# EDGAR Filing Document

**Accession Number:** 0001702123
**File Stem:** 0001104659-25-102722
**Filing Date:** 2025-10
**Character Count:** 27903
**Document Hash:** 2e9cc2190fcf8a1c34f80bd293b6ee09
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001104659-25-102722.hdr.sgml**: 20251028

**ACCESSION NUMBER**: 0001104659-25-102722

**CONFORMED SUBMISSION TYPE**: 6-K

**PUBLIC DOCUMENT COUNT**: 11

**CONFORMED PERIOD OF REPORT**: 20251027

**FILED AS OF DATE**: 20251028

**DATE AS OF CHANGE**: 20251027

**FILER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Cardiol Therapeutics Inc.
- **CENTRAL INDEX KEY:** 0001702123
- **STANDARD INDUSTRIAL CLASSIFICATION:** BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
- **ORGANIZATION NAME:** 03 Life Sciences
- **EIN:** 000000000
- **STATE OF INCORPORATION:** A6
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 6-K
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40712
- **FILM NUMBER:** 251421158

**BUSINESS ADDRESS:**
- **STREET 1:** 602-2265 UPPER MIDDLE ROAD EAST
- **CITY:** OAKVILLE
- **STATE:** A6
- **ZIP:** L6H 0G5
- **BUSINESS PHONE:** 289-910-0850

**MAIL ADDRESS:**
- **STREET 1:** 602-2265 UPPER MIDDLE ROAD EAST
- **CITY:** OAKVILLE
- **STATE:** A6
- **ZIP:** L6H 0G5

**UNITED STATES**

**SECURITIES AND EXCHANGE COMMISSION**

**Washington, D.C. 20549**

**FORM 6-K**

**REPORT OF FOREIGN PRIVATE ISSUER PURSUANT TO RULE 13a-16 OR 15d-16**

**UNDER THE SECURITIES EXCHANGE ACT OF 1934**

For the month of **October 2025**

Commission File Number: 001-40712

**Cardiol Therapeutics Inc.**

(*Name of registrant*)

**602-2265 Upper Middle Road East**

**Oakville, Ontario L6H 0G5**

**Canada**

*(Address of principal executive office)*

 

Indicate by check mark whether the registrant files or will file annual reports under cover of Form 20-F or Form 40-F.

◻ Form 20-F ⌧ Form 40-F

**SIGNATURES**

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.

---

| | | | |
|:---|:---|:---|:---|
|  | **CARDIOL THERAPEUTICS INC.** | **CARDIOL THERAPEUTICS INC.** | **CARDIOL THERAPEUTICS INC.** |
|  | (Registrant) | (Registrant) | (Registrant) |
| Date: October 27, 2025 | By: | /s/ Chris Waddick | /s/ Chris Waddick |
|  |  | Name: | Chris Waddick |
|  |  | Title: | Chief Financial Officer |

---

**Form 6-K Exhibit Index**

---

| | |
|:---|:---|
| **Exhibit<br> Number** | **Document Description** |
| [99.1](tm2518051d4_ex99-1.htm) | [Form 45-106F1 *Report of Exempt Distribution*](tm2518051d4_ex99-1.htm) |

