NUMBER SHARES
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CERTIFICATE NUMBER
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SEE REVERSE FOR
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CERTAIN DEFINITIONS
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CUSIP [●]
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Dated:
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Chief Executive Officer
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Chief Financial Officer
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Transfer Agent
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Alberta
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TEN COM
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-
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as tenants in common
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UNIF GIFT MIN ACT
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Custodian
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(Cust)
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(Minor)
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TEN ENT
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-
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as tenants by the entireties
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JT TEN
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-
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as joint tenants with right of survivorship and not as tenants in common
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(State)
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(PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER(S) OF ASSIGNEE(S))
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(PLEASE PRINT OR TYPEWRITE NAME(S) AND ADDRESS(ES), INCLUDING POSTAL CODE, OF ASSIGNEE(S))
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Dated
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Shareholder
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Signature(s) Guaranteed: By
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