FORM 13-502F1 |
| CLASS 1 AND CLASS 3B REPORTING ISSUERS – PARTICIPATION FEE |
| | MANAGEMENT CERTIFICATION |
| | | I, _______________________, an officer of the reporting issuer noted below have examined this Form13-502F1 (the Form) being submitted hereunder to the Ontario Securities Commission and certify that tomy knowledge, having exercised reasonable diligence, the information provided in the Form is completeand accurate. |
| | | | __________________________Date: | (s)________________________________Name:Title: |
| | | Reporting Issuer Name: |
| | | End date of previous financial year: |
| | | Type of Reporting Issuer: | Class 1 reporting issuer | | | | | Class 3B reporting issuer |
| | | Highest Trading Marketplace:(refer to the definition of “highest trading marketplace” under OSC Rule 13-502 Fees) |
| | | Market value of listed or quoted equity securities:(in Canadian Dollars - refer to section 7.1 of OSC Rule 13-502 Fees) |
| | | Equity Symbol |
| | | | | | _________________________ |
| | | 1st Specified Trading Period (dd/mm/yy)(refer to the definition of “specified trading period” under OSCRule 13-502 Fees) |
| | | | _________________ to _________________ |
| | | Closing price of the security in the class or serieson the last trading day of the specified tradingperiod in which such security was listed or quotedon the highest trading marketplace |
| | | | | | $________________________ (i) |
| | | Number of securities in the class or series of suchsecurity outstanding at the end of the last tradingday of the specified trading period |
| | | | | | _________________________ (ii) |
| | | Market value of class or series | (i) x (ii) | | $_________________________ (A) |
| | | 2nd Specified Trading Period (dd/mm/yy)(refer to the definition of “specified trading period” under OSCRule 13-502 Fees) |
| | | | _________________ to _________________ |
Closing price of the security in the class or serieson the last trading day of the specified tradingperiod in which such security was listed or quotedon the highest trading marketplace |
| $______________________ (iii) |
Number of securities in the class or series of suchsecurity outstanding at the end of the last tradingday of the specified trading period |
| ________________________ (iv) |
Market value of class or series | | (iii) x (iv) | $________________________ (B) |
3rd Specified Trading Period (dd/mm/yy)(refer to the definition of “specified trading period” under OSCRule 13-502 Fees) |
| | | _________________ to _________________ |
Closing price of the security in the class or serieson the last trading day of the specified tradingperiod in which such security was listed or quotedon the highest trading marketplace |
| $ _______________________ (v) |
Number of securities in the class or series of suchsecurity outstanding at the end of the last tradingday of the specified trading period |
| ________________________ (vi) |
Market value of class or series |
| | (v) x (vi) | $________________________ (C) |
4th Specified Trading Period (dd/mm/yy)(refer to the definition of “specified trading period” under OSCRule 13-502 Fees) |
| | | _________________ to _________________ |
Closing price of the security in the class or serieson the last trading day of the specified tradingperiod in which such security was listed or quotedon the highest trading marketplace |
| ________________________ (vii) |
Number of securities in the class or series of suchsecurity outstanding at the end of the last tradingday of the specified trading period |
| ________________________ (viii) |
Market value of class or series | | (vii) x (viii) $________________________ (D) |
5th Specified Trading Period (dd/mm/yy)(if applicable - refer to the definition of “specified tradingperiod” under OSC Rule 13-502 Fees) |
| | | _________________ to _________________ |
Closing price of the security in the class or serieson the last trading day of the specified tradingperiod in which such security was listed or quotedon the highest trading marketplace |
| $_______________________ (ix) |
Number of securities in the class or series of such | ________________________ (x) |
security outstanding at the end of the last tradingday of the specified trading period |
Market value of class or series | (ix) x (x) | $________________________ (E) |
Average Market Value of Class or Series(Calculate the simple average of the market value of the classor series of security for each applicable specified tradingperiod (i.e. A through E above)) |
| | $_________________________ (1) |
(Repeat the above calculation for each other class or series of equity securities of the reporting issuer (and asubsidiary pursuant to paragraph 2.8(1)(c) of OSC Rule 13-502 Fees, if applicable) that was listed or quoted on amarketplace at the end of the previous financial year) |
Fair value of outstanding debt securities:(See paragraph 2.8(1)(b), and if applicable, paragraph 2.8(1)(c)of OSC Rule 13-502 Fees) |
| | $_________________________ (2) |
(Provide details of how value was determined) |
Capitalization for the previous financial year | (1) + (2) | $_________________________ |
Participation Fee | | $_________________________ |
(For Class 1 reporting issuers, from Appendix A ofOSC Rule 13-502 Fees, select the participation fee) |
(For Class 3B reporting issuers, from AppendixA.1 of OSC Rule 13-502 Fees, select theparticipation fee) |
Late Fee, if applicable(As determined under section 2.7 of OSC Rule 13-502 Fees) |
| | $_________________________ |
Total Fee Payable(Participation Fee plus Late Fee) |
| | $_________________________ |