---

## Exhibit 99.1

Exhibit 99.1

---

| | |
|:---|:---|
| &nbsp;&nbsp;![GRAPHIC](tm2518051d4_ex99-1img004.jpg) | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Form 45-106F1 Report of Exempt Distribution Item 1 – REPORT TYPE ☒ New report ☐ Amended report If amended, provide filing date of report that is being amended. (YYYY-MM-DD) Item 2– PARTY CERTIFYING THE REPORT Indicate the party certifying the report (select only one). For guidance regarding whether an issuer is an investment fund, refer to section 1.1 of National Instrument 81-106 Investment Fund Continuous Disclosure and the companion policy to NI 81-106 (in Québec, Regulation 81-106 respecting Investment Fund Continuous Disclosure and Policy Statement to Regulation 81-106 respecting Investment Fund Continuous Disclosure). ☐ Investment fund issuer ☒ Issuer (other than an investment fund) ☐ Underwriter Item 3– ISSUER NAME AND OTHER IDENTIFIERS Provide the following information about the issuer, or if the issuer is an investment fund, about the fund. Full Legal Name CARDIOL THERAPEUTICS INC. Previous full legal name If the issuer's name changed in the last 12 months, provide most recent previous legal name. Website https://www.cardiolrx.com/ (if applicable) If the issuer has a legal entity identifier, provide below. Refer to Part B of the Instructions for the definition of "legal entity identifier". Legal entity identifier 549300EXSOITGMUJOK20 If two or more issuers distributed a single security, provide the full legal name(s) of the co-issuer(s) other than the issuer named above. Full legal name(s) of co-issuer(s) (if applicable) Item 4– UNDERWRITER INFORMATION If an underwriter is completing the report, provide the underwriter's full legal name, firm NRD number, and SEDAR+ profile number. Full Legal Name Firm NRD number (if applicable) SEDAR+ profile number |

---

---

| | |
|:---|:---|
| &nbsp;&nbsp;![GRAPHIC](tm2518051d4_ex99-1img005.jpg) | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Item 5– ISSUER INFORMATION If the issuer is an investment fund, do not complete Item 5. Proceed to Item 6. a) Primary industry Provide the issuer's North American Industry Classification Standard (NAICS) code (6 digits only) that in your reasonable judgment most closely corresponds to the issuer's primary business activity. NAICS industry code 5 4 1 7 1 0 If the issuer is in the mining industry, indicate the stage of operations. This does not apply to issuers that provide services to issuers operating in the mining industry. Select the category that best describes the issuer's stage of operations. ☐ Exploration ☐ Development ☐ Production Is the issuer's primary business to invest all or substantially all of its assets in any of the following? If yes, select all that apply. ☐ Mortgages ☐ Real Estate ☐ Commercial/business debt ☐ Consumer debt ☐ Private companies ☐ Cryptoassets b) Number of employees Number of employees: ☒ 0 – 49 ☐ 50 – 99 ☐ 100 – 499 ☐ 500 or more c) SEDAR+ profile number Provide the issuer's SEDAR+ profile number 0 0 0 4 3 5 4 1 Item 6– INVESTMENT FUND ISSUER INFORMATION If the issuer is an investment fund, provide the following information. a) Investment fund manager information Full Legal Name Firm NRD number (if applicable) SEDAR+ profile number b) Type of investment fund Type of investment fund that most accurately identifies the issuer (select only one) ☐ Money market ☐ Equity ☐ Fixed income ☐ Balanced ☐ Alternative strategies ☐ Cryptoasset ☐ Other (describe) Indicate whether one or both of the following apply to the investment fund. ☐ Invests primarily in other investment fund issuers ☐ Is a UCITs Fund1 1 Undertaking for the Collective Investment of Transferable Securities funds (UCITs Funds) are investment funds regulated by the European Union (EU) directives that allow collective investment schemes to operate throughout the EU on a passport basis on authorization from one member state. c) Net asset value (NAV) of the investment fund Select the NAV range of the investment fund as of the date of the most recent NAV calculation (Canadian $) ☐ $0 to under $5M ☐ $5M to under $25M ☐ $25M to under $100M ☐ $100M to under $500M ☐ $500M to under $1B ☐ $1B or over Date of NAV calculation YYYY MM DD |

