Form 45-106F12 Risk Acknowledgment for Family, Friend and Business Associate Investors | Canada

Investors who are family, friends or business associates of the issuer must complete this form 45-106F12 when buying shares under an exempt private placement offering.

• This form comprises amendments in Ontario that came into effect on May 5, 2015.
• The investor acknowledges that the investment is risky and that they may lose their entire investment.
• This form can only be used by investors who are:
  • a principal of the issuer,
  • a family member, business associate or close friend of a majority shareholder, or
  • a trust or estate of which all of the beneficiaries or a majority of the trustees or executors are one of the above.
• Available in PDF format.
• This free form is issued by the British Columbia Securities Commission.