PROVIDUS MORTGAGE INVESTMENT CORPORATION SUBSCRIPTION AGREEMENTMortgage Investment Corporation Subscription Agreement • May 7th, 2014 • British Columbia
ITEM 1A. SUBSCRIBER INFORMATION INDIVIDUAL SUBSCRIBERS: Mr. Mrs. Miss Ms.Dr. Last Name Given Name(s) Address City Province Postal Code Telephone Email Address SIN Joint Subscribers Joint tenants with rights of survivorship; or Tenants in common Mr. Mrs. Miss Ms.Dr. Last Name Given Name(s) Joint Subscriber’s address same as above in Item 1A If different from 1A: Address City Province Postal Code SIN ENTITY SUBSCRIBERS: Corporation Partnership Trust Other: Name of Entity Address City Province Postal Code Telephone Email Address Incorporation/Registration Number CRA Business or Trust Number Authorized Representative: Name Position/Title Address City Province Postal Code Telephone Email Address Identification: For individuals, please include a photocopy of government issued picture ID. For entities, please include a copy of incorporation documents, a Directors’ Resolution authorizing the Authorized Representative to purchase shares, and a photocopy of government issued picture ID for the