---

---

| | |
|:---|:---|
| &nbsp;&nbsp;![GRAPHIC](tm2518051d4_ex99-1img006.jpg) | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Item 7– INFORMATION ABOUT THE DISTRIBUTION If an issuer located outside of Canada completes a distribution in the jurisdiction of Canada, include in Item 7 and Schedule 1 information about purchasers resident in that jurisdiction of Canada only. Do not include in item 7 securities issued as payment of commissions or finders fees in connection with distribution, which must be disclosed in Item 8. The information provided in Item 7 must reconcile with the information provided in Schedule 1 of the report. a) Currency Select the currency or currencies in which the distribution was made. All dollar amounts provided in the report must be in Canadian dollars. ☐ Canadian dollar ☒ US dollar ☐ Euro Other (describe) b) Distribution Date(s) State the distribution start and end dates. If the report is being filed for securities distributed on only one distribution date, provide the distribution date as both the start and end dates. If the report is being filed for securities distributed on a continuous basis, include the start and end dates for the distribution period covered by the report. Start Date 2025 10 17 End Date 2025 10 20 YYYY MM DD YYYY MM DD c) Detailed purchaser information Complete Schedule 1 of this form for each purchaser d) Types of securities distributed Provide the following information for all distributions reported on a per security basis. Refer to Part A(12) of the Instructions for how to indicate the security code. If providing the CUSIP number, indicate the full 9-digit CUSIP number assigned to the security being distributed. Canadian $ Security Code CUSIP number (if applicable) Description of security Number of securities Single or lowest price Highest price Total amount U N T Unit consisting of one Class A Common Share and one-half of one Common Share Purchase Warrant 11,425,000 $1.4035 $1.4036 $16,035,144.50 e) Details of rights and convertible/exchangeable securities If any rights (e.g. warrants, options) were distributed, provide the exercise price and expiry date for each right. If any convertible/exchangeable securities were distributed, provide the conversion ratio and describe any other terms for each convertible/exchangeable security. Convertible / exchangeable security code Underlying security code Exercise price (Canadian $) Expiry date (YYYY-MM-DD) Conversion ratio Describe other terms (if applicable) Lowest Highest W N T C M S $1.4035 $1.4035 2027/10/17 1:1 Each warrant grants the holder the right to purchase 1 common share for a period of 24 months from the date of issuance. W N T C M S $1.4036 $1.4036 2027/10/21 1:1 Each warrant grants the holder the right to purchase 1 common share for a period of 24 months from the date of issuance. f) Summary of the distribution by jurisdiction and exemption State the total dollar amount of securities distributed and the number of purchasers for each jurisdiction of Canada and foreign jurisdiction where a purchaser resides and for each exemption relied on in Canada for that distribution. However, if an issuer located outside of Canada completes a distribution in a jurisdiction of Canada, include distributions to purchasers resident in that jurisdiction of Canada only. This table requires a separate line item for: (i) each jurisdiction where a purchaser resides, (ii) each exemption relied on in the jurisdiction where a purchaser resides, if a purchaser resides in a jurisdiction of Canada, and (iii) each exemption relied on in Canada, if a purchaser resides in a foreign jurisdiction. For jurisdictions within Canada, state the province or territory, otherwise state the country. Province or country Exemption relied on Number of unique purchasers2a Total amount (Canadian $) AB NI 45-106 2.3 [Accredited investor] 2 $477,194.00 BC NI 45-106 2.3 [Accredited investor] 2 $421,055.00 ON NI 45-106 2.3 [Accredited investor] 8 $2,245,665.00 QC NI 45-106 2.3 [Accredited investor] 1 $350,875.00 Bahamas OSC Rule 72-503 - Distributions Outside of Canada 1 $1,122,800.00 |

---

---

| | |
|:---|:---|
| &nbsp;&nbsp;![GRAPHIC](tm2518051d4_ex99-1img007.jpg) | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Cayman Islands OSC Rule 72-503 - Distributions Outside of Canada 1 $3,508,750.00 Germany OSC Rule 72-503 - Distributions Outside of Canada 2 $1,614,025.00 Isle of Man OSC Rule 72-503 - Distributions Outside of Canada 1 $140,360.00 Luxembourg OSC Rule 72-503 - Distributions Outside of Canada 1 $701,750.00 Malta OSC Rule 72-503 - Distributions Outside of Canada 1 $238,595.00 South Africa OSC Rule 72-503 - Distributions Outside of Canada 2 $484,232.50 United Arab Emirates OSC Rule 72-503 - Distributions Outside of Canada 3 $238,612.00 United Kingdom OSC Rule 72-503 - Distributions Outside of Canada 7 $3,424,571.00 USA OSC Rule 72-503 - Distributions Outside of Canada 7 $1,066,660.00 Total dollar amount of securities distributed $16,035,144.50 Total number of unique purchasers2b 39 2aIn calculating the number of unique purchasers per row, count each purchaser only once. Joint purchasers may be counted as one purchaser. 2bIn calculating the total number of unique purchasers to which the issuer distributed securities, count each purchaser only once, regardless of whether the issuer distributed multiple types of securities to, and relied on multiple exemptions for, that purchaser. g) Net proceeds to the investment fund by jurisdiction If the issuer is an investment fund, provide the net proceeds to the investment fund for each jurisdiction of Canada and foreign jurisdiction where a purchaser resides.3 If an issuer located outside of Canada completes a distribution in a jurisdiction of Canada, include net proceeds for that jurisdiction of Canada only. For jurisdictions within Canada, state the province or territory, otherwise state the country. Province or country Net proceeds (Canadian $) Total net proceeds to the investment fund 3 "Net proceeds" means the gross proceeds realized in the jurisdiction from the distributions for which the report is being filed, less the gross redemptions that occurred during the distribution period covered by the report |

