exv4w5














 




    Exhibit 4.5




    
    



 




    SPECIAL
    DIVIDEND REINVESTMENT PLAN — ENROLLMENT FORM



 






    Only residents of Canada and the United States are eligible
    to participate in the Plan.



 



    Do not complete this form if you wish to receive the Special
    Dividend (as defined herein) in cash (net of any applicable
    withholding tax).



 



    I wish to enroll in the Special Dividend Reinvestment Plan (the
    “Plan”) of Valeant Pharmaceuticals International, Inc.
    (the “Company”) in order to reinvest the one-time
    special dividend of US$1.00 per common share of the Company (the
    “Special Dividend”) in common shares of the Company. I
    hereby instruct the Company to forward to CIBC Mellon
    Trust Company, the Agent under the Plan (the
    “Agent”), 100% of the Special Dividend paid on all
    common shares of the Company now registered in my name and
    direct the Agent to invest such Special Dividend (net of any
    applicable withholding tax) in common shares of the Company in
    accordance with the provisions of the Plan. Fractional common
    shares will not be issued under the Plan; instead participants
    will receive a cash payment in lieu of any fractional common
    shares in accordance with the provisions of the Plan. By signing
    this form, I request enrollment in the Plan, acknowledge that I
    have read the Offering Circular containing and describing the
    Plan and that my participation in the Plan will be subject to
    its terms and conditions.



 


	 	 	 
	
    

	
 
	
    


	
    Registered Shareholder Account Number
	
 
	
    Name of Registered Shareholder

    (Print Name)

	
 
	
 
	
 

	
    

	
 
	
 

	

    Daytime Telephone Number


	
 
	
 

	
 
	
 
	
 

	
    

	
 
	
    


	

    Date


	
 
	
    Signature of Registered Shareholder









 



    Notes:






    1. This form must be completed and delivered to the
    Agent, in accordance with the instructions below, by no later
    than 5:00 p.m. (Toronto time) on December 8, 2010, in
    order to be effective.



 



    2. If common shares are held jointly, all holders must
    sign. All signatures should be exactly as they appear on the
    share certificate(s).



 



    3. If your common shares are held in more than one account,
    a separate participation form must be completed for each account
    that you wish to participate.



 



    4. Where a participation form is executed on behalf of a
    corporation, partnership, association, agency, estate or trust,
    the Agent requires submission of satisfactory evidence of
    authority of the person executing the form.



 



    5. The Plan is administered by CIBC Mellon
    Trust Company. You can contact CIBC Mellon
    Trust Company at
    416-643-5500
    in Toronto, or toll free in the rest of North America at
    1-800-387-0825.




 



    If you wish to participate in this Plan, please complete this
    form and return it by mail, using the enclosed envelope to the
    address below, or send it by facsimile, as follows:



 


	 	 	 	 	 
	

    By Mail:


	
 
	
    CIBC Mellon Trust Company P.O. Box 7010
	
 
	

    By Fax: CIBC Mellon Trust Company

     416-643-5020



	
 
	
 
	
    Adelaide Street Postal Station
	
 
	
 

	
 
	
 
	
    Toronto, ON M5C 2W9
	
 
	
 

	
 
	
 
	
    Attention: Dividend Reinvestment Dept.
	
 
	
 









 



    Non-registered holders should contact their intermediaries
    to discuss enrollment in the Plan and the administrative
    practices of that institution with regard to participation in
    the Plan.