55-102F3 Issuer Profile Supplement [F]

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55-102F3 [F] May 6, 2011
55-102F3 [F] May 6 2011
Published: 2008-06-13
Effective: 2008-06-13

Concurrently Published

Document
BCN 2008/29 BCN 2008/29 Adoption of Housekeeping Amendments to National Instrument 55-102 System for Electronic Disclosure by Insiders (SEDI) and related Forms 55-102F1 Insider Profile, 55-102F2 Insider Report, 55-102F3 Issuer Profile Supplement and 55-102F6 Insider Report [BCN]

FORM 55-102F3

Issuer Profile Supplement

An issuer profile supplement filed in SEDI format shall contain the information prescribed below.  The information shall be entered using the online version of this form accessible by SEDI users at the SEDI web site (www.sedi.ca).  All references to web pages, fields and lists relate to the online version of the form.

1. Name of reporting issuer

Provide the name of the reporting issuer for which the issuer profile supplement is being created by searching for the reporting issuer using the reporting issuer's SEDAR number or the reporting issuer's legal name (in English or French).  If the reporting issuer's name does not appear in the search results, an issuer profile must be created for the reporting issuer in SEDAR before proceeding further with any SEDI filings.  See National Instrument 13-101 System for Electronic Document Analysis and Retrieval (SEDAR).

2. Name of insider affairs contact

Provide the full legal name of an individual who will act as "insider affairs contact" for the reporting issuer.  Use the "Family name" and "Given names" fields for this purpose.  Use upper and lower case letters as applicable.  Do not use initials, nicknames or abbreviations.  SEDI will automatically deliver an e-mail message to the e-mail address provided for the insider affairs contact each time an insider profile or an amended insider profile is filed by or on behalf of a person or company disclosing an insider relationship with the reporting issuer.  This is intended to assist the reporting issuer in identifying any incorrect or inappropriate SEDI filings made in respect of the reporting issuer.  Insider affairs contact information is not accessible by the public.

3. Address of insider affairs contact

Provide a business address for the insider affairs contact.  Indicate the country and provide the address (street name and number, etc.), the municipality (city, town, etc.), province, territory or state and postal or zip code, as applicable. A post office box or similar mailing address is not acceptable.

4. Telephone number and e-mail address of insider affairs contact

Provide a business telephone number and a business e-mail address for the insider affairs contact.

5. Fax number of insider affairs contact (if applicable)

If available, provide a business fax number for the insider affairs contact.

6. Confidential question and answer

Provide a "confidential question" and an answer to the confidential question for use in identifying the issuer's representative if a request is being made to the SEDI operator for a new issuer access key.  Keep a record of the confidential question and answer in a secure location.
 

7. Security designations

Provide the security designation for each outstanding security and each class of outstanding securities of the reporting issuer that is held by an insider of the reporting issuer who has direct or indirect beneficial ownership of, or control or direction over, that security or class of security.  For each security or class of securities, select the appropriate "Security category" by choosing "Debt", "Equity" or "Issuer Derivative" from the list provided.  Then provide a designation of the security or class of securities using the fields provided for this purpose, as follows.  First, select the "Security name" from the list of generic security names provided.  Second, if applicable, enter any additional words used to describe the specific security or class of securities.  For example, to provide the designation of "Class A Preferred Shares, Series 1", select "Preferred Shares" from the "Security name" field and then type "Class A, Series 1" in the "Additional description" field.

If the security whose designation is being added is an issuer derivative, provide the designation of the underlying security or class of underlying securities in addition to the designation of the issuer derivative itself.  First, select the applicable securities category for the underlying security and then provide the designation for the underlying security using the "Security name" and "Additional description" fields in the same manner as described above. 

8. Amending a security designation

If there is any change in the security designation disclosed previously for a security or class of securities of the reporting issuer that is outstanding or that may be issued in the future, use the "Amend security designation" function to amend the applicable security designation in the issuer profile supplement.  Select the applicable security designation to be amended and a web page with pre-populated fields containing the existing security designation information will be displayed for purposes of making the necessary amendment(s). 

Note that a security designation should only be amended for corrections or for changes that do not result in the security or class of securities ceasing to exist.  If a security or class of securities ceases to exist and is replaced by another security or class of securities, the "old" security must be archived in the manner described under item 9 below and a security designation must be added for the "new" security in the manner described under item 7 above.