---

---

| | |
|:---|:---|
| &nbsp;&nbsp;![GRAPHIC](tm2518051d4_ex99-1img008.jpg) | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Item 8 – COMPENSATION INFORMATION Provide information for each person (as defined in NI 45-106 (in Quebec, Regulation 45-106 respecting Prospects Exemptions)) to whom the issuer directly provides, or will provide, any compensation in connection with the distribution. Complete additional copies of this page if more than one person was, or will be, compensated. Indicate whether any compensation was paid, or will be paid, in connection with the distribution ☐ No ☒ Yes If yes, indicate number of persons compensated. 2 a) Name of person compensated and registration status Indicate whether the person compensated is a registrant ☐ No ☒ Yes If the person compensated is an individual, provide the name of the individual Full legal name of individual Family name First given name Secondary given names If the person compensated is not an individual, provide the following information. Full legal name of non-individual Leede Financial Inc. Firm NRD number 5 7 7 0 (if applicable) Indicate whether the person compensated facilitated the distribution through a funding portal or an internet-based portal. ☒ No ☐ Yes b) Business contact information If a firm NRD number is not provided in Item 8a), provide the business contact information of the person being compensated. Street address Municipality Province/State Country Postal code/Zip code Email address Telephone number c) Relationship to issuer or investment fund manager Indicate the person's relationship with the issuer or investment fund manager (select all that apply). Refer to the meaning of "connected" in Part B(2) of the Instructions and the meaning of "control" in section 1.4 of NI 45-106 (in Quebec, Regulation 45-106 respecting Prospectus Exemptions) for the purposes of completing this section. ☐ Connected with the issuer or investment fund manager ☐ Insider of the issuer (other than an investment fund) ☐ Director or officer of the investment fund or investment fund manager ☐ Employee of the issuer or investment fund manager ☒ None of the above d) Compensation details Provide details of all compensation paid, or to be paid, to the person identified in Item 8a) in connection with the distribution. Provide all amounts in Canadian dollars. Include cash commissions, securities-based compensation, gifts, discounts or other compensation. Do not report payments for services incidental to the distribution, such as clerical, printing, legal or accounting services. An issuer is not required to ask for details about, or report on, internal allocation arrangements with the directors, officers or employees of a non-individual compensated by the issuer. Cash commissions paid $21,054 Value of all securities distributed as compensation4 Security code 1 Security code 2 Security code 3 Security codes Describe terms of warrants, options or other rights Other compensation5 Describe Total compensation paid $21,054 ☐ Check box if the person will or may receive any deferred compensation (describe the terms below) 4Provide the aggregate value of all securities distributed as compensation, excluding options, warrants or other rights exercisable to acquire additional securities of the issuer. Indicate the security codes for all securities distributed as compensation, including options, warrants or other rights exercisable to acquire additional securities of the issuer. |

