Form 45-106f4 Risk Acknowledgement printable pdf download

Form 45-106f4 Risk Acknowledgement

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