FORM B Instructions: This form of affidavit is to be used to effect a change in the ownership of record of securities already issued and registered, after a sale or transfer of value. IN THE MATTER OF THE SECURITIES ACT - and -IN THE MATTER OF (Name of Issuer of Security) AFFIDAVIT OF I, (State Full Name) of (State Full Address) make oath and say as follows that: 1. The Deponent is the owner of/the agent of the owner of, the following security: (State full description of security including certificate(s), number(s) and registration(s)) 2. Said security was purchased, acquired or transferred for valuable consideration on the day of , 20 which date was prior to the date that a cease trading order was issued against the security under the Act. MG-3476
3. This declaration is made for the purpose of having the within described security, transferred into the name of (State Full Name and Address of Transferee) 4. I have such knowledge of the matters herein deposed to and no material facts having any bearing on the foregoing have been omitted or misrepresented. ) SWORN BEFORE ME at the of ) in the of ) ) , 20 . ) A Commissioner for Oaths or Notary Public (signature) Note #1: This affidavit is to be taken by the purchaser or an agent of the purchaser. Note #2: A copy of this affidavit is to be sent to the Securities Commission within 5 days of its receipt by the transfer agent.
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.