If the security or class of securities affected by the change is an underlying security for an issuer derivative, use the "Amend security designation" function to amend the security designation of the underlying security as well.

9. Archiving a security designation

If any security or class of securities designated previously by the reporting issuer has ceased to be outstanding and the security or class of securities may no longer be issued, use the "Archive security designation" function to remove the relevant security designation from the reporting issuer's list of "outstanding securities" and place it in the reporting issuer's list of "archived securities".  Archived security designations may not be reactivated if the applicable security or class of securities is re-issued or becomes subject to the issuance.  In such circumstances, a new security designation must be added to the issuer profile supplement in the manner described under item 7 above.

 
Notice - Collection and Use of Personal Information

The personal information required under this form is collected on behalf of and used by the securities regulatory authorities set out below for purposes of the administration and enforcement of certain provisions of the securities legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Northwest Territories, Quebec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Yukon. Some of the required information will be made public pursuant to the securities legislation in each of the jurisdictions indicated above.  Other required information will remain confidential and will not be disclosed to any person or company except to any of the securities regulatory authorities or their authorized representatives.  If you have any questions about the collection and use of this information, you may contact the securities regulatory authority in any jurisdiction(s) in which the required information is filed, at the address(es) or telephone number(s) set out below. In Quebec, questions may also be addressed to the Commission d'accès à l'information du Québec
(1-888-528-7741, web site: www.cai.gouv.qc.ca).

Alberta Securities Commission
Suite 600, 250-5th Street SW
Calgary, AB   T2P 0R4
Attention: Information Officer
Telephone: (403) 297-6454
British Columbia Securities Commission
P.O. Box 10142, Pacific Centre
701 West Georgia Street
Vancouver, BC  V7Y 1L2
Attention: Supervisor, Insider Reporting
Telephone: (604) 899-6500 or (800) 373-6393 (in BC) 
The Manitoba Securities Commission
500-400 St. Mary Avenue,
Winnipeg, MB   R3C 4K5
Attention: Director, Legal
Telephone: (204) 945-4508
Securities Commission of Newfoundland
P.O. Box 8700
2nd Floor, West Block
Confederation Building
St. John's, NFLD   A1B 4J6
Attention: Director of Securities
Telephone: (709) 729-4189
Superintendent of Securities
Department of Justice
Government of the Northwest Territories
1st Floor, Stuart M. Hodgson Building
5009-49th Street
P.O.Box 1320
Yellowknife, Northwest Territories, X1A 2L9
Attention: Deputy Superintendent of Securities
Tel: (867) 920-3318
Nova Scotia Securities Commission
2nd Floor, Joseph Howe Building
1690 Hollis Street
P.O. Box 458
Halifax, NS   B3J 3J9
Attention: FOI Officer
Telephone: (902) 424-7768
Government of Nunavut
Legal Registries Division
P.O. Box 100, Station 570
1st Floor, Brown Building
Iqualuit, Nunavat, X0A 0H0
Contact person: Superintendent of Securities
Tel: (867) 975-6590
Fax: (867) 975-6595
Email: legal.registries@gov.nu.ca
Ontario Securities Commission
Suite 1903, Box 55
20 Queen Street West
Toronto, ON   M5H 3S8
Attention: FOI Coordinator
Telephone: (416) 593-8314
Autorité des marchés financiers
Stock Exchange Tower
P.O. Box 246, 22nd Floor
800 Victoria Square
Montréal, PQ   H4Z 1G3
Attention: Responsable de l'accès à l'information
Telephone: (514) 940-2150 or (800) 361-5072 (in Quebec)
Saskatchewan Financial Services Commission
Securities Division
6th Floor, 1919 Saskatchewan Drive
Regina, SK   S4P 3V7
Attention: Director
Telephone: (306) 787-5645
New Brunswick Securities Commission
85 Charlotte Street ,Suite 300
Saint John, NB  E2L 2J2
Attention: Corporate Finance Officer
Telephone: (506) 658-3060 or (866) 933-2222 (in New Brunswick)
Superintendent of Securities
Government of Prince Edward Island
4th Floor, Shaw Building
95 Rochford Street
P.O. Box 2000
Charlottetown PE  C1A 7N8
Tel: (902) 368-4550
Yukon Securities Office
Government of Yukon
3rd floor – 2130 Second Avenue
Whitehorse, Yukon
Y1A 2C6 (C-6)
Attention: Superintendent of Securities
Tel: (867) 667-5505