---

---

| | |
|:---|:---|
| &nbsp;&nbsp;![GRAPHIC](tm2518051d4_ex99-1img009.jpg) | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5Do not include deferred compensation. a) Name of person compensated and registration status Indicate whether the person compensated is a registrant ☐ No ☒ Yes If the person compensated is an individual, provide the name of the individual Full legal name of individual Family name First given name Secondary given names If the person compensated is not an individual, provide the following information. Full legal name of non-individual Research Capital Corporation Firm NRD number 3 0 7 0 (if applicable) Indicate whether the person compensated facilitated the distribution through a funding portal or an internet-based portal. ☒ No ☐ Yes b) Business contact information If a firm NRD number is not provided in Item 8a), provide the business contact information of the person being compensated. Street address Municipality Province/State Country Postal code/Zip code Email address Telephone number c) Relationship to issuer or investment fund manager Indicate the person's relationship with the issuer or investment fund manager (select all that apply). Refer to the meaning of "connected" in Part B(2) of the Instructions and the meaning of "control" in section 1.4 of NI 45-106 (in Quebec, Regulation 45-106 respecting Prospectus Exemptions) for the purposes of completing this section. ☐ Connected with the issuer or investment fund manager ☐ Insider of the issuer (other than an investment fund) ☐ Director or officer of the investment fund or investment fund manager ☐ Employee of the issuer or investment fund manager ☒ None of the above d) Compensation details Provide details of all compensation paid, or to be paid, to the person identified in Item 8a) in connection with the distribution. Provide all amounts in Canadian dollars. Include cash commissions, securities-based compensation, gifts, discounts or other compensation. Do not report payments for services incidental to the distribution, such as clerical, printing, legal or accounting services. An issuer is not required to ask for details about, or report on, internal allocation arrangements with the directors, officers or employees of a non-individual compensated by the issuer. Cash commissions paid 85,058.16 Value of all securities distributed as compensation4 Security code 1 Security code 2 Security code 3 Security codes Describe terms of warrants, options or other rights Other compensation5 Describe Total compensation paid 85,058.16 ☐ Check box if the person will or may receive any deferred compensation (describe the terms below) 4Provide the aggregate value of all securities distributed as compensation, excluding options, warrants or other rights exercisable to acquire additional securities of the issuer. Indicate the security codes for all securities distributed as compensation, including options, warrants or other rights exercisable to acquire additional securities of the issuer. 5Do not include deferred compensation. Item 9 – DIRECTORS, EXECUTIVE OFFICERS AND PROMOTERS OF THE ISSUER If the issuer is an investment fund, do not complete Item 9. Proceed to Item 10. |

---

---

| | |
|:---|:---|
| &nbsp;&nbsp;![GRAPHIC](tm2518051d4_ex99-1img010.jpg) | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Indicate whether any compensation was paid, or will be paid in connection with the distribution. ☒ Reporting issuer in any jurisdiction of Canada ☐ Foreign public issuer ☐ Wholly owned subsidiary or a reporting issuer in any jurisdiction of Canada6 Provide name of reporting issuer ☐ Wholly owned subsidiary of a foreign public issuer6 Provide name of foreign public issuer ☐ Issuer distributing only eligible foreign securities and the distribution is to permitted clients only7 If the issuer is at least one of the above, do not complete Item 9a) – (c). Proceed to Item 10. 6An issuer is a wholly owned subsidiary of a reporting issuer or a foreign public issuer if all of the issuer's outstanding voting securities, other than securities that are required by law to be owned by its directors, are beneficially owned by the reporting issuer or the foreign public issuer, respectively. 7Check this box if it applies to the current distribution even if the issuer made previous distributions of other types of securities to non-permitted clients. Refer to the definitions of "eligible foreign security" and "permitted client" in Part B(1) of the Instructions. ☐ If the issuer is none of the above, check this box and complete Item 9a) – (c) a) Directors, executive officers and promoters of the issuer Provide the following information for each director, executive officer and promoter of the issuer. For locations within Canada, state the province or territory, otherwise state the country. For "Relationship to issuer", "D" – Director, "O" – Executive Officer, "P" – Promoter. Organization or company name Family name First given name Secondary given names Business location of non-individual or residential jurisdiction of individual Relationship to issuer (select all that apply) Province or country D O P b) Promoter information If the promoter listed above is not an individual, provide the following information for each director and executive officer of the promoter. For locations within Canada, state the province or territory, otherwise state the country. For "Relationship to promoter", "D" – Director, "O" – Executive Officer. Organization or company name Family name First given name Secondary given names Business location of non-individual or residential jurisdiction of individual Relationship to promoter (select all that apply) Province or country D O c) Residential address of each individual Complete Schedule 2 of this form, including the full residential address of each individual whose name appears in Item 9a) or (b). Schedule 2 also requires information to be provided about control persons. Item 10 – CERTIFICATION Provide the following certification and business contact information of an officer, director or agent of the issuer or underwriter. If the issuer or underwriter is not a company, an individual who performs functions similar to that of a director or officer may certify the report. For example, if the issuer is a trust, the report may be certified by the issuer's trustee. If the issuer is an investment fund, a director or officer of the investment fund manager (or, if the investment fund manager is not a company, an individual who performs similar functions) may certify the report if the director or officer has been authorized to do so by the investment fund. |

---

---

| | |
|:---|:---|
| &nbsp;&nbsp;![GRAPHIC](tm2518051d4_ex99-1img011.jpg) | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The certification may be delegated, but only to an agent that has been authorized by an officer or director of the issuer or underwriter to prepare and certify the report on behalf of the issuer or underwriter. If the report is being certified by an agent on behalf of the issuer or underwriter, provide the applicable information for the agent in the boxes below. If the individual completing and filing the report is different from the individual certifying the report, provide the name and contact details for the individual completing and filing the report in Item 11. The signature on the report must be in typed form rather than handwritten form. The report may include an electronic signature provided the name of the signatory is also in typed form. Securities legislation requires an issuer or underwriter that makes a distribution of securities under certain prospectus exemptions to file a completed report of exempt distribution. By completing the information below, I certify, on behalf of the issuer/underwriter/investment fund manager, to the securities regulatory authority or regulator, as applicable, that I have reviewed this report and to my knowledge, having exercised reasonable diligence, the information provided in this report is true and, to the extent required, complete. Name of issuer/underwriter/ investment fund manager/agent Cardiol Therapeutics Inc. Full legal name Crandall Dan Family Name First given name Secondary given names Title Director of Finance Telephone number 289 910 0856 Email address dan.crandall@cardiolrx.com Signature Date 2025 10 27 YYYY MM DD Item 11 – CONTACT PERSON Provide the following business contact information for the individual that the securities regulatory authority or regulator may contact with any questions regarding the contents of this report, if different than the individual certifying the report in Item 10. ☒ Same as individual certifying the report Full legal name Family name First given name Secondary given names Name of company Telephone number Email address |

---

---

| | |
|:---|:---|
| &nbsp;&nbsp;![GRAPHIC](tm2518051d4_ex99-1img012.jpg) | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;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 authority or regulator under the authority granted in securities legislation for the purposes of the administration and enforcement of the securities legislation. If you have any questions about the collection and use of this information, contact the securities regulatory authority or regulator in the local jurisdiction(s) where the report is filed, at the address(es) listed at the end of this form. Schedules 1 and 2 may contain personal information of individuals and details of the distribution(s). The information in Schedules 1 and 2 will not be placed on the public file of any securities regulatory authority or regulator. However, freedom of information legislation may require the securities regulatory authority or regulator to make this information available if requested. By signing this report, the issuer/underwriter confirms that each individual listed in Schedule 1 or 2 of the report who is resident in a jurisdiction of Canada: a) Has been notified by the issuer/underwriter of the delivery to the securities regulatory authority or regulator of the information pertaining to the individual as set out in Schedule 1 or 2, that this information is being collected by the securities regulatory authority or regulator under the authority granted in securities legislation, that this information is being collected for the purposes of the administration and enforcement of the securities legislation of the local jurisdiction, and of the title, business address and business telephone number of the public official in the local jurisdiction, as set out in this form, who can answer questions about the security regulatory authority's or regulator's indirect collection of the information, and b) has authorized the indirect collection of the information by the securities regulatory authority or regulator. |

---