Unofficial Consolidation: Form 13-502F2A Adjustment of Fee Payment for Class 2 Reporting Issuers

Unofficial Consolidation: Form 13-502F2A Adjustment of Fee Payment for Class 2 Reporting Issuers

Unofficial Consolidation Forms
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Ontario Securities Commission

Form 13-502F2A

Unofficial consolidation current to 2015-04-06

This document is not an official statement of law or policy and should be used for reference purposes only.

FORM 13-502F2A
ADJUSTMENT OF FEE PAYMENT FOR CLASS 2 REPORTING ISSUERS

MANAGEMENT CERTIFICATION

I, _______________________, an officer of the reporting issuer noted below have examined this Form 13-502F2A (the Form) being submitted hereunder to the Ontario Securities Commission and certify that to my knowledge, having exercised reasonable diligence, the information provided in the Form is complete and accurate.

(s)________________________________

__________________________

Name:

Title:

Date:

Reporting Issuer Name:       ___________________________

Financial year end date used
to calculate capitalization:             _________________

 

State the amount of participation fee paid under subsection 2.2(1) of OSC
Rule 13-502 Fees:

$                 (i)

Show calculation of actual capitalization based on audited financial statements:

 

 

Financial Statement Values:

 

Retained earnings or deficit

$                 (A)

Contributed surplus

$                 (B)

Share capital or owners’ equity, options, warrants and preferred shares (whether such shares are classified as debt or equity for financial reporting purposes)

$                 (C)

Non-current borrowings (including the current portion)

$                 (D)

Finance leases (including the current portion)

$                 (E)

Non-controlling interest

$                 (F)

Items classified on the statement of financial position as non-current liabilities (and not otherwise listed above)

$                 (G)

Any other item forming part of equity and not set out specifically above

$                 (H)

Capitalization

(Add items (A) through (H))

$                   

Participation Fee

(From Appendix A of OSC Rule 13-502 Fees, select the participation fee
beside the capitalization calculated above)

$                 (ii)

Refund due (Balance owing)

(Indicate the difference between (i) and (ii) and enter nil if no difference)
(i) –   (ii) =

$