Management Certification

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FORM 13-502F1 CLASS 1 AND CLASS 3B REPORTING ISSUERS – PARTICIPATION FEE
MANAGEMENT CERTIFICATION
I, _______________________, an officer of the reporting issuer noted below have examined this Form 13-502F1 (the
Form) being submitted hereunder to the Ontario Securities Commission and certify that to my knowledge, having
exercised reasonable diligence, the information provided in the Form is complete and accurate.
(s)________________________________
__________________________
Name:
Date:
Title:
Reporting Issuer Name:
End date of previous financial year:
 Class 1 reporting issuer
 Class 3B reporting issuer
Type of Reporting Issuer:
Highest Trading Marketplace:
(refer to the definition of “highest trading marketplace” under OSC Rule 13-502 Fees)
Market value of listed or quoted equity securities:
(in Canadian Dollars - refer to section 7.1 of OSC Rule 13-502 Fees)
Equity Symbol
_________________________
st
1
Specified Trading Period (dd/mm/yy)
(refer to the definition of “specified trading period” under OSC Rule
13-502 Fees)
_________________ to _________________
Closing price of the security in the class or series on the last
trading day of the specified trading period in which such
security was listed or quoted on the highest trading
marketplace
$________________________ (i)
Number of securities in the class or series of such security
outstanding at the end of the last trading day of
_________________________ (ii)
the specified trading period
(i) x (ii)
$_________________________ (A)
Market value of class or series
nd
2
Specified Trading Period (dd/mm/yy)
(refer to the definition of “specified trading period” under OSC Rule
13-502 Fees)
_________________ to _________________
Closing price of the security in the class or series on the last
trading day of the specified trading period in which such
security was listed or quoted on the highest trading

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