other securities.
You will receive an offering memorandum Read the offering memorandum carefully because
it has important information about the issuer and its securities. Keep the offering memorandum
because you have rights based on it. Talk to a lawyer for details about these rights.
You will not receive advice [Instruction: Delete if sold by registrant]
You will not get professional advice about whether the investment is suitable for you. But you
can still seek that advice from a registered adviser or registered dealer. In Alberta, Manitoba,
Northwest Territories, Nunavut, Prince Edward Island, Québec, Saskatchewan and Yukon to
qualify as an eligible investor, you may be required to obtain that advice.
The securities you are buying are not listed [Instruction: Delete if securities are listed or
quoted]
The securities you are buying are not listed on any stock exchange, and they may never be listed.
You may never be able to sell these securities.
The issuer of your securities is a non-reporting issuer [Instruction: Delete if issuer is
reporting]
A non-reporting issuer does not have to publish financial information or notify the public of
changes in its business. You may not receive ongoing information about this issuer.
For more information on the exempt market, call your local securities regulatory authority or
regulator. [Instruction: Insert the name, telephone number and website address of the securities
regulatory authority or regulator in the jurisdiction in which you are selling these securities.]
[Instruction: The purchaser must sign 2 copies of this form. The purchaser and the issuer
must each receive a signed copy.]
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