Registrant & Market Regulation

Test New Exemption Form

Name: Test New Exemption Form | ASC
Address: 250 5 St SW #600, Calgary, Alberta, T2P 0R4
Telephone: (403) 297-6454

Date

To: Executive Director, Alberta Securities Commission (ASC)

I am filing this report in compliance with the dealer registration exemption in ASC Blanket Order 31-536 Alberta Small Business Finder’s Exemption.

I am filing this report for the first time: Yes No I am filing this report to update a previously filed report Yes No

If you select Yes to the question below, the individual information section will be displayed. If you select No, you will be submitting the form as a Company and the company information section will be displayed.

I am filing this report as an individual Yes No

Individual Information

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Test New Exemption Form

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