SUBSCRIPTION AND SUBSCRIBER INFORMATION. Aggregate Subscription Price: (the “Subscription Amount”) Number of Units: x $0.20 = Subscription Amount If the Subscriber is signing as agent or trustee for a principal (a “Disclosed Principal”) and is not purchasing as trustee or agent for accounts fully managed by it, so as to be deemed to be purchasing as principal pursuant to NI 45-106 complete the following: (Name of Disclosed Principal) (Residential Address of Disclosed Principal) (Telephone Number of Disclosed Principal) (Account Reference, if applicable) Please print all information (other than signatures), as applicable, in the space provided below Subscriber Information and Signature (Name of Subscriber) Account Reference (if applicable): By: Authorized Signature (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Subscriber’s Residential Address, including Municipality and Province) (Address continued) (Subscriber’s Telephone Number) (Subscriber’s Email Address) **see Section 1.1 - “Definitions” in the attached Terms and Conditions for defined terms. Account Registration Information: (Name) (Account Reference, if applicable) (Address, including Postal Code) (Address continued)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below Number of Units: (Name of Subscriber) Unit Price: X $3.85 Account Reference (if applicable): Aggregate Subscription Price: By: (the “Subscription Price”) Authorized Signature If the Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Name of Principal) (Subscriber’s Address, including State) (Principal’s Address) (Telephone Number) (Email Address)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below. Please also ensure all Schedules (as applicable) are completed and executed. FCMI FINANCIAL CORPORATION Number of Units: 12,000,000 x C$0.75 (Name of Subscriber) By: /s/ Xxxxx Xxxxx Aggregate Subscription Cost (C$): C$9,000,000 Authorized Signature (the “Subscription Amount”) Please complete if purchasing as agent for a principal (beneficial purchaser) (the “Disclosed Principal”) and not purchasing as a trust company, trust corporation or portfolio manager for accounts fully managed by it: Executive Vice President (Official Capacity or Title – if the Subscriber is not an individual) Xxxxxxx (Xxxxx) Xxxxx (Name of Disclosed Principal) (Name of individual whose signature appears above if different than the name of the subscriber printed above.) Xxxxx 000, XXX Xxxxx, 000 Xxx Xxxxxx (Address of Disclosed Principal) (Subscriber’s Address, including Municipality and Province/State) Xxxxxxx, Xxxxxxx, X0X 0X0 (Account Reference, if applicable) (Telephone Number) (Email Address)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below. Amount of Subscription Number of Units: x US$[3.08][3.205] Aggregate Subscription Price: US$_________________ Beneficial Owner of Subscriber If the Subscriber is not an individual, the Subscriber represents and warrants that it has ¨ / does not have ¨ (check one) a Beneficial Owner (as defined in the Terms and Conditions of Subscription) and, if it has a Beneficial Owner, the name and address of the Beneficial Owner is as follows: Name of Beneficial Owner Residential Address of Beneficial Owner
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print ALL information (other than signatures), as applicable, in the space provided below (Name of Subscriber): _________________________________ Number of Flow-Through Shares: ___________ x $0.55 Account Reference (if applicable): _______________________ = Aggregate Subscription Price: _____________________ By: (the "Subscription Price") Authorized Signature (Official Capacity or Title - if the Subscriber is not an individual) If the Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: (Name of individual whose signature appears above if different than the name of the subscriber printed above.) (Name of Principal) (Subscriber’s Address, including Municipality and Province) (Principal’s Address) S.I.N. or Taxation Account of Subscriber (Telephone Number) (Email Address)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below (Name of Subscriber — please print) By: (Authorized Signature) (Please print name of individual whose signature appears above if different than the name of the subscriber printed above and title, if applicable.) (Subscriber’s Address) (Telephone Number) (Fax Number) (E-mail Address) Number of Common Shares Aggregate Consideration: $ (number of Common Shares x $5.00 (the “Subscription Amount”) Register the Common Shares as set forth below: (Name) (Account Reference, if applicable) (Address) Deliver the Common Shares as set forth below:
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below. Amount of Subscription Number of Units: ________________________x C$0.60 Aggregate Subscription Price: C$___________________ Beneficial Owner of Subscriber If the Subscriber is not an individual, the Subscriber represents and warrants that it has ¨ / does not have ¨ (check one) a Beneficial Owner (as defined in the Terms and Conditions of Subscription) and, if it has a Beneficial Owner, the name and address of the Beneficial Owner is as follows: ____________________________________________________________ Name of Beneficial Owner ____________________________________________________________ Residential Address of Beneficial Owner ____________________________________________________________
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below Fidelity Financial Trust: Fidelity Independence Fund (Name of Subscriber — please print) By: /s/ Xxxxxxx Xxxxxxxxx (Authorized Signature) Xxxxxxx Xxxxxxxxx (Please print name of individual whose signature appears above if different than the name of the subscriber printed above and title, if applicable.) (Subscriber’s Address) (Telephone Number) (Fax Number) (E-mail Address) Number of Common Shares 364,300 Aggregate Consideration: $ 1,821,500.00 (number of Common Shares x $5.00 (the “Subscription Amount”)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print ALL information (other than signatures), as applicable, in the space provided below (Name of Subscriber):__________________________________ Number of Units:___________________________________x U.S.$1.00 Account Reference (if applicable):_________________________________ = Aggregate Subscription Price:__________________________________ By:_________________________________________________________ (the "Subscription Price") Authorized Signature (Official Capacity or Title – if the Subscriber is not an individual) If the Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, and in each case satisfying the criteria set forth in National Instrument 45-106, complete the following: (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Name of Principal) (Subscriber's Residential Address) (Principal's Residential Address) (Subscriber's Telephone Number) (Email Address) (Principal's Telephone Number)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print ALL information (other than signatures), as applicable, in the space provided below (Name of Subscriber) Account Reference (if applicable): By: Authorized Signature (Name of individual whose signature appears above if different than the name of the subscriber printed above) (Subscriber’s Address) (Telephone Number) (Email Address) Number of Units: ___________ x $0.20 Aggregate Subscription Amount:
