Document:

f8k030510ex10i_silveramerca.htm

    Exhibit
10.1

    Letter
of Intent

     

     

    March
5,2010

     

    Gentlemen:

     

    This
letter confirms our agreement on the principal terms and conditions of Yale
Resources Ltd. ("Yale") proposing to grant an option to Silver America Inc.
("SILVER AMERICA") to acquire a property interest in the Guadalupe property in
Zacatcas State, Mexico, more particularly described in Schedule "B" attached
hereto (the "Property"). Each party understands and agrees that preparation and
execution of a definitive agreement is required and that it will contain the
Gems set forth in Schedule "A" and may include additional terms as Yale and
SILVER AMERICA might agree to after good faith negotiation. This Letter of
Intent is intended to be binding with respect to the matters discussed in
Schedule "A". This Letter of Intent may be executed in one or more counterparts,
each of which shall be deemed an original for all purposes.

     

    
      	 	YALE RESOURCES
      LTD.	 
	 	 	 	 
	
               

            	
              By:
      

            	/s/ Ian
      Foreman	 
	 	 	Name :
      Ian Foreman	 
	 	 	Title
      : President	 
	 	 	 	 
	 	 	 	 
	 	SILVER
      AMERICA INC.	 
	 	 	 	 
	 	
              By:
      

            	/s/ Johannes
      Petersen	 
	 	 	Name
      : Johannes Petersen	 
	 	 	Title
      : CFO, Director	 

    

     

     

    
      
        
        

      

      
        1

        
          

        

      

      
        
        

      

    

     

    Schedule
"A"

     

    Yale
Resources Ltd. / SILVER AMERICA Inc.

     

     TERM SHEET 

     

    March
5,2010

     

    This term
sheet of the Letter of Intent sets forth the proposed terms and structure of a
transaction in which Yale will
grant an option to SILVER AMERICA to acquire a 90% interest in the Property.
This Letter of Intent is a binding
agreement. Any transaction will be subject in all respects to a fully negotiated
and executed definitive option
agreement (the "Definitive Agreement") and approval, if required, of the
appropriate regulatory bodies.

     

    
      	1. Option
      Agreement 	THE
      PARTIES AGREE to negotiate in good faith a Definitive Agreement to
      include the following terms and conditions;
	
            	 	 	 
	 	
              (a)

            	Yale
      grants to SILVER AMERICA an Option for SILVER AMERICA to acquire a 90%
      undivided interest in the Property.
	 	 	 	 
	 	 	To exercise the
      Option, SILVER AMERICA shall pay cash to Yale, issue common shares of
      SILVER AMERICA and fund exploration and development expenditures (the
      "Expenditures") on the Property (all amounts in US$) in the following
      manner:
	 	 	 	 
	 	 	
              (i)

            	
              pay
      the refundable amount of $10,000 to Yale upon the signing of
      this Letter of Intent;

            
	 	 	 	 
	 	 	
              (ii)

            	
              Pay
      an additional $10,000 and issue 100,000 common shares in the
      capital of SILVER AMERICA on signing of a Definitive Agreemsnt;

            
	 	 	 	 
	 	 	
              (iii)

            	
              on
      or before the 30th
      of June 2010 SILVER AMERICA will pay Yale
      $20,000 and issue an additional 100,000 common shares in the
      capital of SILVER AMERICA to Yale.

            
	 	 	 	 
	 	 	
              (iv)

            	
              on
      or before the 30th of
      December 2010 SILVER AMERICA will
      pay Yale $30,000 and issue an additional 100,000 common shares
      in the capital of SILVER AMERICA to Yale.

            
	 	 	 	 
	 	 	
              (v)

            	
              on
      or before the 30th of June
      2011 SILVER AMERICA will pay Yale
      $50,000, issue an additional 100,000 common shares in the capital
      of SILVER AMERICA to Yale and have minimum expenditures
      of $400,000 (with a minimum of 2,000 metres of ,
      drilling).

            
	 	 	 	 
	 	 	
              (vi)

            	
              on
      or before the 30th of
      December 2011 SILVER AMERICA will
      pay Yale $50,000 and issue an additional 100,000 common shares
      in the capital of SILVER AMERICA to Yafe.

            
	 	 	 	 
	 	 	
              (vii)

            	
              on
      or before the 30th of June
      2012 SILVER AMERICA will pay Yale
      $75,000 and issue an additional 100,000 common shares in the
      capital of SILVER AMERICA to Yale.

            
	 	 	
              (viii)

            	
              on
      or before the 30th of
      December 2012 SILVER AMERICA will
      pay Yale $100,000, issue an additional 100,000 common shares
      in the capital of SILVER AMERICA to Yale and have minimum
      expenditures of an additional
    $700,000.

            

       

      
        
          
          

        

        
          2

          
            

          

        

        
          
          

        

      

       

      
        
          	 	 	
                  (ix)

                	
                  on
      or before the 30th of
      June 2013 SILVER AMERICA will pay Yale
      $200,000 and issue an additional 100.000 common shares in
      the capital of SILVER AMERICA to Yale.

                
	 	 	 	 
	 	 	
                  (x)

                	
                  on
      or before the 30th of
      December 2013 SILVER AMERICA will
      pay Yale $355,000, issue an additional 200,000 common minimum
      expenditures of an additional $900,000. shares
      in the capital of SILVER AMERICA to Yale and
      have

                
	 	 	 	 
	 	 	Any Expenditures greater than the minimum amount will be credited
      towards the next year.The common shares issued by SILVER AMERICA will be restricted as
      per the minimum requirements set by the appropriate regulatory
      body.If drilling has not started by die ln of June 2011 Yale will give 3 months notice to have a
      drill program started and if drilling has not started by the lsl of August 2011 the Agreement will be
      cancelled.
	 	 	 	 
	 	(b)	Upon
      the execution and exercise of the Option, Yale agrees to transfer a 90%
      undivided interest in the Property to the Mexican subsidiary of SILVER
      AMERICA.
	 	 	 	 
	 	 	Yale will retain a 2% NSR (a total of 3% for the property) that can be
      bought out in entirety for US $2,000,000.Yale agrees to maintain all filings and payments on all claims
      within the Property in accordance with the laws of Mexico until such time
      as the Property is transferred to SILVER AMERICA- All such costs are to be
      reimbursed by SILVER AMERICA.
	 	 	 	 
	 	(c) 	Until
      the execution and exercise of the Option, the parties agree to the
      following:
	 	 	 	 
	 	 	
                  (i)

                	
                  Yale
      will be the operator of the Property and will charge a standard
      15% management fee on all Expenditures incurred on the
      Property;

                
	 	 	 	 
	 	 	
                  (ii)

                	
                  On
      an ongoing basis, Yale will budget for die project for each phase
      and receive 50% before starting each phase. The allocation of
      (he funds will be determined by mutual consent of both
      parties.

                
	 	 	 	 
	 	 	
                  (iii)

                	
                  That
      SILVER AMERICA will fund a minimum of $15,000 of exploration
      work (not just Expenditures) every quarter (e.g. Apr/May/Jun,).

                
	 	 	 	 
	 	 	
                  (iv)

                	
                  Yale
      will deliver to SILVER AMERICA a detailed account of work
      expenditures upon request, but not more often than
      every three
      (3) months;

                
	 	 	 	 
	 	 	
                  (v)

                	
                  Regardless
      of the amount of expenditures that have been committed,
      SILVER AMERICA will be responsible for paying the
      property taxes that are due
  bi-annualty.

                

        

         

        
          
            
            

          

          
            3

            
              

            

          

          
            
            

          

        

         

        
          
            	2. Due Diligence
      Investigation	Yale agrees to make available and grant access to SILVER AMERICA
      and their representatives, any corporate, financial, geological or other
      information as is reasonably necessary to conduct a due diligence review
      of the Property- Yale shall take reasonable good faith efforts promptly to
      provide SILVER AMERICA or its representatives such documents as may
      reasonably be requested in writing. Yale will grant to SILVER AMERICA and
      ils consultants the right of entry to the Properly for the purpose of
      carrying out its due diligence review of the Property and to perform such
      investigations, surveys and tests as SILVER AMERICA deems desirable. The
      Closing of the Definitive Agreement is subject to SILVER AMERICA's satisfactory due diligence review of the
      Property.
	 	 	 	 
	3. Budgets and
      payments 	
                    While
      Yale is Operator, Yale will provide SILVER AMERICA a budget for
      each successive phase of exploration and SILVER AMERICA agrees
  to:

                  
	 	 	 	 
	 	
                    (a)
      

                  	approve
      and/or provide comments on the budget within fourteen (14)
      days;
	 	 	 	 
	 	(b)	give
      to Yale an advance of at least 50% of each budget within 30 days of its
      approval and that Yale will not start that next phase of exploration until
      the advance has been received;
	 	 	 	 
	 	Payment to Yale for
      each completed phase of exploration will be due within thirry (30) days of
      receipt of request from Yale and will be accompanied by a detailed
      breakdown of cosls.
	 	 	 	 
	 	If the complete
      funds are not received within thirty (30) days, Yale will have (he right
      to issue a letter of default for the amount owed and that if the funds
      have not been received within an additional thirty (30) days, Yale will
      have the right to terminate the Option. For greater clarity, if
      expenditures have not been refunded/paid to Yale within sixty (60) days
      from the date of the original request the agreement will be
      terminated.
	 	 	 	 
	4. Closing
      Conditions 	Conditions to
      Closing shall include, without limitation:
	 	 	 	
                  
	 	(i)	receipt of any
      necessary regulatory approvals;
	 	 	 	 
	 	(ii) 	SILVER
      AMERICA completing a due diligence review of the Property and SILVER
      AMERICA being satisfied, in its sole and absolute discretion, with the
      results of such a review and verification;
	 	 	 	 
	
                  	 	The
      parties agree to close the Definitive Agreement within sixty (60) days
      after the execution of this Letter of Intent and agree to extend the
      closing date for an additional thirty (30) days if there is a
      delay.
	
                  	 	 	 
	5. Disclosure	
                    The
      parties are permitted to make any public announcement regarding this
      Letter of Intent or any transaction contemplated hereby as required by
      applicable securities law. 

                  
	 	 	 	 
	
                    6.
      No-Shop and Exclusive Provisions

                  	
                    Until sixty (60)
      days after the date of this Letter of Intent and in consideration for
      SILVER AMERICA's
      commitment of time and resources to perform due diligence, Yale
      will not, directly or indirectly, through any officer, director, employee,
      affiliate or agent or otherwise, take any action to solicit, initiate,
      seek, encourage or support any inquiry, proposal or offen from,
      furnish any information to, or participate in any negotiations with, any
      third party regarding the sale of the Property, or any plans to develop
      the Property. Yale agrees that my such negotiations
      (other than negotiations with SILVER AMERICA) in progress as of the date
      of this letter will be suspended during such period, and that Yale will
      not accept or enter into any agreement, arrangement or understanding for
      sale or option of the Properly or for the development of the Property
      during such period.

                  

          

           

          
            
              
              

            

            
              4

              
                

              

            

            
              
              

            

          

           

          	 	If Yale or any of
      its officers, directors, employees, affiliates or agents receives any
      proposal for, or inquiry respecting, any third party acquisition of or
      development for the Property, Yale will promptly notify SILVER AMERICA,
      describing in detail the identity of the person making such proposal or
      inquiry and the terms and conditions of such proposal or
  inquiry.
	 	 	 	 
	7. (a)
      Expenses      	Otherwise
      stated herein. Yale and SILVER AMERICA shall each be liable for their
      own costs, including legal, accounting, and other such costs. incurred by
      each of them in the negotiation and closing of this transaction. SILVER
      AMERICA shall be responsible for all costs relating to its due diligence
      review of the Property.
	 	 	 	 
	   
      (b) Break-up Fee	
                  If within thirty
      (30) days from the date of this Letter of Intent or anytime 
      prior
      to the Closing of the Definitive Agreement, Yale fails to complete
      the terms
      outlined within this Letter of Intent, Yale will reimburse to SILVER
      AMERICA ail the expenses that have been incurred including the legal fees,
      due diligence expenses, taxes and disbursements incurred by SILVER AMERICA
      in relation to the review of the Property and drafting of the Definitive
      Agreement (and Joint Venture Agreement) and such reimbursement costs will
      not exceed $25,000.

                
	
                	 	 	 
	8. Area of
      Interest	There
      will be no Area of Interest surrounding the Property.
	 	 	 	 
	 	If Yale were to
      acquire a property or properties adjoining the Property, such
      property(ies) would be offered to SILVER AMERICA on a first right of
      refusal basis under terms similar to those within the Definitive
      Agreement.
	 	 
	This Letter of
      Intent represents only the current thinking of the parties relating to the
      proposed transaction. All rights and obligations of the parties will be
      subject to negotiation and execution of a definitive agreement among the
      parties, completion of the due diligence, other matters set forth above,
      and the approval, if required, of the appropriate regulatory
    bodies.

        

      

    

     

    
      
        
        

      

      
        5

        
          

        

      

      
        
        

      

    

     

    Schedule
"B"- List of mineral concessions comprising the Property

    
      	Concession  name	 	Title   number	 	Approx.
      Area (ha)
	 	 	 	 	 
	GUADALUPE	 	233872	 	127.4100
	GUADALUPE
2	 	233873	 	155.4200
	 	 	Total:	 	282.83

    

     

     

    
      
        
        

      

      
        6ex10-1.htm

    Exhibit 10.1

    

 

    THIS
PRIVATE PLACEMENT SUBSCRIPTION AGREEMENT (“SUBSCRIPTION AGREEMENT”) RELATES TO
AN OFFERING OF SECURITIES IN AN OFFSHORE TRANSACTION TO PERSONS WHO ARE NOT U.S.
PERSONS PURSUANT TO REGULATION S UNDER THE UNITED STATES SECURITIES ACT OF 1933,
AS AMENDED (THE “1933 ACT”).

     

    NONE
OF THE SECURITIES TO WHICH THIS PRIVATE PLACEMENT SUBSCRIPTION AGREEMENT (THE
“SUBSCRIPTION AGREEMENT”) RELATES HAVE BEEN REGISTERED UNDER THE 1933 ACT OR ANY
U.S. STATE SECURITIES LAWS AND, UNLESS SO REGISTERED, NONE MAY BE OFFERED OR
SOLD, DIRECTLY OR INDIRECTLY, IN THE UNITED STATES OR TO U.S. PERSONS EXCEPT IN
ACCORDANCE WITH THE PROVISIONS OF REGULATION S UNDER THE 1933 ACT, PURSUANT TO
AN EFFECTIVE REGISTRATION STATEMENT UNDER THE 1933 ACT, OR PURSUANT TO AN
AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION
REQUIREMENTS OF THE 1933 ACT AND IN EACH CASE ONLY IN ACCORDANCE WITH APPLICABLE
STATE SECURITIES LAWS.  IN ADDITION, HEDGING TRANSACTIONS INVOLVING
THE SECURITIES MAY NOT BE CONDUCTED UNLESS IN ACCORDANCE WITH THE 1933 ACT.
"UNITED STATES" AND "U.S. PERSON" ARE AS DEFINED BY REGULATION S UNDER THE 1933
ACT.

     

    SUBSCRIPTION
AGREEMENT

     

    FOR
CANADIAN AND NON US SUBSCRIBERS

    

     

    
      	
              TO:

            	
              Big
      Bear Mining Corp (the “Company”)

            

    

     

    

     

    

     

    

     

    
      	
               
      

            	
              Purchase of
      Shares

            

    

     

    
      	
              1.

            	
              Subscription

            

    

     

    1.1                         
On the basis of the representations and warranties and subject to the terms and
conditions set forth herein, (the
“Subscriber”) hereby
irrevocably subscribes for and agrees to purchase  shares (each a “Share” and collectively the
“Shares”), with a price
per Share of USD $0.20 (such subscription and agreement to purchase being the
“Subscription”), for an
aggregate purchase price of USD$_____________ (the “Subscription
Proceeds”).

     

    1.2                         
On the basis of the representations and warranties and subject to the terms and
conditions set forth herein, the Company hereby irrevocably agrees to sell the
Shares to the Subscriber.

     

    1.3                         
Subject to the terms hereof, the Subscription will be effective upon its
acceptance by the Company.

     

    
      	
              2.

            	
              Payment

            

    

     

    2.1                         
The Subscription Proceeds must accompany this Subscription and shall be paid by
cashiers cheque or bank draft payable to the order of Big Bear Mining Corp.,
drawn in U.S. funds on a Canadian bank or on a U.S. bank that is reasonably
acceptable to the Company or, at the Subscriber’s option, by wire
transfer.

    

    

      
        
           

        

        
          1

          
            

          

        

        
           

        

      

    Reference: Big Bear
Mining

    

     

    2.2                      The
Subscriber acknowledges and agrees that this Subscription Agreement, the
Subscription Proceeds and any other documents delivered in connection herewith
will be held on behalf of the Company.  In the event that this
Subscription Agreement is not accepted by the Company for whatever reason, which
the Company expressly reserves the right to do, within 30 days of the delivery
of an executed Subscription Agreement by the Subscriber, this Subscription
Agreement, the Subscription Proceeds (without interest thereon) and any other
documents delivered in connection herewith will be returned to the Subscriber at
the address of the Subscriber as set forth in this Subscription
Agreement.

     

    2.3                      The
Company is entitled to treat the Subscription Proceeds as an interest free loan
to the Company until such time as the Subscription is accepted and a certificate
representing the Shares has been issued to the Subscriber.

     

    
      	
              3.

            	
              Documents Required
      from Subscriber

            

    

     

    3.1                      The
Subscriber must complete, sign and return to the Company an executed copy of
this Subscription Agreement and if the subscriber is a resident of Canada an
executed copy of the Accredited Investor Questionnaire attached to this
Agreement as Exhibit “A” (the “Questionnaire”).

     

    3.2                      The
Subscriber shall complete, sign and return to the Company as soon as possible,
on request by the Company, any documents, questionnaires, notices and
undertakings as may be required by regulatory authorities, the OTC Bulletin
Board and applicable law.

     

    
      	
              4.

            	
              Closing

            

    

     

    4.1                      Closing
of the offering of the Shares (the “Closing”) shall occur on or
before January 14, 2010, or on such later date as may be determined by the
Company (the “Closing
Date”).

     

    
      	
              5.

            	
              Acknowledgements of
      Subscriber

            

    

     

    5.1                      The
Subscriber acknowledges and agrees that:

     

    
      	
               
      

            	
              (a)

            	
              none
      of the Shares have been or, except as otherwise expressly set forth in
      this Agreement, will be registered under the 1933 Act, or under any state
      securities or “blue sky” laws of any state of the United States, and,
      unless so registered, may not be offered or sold in the United States or,
      directly or indirectly, to U.S. Persons, as that term is defined in
      Regulation S under the 1933 Act (“Regulation S”), except
      in accordance with the provisions of Regulation S, pursuant to an
      effective registration statement under the 1933 Act, or pursuant to an
      exemption from, or in a transaction not subject to, the registration
      requirements of the 1933 Act and in each case only in accordance with
      applicable state securities laws;

            

    

     

    
      	
               
      

            	
              (b)

            	
              other
      than as set out herein, the Company has not undertaken to, and will have
      no obligation to, register any of the Shares under the 1933 Act or any
      other securities legislation;

            

    

     

    
      	
               
      

            	
              (c)

            	
              it
      has received and carefully read this Subscription
    Agreement;

            

    

     

    
      	
               
      

            	
              (d)

            	
              if
      the Subscriber is a resident of Canada, by completing the Questionnaire,
      the Subscriber is representing and warranting that the Subscriber is not a
      resident of the United States and that the subscriber is an “Accredited
      Investor”, as that term is defined in National Instrument 45-106, as
      adopted by the British Columbia Securities
  Commission;

            

    

     

    
      	
               
      

            	
              (e)

            	
              no
      prospectus or offering memorandum within the meaning of the securities
      laws has been delivered to, summarized for or seen by the Subscriber (and,
      if applicable, others for whom it is contracting hereunder) in connection
      with the Offering and the Subscriber (and, if applicable, others for whom
      it is contracting hereunder) is not aware of any prospectus or offering
      memorandum having been prepared by the
Company;

            

    

    
      
         

      

      
        2

        
          

        

      

      
         

      

    

     

    
      	
               
      

            	
              (f)

            	
              the
      decision to execute this Subscription Agreement and acquire the Shares
      hereunder has not been based upon any oral or written representation as to
      fact or otherwise made by or on behalf of the Company, and such decision
      is based entirely upon a review of information (the adequacy of which is
      hereby acknowledged) about the Company that is available to any member of
      the public on the EDGAR database maintained by the U.S. Securities and
      Exchange Commission (the “SEC”) at
      www.sec.gov;

            

    

     

    
      	
               
      

            	
              (g)

            	
              it
      has not received, nor has it requested, nor does it have any need to
      receive, any offering memorandum (as defined in or contemplated by
      applicable securities legislation) or any other document (other than
      financial statements or any other continuous disclosure documents, the
      contents of which are prescribed by statute or regulation) describing the
      business and affairs of the Company which has been prepared for delivery
      to, and review by, prospective subscribers in order to assist them in
      making an investment decision in respect of the Shares, and it has not
      become aware of any advertisement including, by way of example and not in
      limitation, advertisement in any printed media of general and regular
      circulation or on radio or television with respect to the distribution of
      the Shares;

            

    

     

    
      	
               
      

            	
              (h)

            	
              it
      and its advisor(s) have had a reasonable opportunity to ask questions of
      and receive answers from the Company in connection with the sale of the
      Shares hereunder, and to obtain additional information, to the extent
      possessed or obtainable by the Company without unreasonable effort or
      expense;

            

    

     

    
      	
               
      

            	
              (i)

            	
              the
      books and records of the Company were available upon reasonable notice for
      inspection, subject to certain confidentiality restrictions, by the
      Subscriber during reasonable business hours at its principal place of
      business and that all documents, records and books in connection with the
      sale of the Shares hereunder have been made available for inspection by
      him and his attorney and/or
advisor(s);

            

    

     

    
      	
               
      

            	
              (j)

            	
              all
      information which the Subscriber has provided to the Company is correct
      and complete as of the date the Subscription Agreement is signed, and if
      there should be any change in such information prior to this Subscription
      Agreement being executed by the Company, the Subscriber will immediately
      provide the Company with such
information;

            

    

     

    
      	
               
      

            	
              (k)

            	
              the
      Company is entitled to rely on the representations and warranties of the
      Subscriber contained in this Subscription Agreement and the Subscriber
      will hold harmless the Company from any loss or damage it or they may
      suffer as a result of the Subscriber’s failure to correctly complete this
      Subscription Agreement;

            

    

     

    
      	
               
      

            	
              (l)

            	
              if
      the Subscriber is a resident of Canada, the Company has advised the
      Subscriber that the Company is relying on an exemption from the
      requirements of the regulatory authorities in Canada requiring that the
      Company provide the Subscriber with a prospectus and sell the Shares to
      the Subscriber through a person registered to sell securities under the
      securities laws of the Canadian Province where the Subscriber resides and,
      as a consequence of acquiring the Shares pursuant to this exemption,
      certain protections, rights and remedies provided by the securities laws
      of that Canadian Province, including statutory rights of rescission or
      damages, will not be available to the
  Subscriber;

            

    

     

    
      	
               
      

            	
              (m)

            	
              the
      Subscriber has not acquired the Shares as a result of, and will not itself
      engage in, any “directed selling efforts” (as that term is defined in
      Regulation S) in the United States in respect of the Shares which would
      include any activities undertaken for the purpose of, or that could
      reasonably be expected to have the effect of, conditioning the market in
      the United States for the resale of the Shares; provided, however, that
      the Subscriber may sell or otherwise dispose of the Shares pursuant to
      registration thereof under the 1933 Act and any applicable state and
      provincial Shares laws or under an exemption from such registration
      requirements;

            

    

     

    
      	
               
      

            	
              (n)

            	
              the
      Subscriber will indemnify and hold harmless the Company and, where
      applicable, its respective directors, officers, employees, agents,
      advisors and shareholders from and against any and all loss, liability,
      claim, damage and expense whatsoever (including, but not limited to, any
      and all fees, costs and expenses whatsoever reasonably incurred in
      investigating, preparing or defending against any claim, lawsuit,
      administrative proceeding or investigation whether commenced
      or

            

    

    
      
         

      

      
        3

        
          

        

      

      
         

      

    

     

    
      	
               
      

            	
              threatened)
      arising out of or based upon any representation or warranty of the
      Subscriber contained herein or in any document furnished by the Subscriber
      to the Company in connection herewith being untrue in any material respect
      or any breach or failure by the Subscriber to comply with any covenant or
      agreement made by the Subscriber to the Company in connection
      therewith;

            

    

     

    
      	
               
      

            	
              (o)

            	
              the
      statutory and regulatory basis for the exemption from U.S. registration
      requirements claimed for the offer of the Shares, although in technical
      compliance with Regulation S, would not be available if the offering is
      part of a plan or scheme to evade the registration provisions of the 1933
      Act or any applicable state or provincial securities
  laws;

            

    

     

    
      	
               
      

            	
              (p)

            	
              the
      Subscriber has been advised to consult the Subscriber’s own legal, tax and
      other advisors with respect to the merits and risks of an investment in
      the Shares and with respect to applicable resale restrictions, and it is
      solely responsible (and the Company is not in any way responsible) for
      compliance with:

            

    

     

    
      	
               
      

            	
              (i)

            	
              any
      applicable laws of the jurisdiction in which the Subscriber is resident in
      connection with the distribution of the Shares hereunder,
    and

            

    

     

    
      	
               
      

            	
              (ii)

            	
              applicable
      resale restrictions;

            

    

     

    
      	
               
      

            	
              (q)

            	
              none
      of the Shares are listed on any stock exchange or automated dealer
      quotation system and no representation has been made to the Subscriber
      that any of the Shares will become listed on any stock exchange or
      automated dealer quotation system, except that currently certain market
      makers make market in the common shares of the Company on the National
      Association of Securities Dealers, Inc.’s OTC Bulletin
    Board;

            

    

     

    
      	
               
      

            	
              (r)

            	
              if
      the Subscriber is a resident of Canada, in addition to resale restrictions
      imposed under U.S. securities laws, there are additional restrictions on
      the Subscriber’s ability to resell the Shares under Canadian provincial
      securities laws and Canadian National Instrument
  45-102;

            

    

     

    
      	
               
      

            	
              (s)

            	
              the
      Company will refuse to register any transfer of the Shares not made in
      accordance with the provisions of Regulation S, pursuant to an effective
      registration statement under the 1933 Act or pursuant to an available
      exemption from the registration requirements of the 1933 Act and in each
      case in accordance with applicable state securities
  laws;

            

    

     

    
      	
               
      

            	
              (t)

            	
              neither
      the SEC nor any other securities commission or similar regulatory
      authority has reviewed or passed on the merits of the
    Shares;

            

    

     

    
      	
               
      

            	
              (u)

            	
              no
      documents in connection with the sale of the Shares hereunder have been
      reviewed by the SEC or any state securities
  administrators;

            

    

     

    
      	
               
      

            	
              (v)

            	
              there
      is no government or other insurance covering any of the
      Shares;

            

    

     

    
      	
               
      

            	
              (w)

            	
              the
      issuance and sale of the Shares to the Subscriber will not be completed if
      it would be unlawful or if, in the discretion of the Company acting
      reasonably, it is not in the best interests of the Company;
      and

            

    

     

    
      	
               
      

            	
              (x)

            	
              this
      Subscription Agreement is not enforceable by the Subscriber unless it has
      been accepted by the Company.

            

    

     

    
      	
              6.

            	
              Representations,
      Warranties and Covenants of the
  Subscriber

            

    

     

    6.1                      The
Subscriber hereby represents and warrants to and covenants with the Company
(which representations, warranties and covenants shall survive the Closing)
that:

     

    
      	
               
      

            	
              (a)

            	
              the
      Subscriber has the legal capacity and competence to enter into and execute
      this Subscription Agreement and to take all actions required pursuant
      hereto and, if the Subscriber is a corporation, it is duly incorporated
      and validly subsisting under the laws of its jurisdiction of incorporation
      and all

            

    

    
      
         

      

      
        4

        
          

        

      

      
         

      

    

     

    
      	
               
      

            	
              necessary
      approvals by its directors, shareholders and others have been obtained to
      authorize execution and performance of this Subscription Agreement on
      behalf of the Subscriber;

            

    

     

    
      	
               
      

            	
              (b)

            	
              if
      the Subscriber is a corporation or other entity, the entering into of this
      Subscription Agreement and the transactions contemplated hereby do not and
      will not result in the violation of any of the terms and provisions of any
      law applicable to, or the constating documents of, the Subscriber or of
      any agreement, written or oral, to which the Subscriber may be a party or
      by which the Subscriber is or may be
bound;

            

    

     

    
      	
               
      

            	
              (c)

            	
              the
      Subscriber has duly executed and delivered this Subscription Agreement and
      it constitutes a valid and binding agreement of the Subscriber enforceable
      against the Subscriber;

            

    

     

    
      	
               
      

            	
              (d)

            	
              the
      Subscriber is not a U.S. Person, as that term is defined in Regulation
      S;

            

    

     

    
      	
               
      

            	
              (e)

            	
              the
      Subscriber is not acquiring the Shares for the account or benefit of,
      directly or indirectly, any U.S. Person, as that term is defined in
      Regulation S;

            

    

     

    
      	
               
      

            	
              (f)

            	
              if
      the Subscriber is a resident of Canada, the Subscriber is an Accredited
      Investor (as defined in National Instrument 45-106) and the Subscriber
      agrees that the Company shall not consider the Subscriber's Subscription
      for acceptance unless the undersigned provides to the Company, along with
      an executed copy of this Agreement:

            

    

     

    
      	
               
      

            	
              (i)

            	
              a
      fully completed and executed Questionnaire in the form attached as Exhibit
      A hereto; and

            

    

     

    
      	
               
      

            	
              (ii)

            	
              such
      other supporting documentation that the Company or its legal counsel may
      request to establish the Subscriber's qualification as an Accredited
      Investor;

            

    

     

    
      	
               
      

            	
              (g)

            	
              the
      Subscriber is resident in the jurisdiction set out under the heading “Name
      and Address of Subscriber” on the signature page of this Subscription
      Agreement;

            

    

     

    
      	
               
      

            	
              (h)

            	
              the
      sale of the Shares to the Subscriber as contemplated in this Subscription
      Agreement complies with or is exempt from the applicable securities
      legislation of the jurisdiction of residence of the
      Subscriber;

            

    

     

    
      	
               
      

            	
              (i)

            	
              the
      Subscriber is outside the United States when receiving and executing this
      Agreement and is acquiring the Shares as principal for the Subscriber's
      own account, for investment purposes only, and not with a view to, or for,
      resale, distribution or fractionalisation thereof, in whole or in part,
      and no other person has a direct or indirect beneficial interest in such
      Shares;

            

    

     

    
      	
               
      

            	
              (j)

            	
              the
      decision to execute this Agreement and acquire the Shares hereunder has
      not been based upon any oral or written representation as to fact or
      otherwise made by or on behalf of the
Company;

            

    

     

    
      	
               
      

            	
              (k)

            	
              the
      Subscriber is acquiring the Shares as principal for its own account for
      investment purposes only and not for the account of any other person and
      not for distribution, assignment or resale to others, and no other person
      has a direct or indirect beneficial interest in such Shares, and it has
      not subdivided its interest in the Shares with any other
      person;

            

    

     

    
      	
               
      

            	
              (l)

            	
              the
      Subscriber is aware that an investment in the Company is speculative and
      involves certain risks, including the possible loss of the entire
      investment and it has carefully read and considered the matters set forth
      under the heading “Risk Factors” appearing in the Company’s Form 10-KSB
      and any other filings filed with the
SEC;

            

    

     

    
      	
               
      

            	
              (m)

            	
              the
      Subscriber has made an independent examination and investigation of an
      investment in the Shares and the Company and has depended on the advice of
      its legal and financial advisors and agrees that the Company will not be
      responsible in any way whatsoever for the Subscriber’s decision to invest
      in the Shares and the Company;

            

    

    
      
         

      

      
        5

        
          

        

      

      
         

      

    

     

    
      	
               
      

            	
              (n)

            	
              the
      Subscriber (i) has adequate net worth and means of providing for its
      current financial needs and possible personal contingencies, (ii) has no
      need for liquidity in this investment, and (iii) is able to bear the
      economic risks of an investment in the Shares for an indefinite period of
      time;

            

    

     

    
      	
               
      

            	
              (o)

            	
              the
      Subscriber understands and agrees that the Company and others will rely
      upon the truth and accuracy of the acknowledgements, representations and
      agreements contained in this Subscription Agreement and agrees that if any
      of such acknowledgements, representations and agreements are no longer
      accurate or have been breached, the Subscriber shall promptly notify the
      Company;

            

    

     

    
      	
               
      

            	
              (p)

            	
              the
      Company is entitled to rely on the representations and warranties of the
      Subscriber contained in this Agreement and the Questionnaire and the
      Subscriber will indemnify and hold harmless the Company and, where
      applicable, its directors, officers, employees, agents, advisors and
      shareholders, from and against any and all loss, liability, claim, damage
      and expense whatsoever (including, but not limited to, any and all fees,
      costs and expenses whatsoever reasonably incurred in investigating,
      preparing or defending against any claim, lawsuit, administrative
      proceeding or investigation whether commenced or threatened) arising out
      of or based upon any representation or warranty of the Subscriber
      contained herein, the Questionnaire or in any document furnished by the
      Subscriber to the Company in connection herewith being untrue in any
      material respect or any breach or failure by the Subscriber to comply with
      any covenant or agreement made by the Subscriber to the Company in
      connection therewith;

            

    

     

    
      	
               
      

            	
              (q)

            	
              the
      Subscriber has the legal capacity and competence to enter into and execute
      this Subscription Agreement and to take all actions required pursuant
      hereto;

            

    

     

    
      	
               
      

            	
              (r)

            	
              the
      Subscriber has duly executed and delivered this Subscription Agreement and
      it constitutes a valid and binding agreement of the Subscriber enforceable
      against the Subscriber in accordance with its
  terms;

            

    

     

    
      	
               
      

            	
              (s)

            	
              it
      is not an underwriter of, or dealer in, the common shares of the Company,
      nor is the Subscriber participating, pursuant to a contractual agreement
      or otherwise, in the distribution of the Shares or any of
      them;

            

    

     

    
      	
               
      

            	
              (t)

            	
              the
      Subscriber understands and agrees that none of the Shares have been or
      will, except as set forth in this Agreement, be registered under the 1933
      Act, or under any state securities or “blue sky” laws of any state of the
      United States, and, unless so registered, may not be offered or sold in
      the United States or, directly or indirectly, to U.S. Persons, as that
      term is defined in Regulation S, except in accordance with the provisions
      of Regulation S, pursuant to an effective registration statement under the
      1933 Act, or pursuant to an exemption from, or in a transaction not
      subject to, the registration requirements of the 1933 Act and in each case
      only in accordance with applicable state securities
  laws;

            

    

     

    
      	
               
      

            	
              (u)

            	
              the
      Subscriber acknowledges that the Subscriber has not acquired the Shares as
      a result of, and will not itself engage in, any “directed selling efforts”
      (as defined in Regulation S) in the United States in respect of the Shares
      which would include any activities undertaken for the purpose of, or that
      could reasonably be expected to have the effect of, conditioning the
      market in the United States for the resale of the Shares; provided,
      however, that the Subscriber may sell or otherwise dispose of the Shares
      pursuant to registration of the Shares  pursuant to the 1933 Act
      and any applicable state and provincial securities laws or under an
      exemption from such registration requirements and as otherwise provided
      herein;

            

    

     

    
      	
               
      

            	
              (v)

            	
              the
      Subscriber understands and agrees that offers and sales of any of the
      Shares prior to the expiration of a period of one year after the date of
      original issuance of the Shares (the one year period hereinafter referred
      to as the "Distribution
      Compliance Period") shall only be made in compliance with the safe
      harbor provisions set forth in Regulation S, pursuant to the registration
      provisions of the 1933 Act or an exemption therefrom, and that all offers
      and sales after the Distribution Compliance Period shall be made only in
      compliance with the registration provisions of the 1933 Act or an
      exemption therefrom and in each case only in accordance with applicable
      state and provincial securities
laws;

            

    

    
      
         

      

      
        6

        
          

        

      

      
         

      

    

     

    
      	
               
      

            	
              (w)

            	
              the
      Subscriber understands and agrees not to engage in any hedging
      transactions involving any of the Shares unless such transactions are in
      compliance with the provisions of the 1933 Act and in each case only in
      accordance with applicable state and provincial securities
      laws;

            

    

     

    
      	
               
      

            	
              (x)

            	
              the
      Subscriber understands and agrees that the Company will refuse to register
      any transfer of the Shares not made in accordance with the provisions of
      Regulation S, pursuant to an effective registration statement under the
      1933 Act or pursuant to an available exemption from the registration
      requirements of the 1933 Act;

            

    

     

    
      	
               
      

            	
              (y)

            	
              the
      Subscriber is not aware of any advertisement of, or any general
      solicitation in respect of, any of the Shares;
  and

            

    

     

    
      	
               
      

            	
              (z)

            	
              no
      person has made to the Subscriber any written or oral
      representations:

            

    

     

    
      	
               
      

            	
              (i)

            	
              that
      any person will resell or repurchase any of the
  Shares;

            

    

     

    
      	
               
      

            	
              (ii)

            	
              that
      any person will refund the purchase price of any of the
      Shares;

            

    

     

    
      	
               
      

            	
              (iii)

            	
              as
      to the future price or value of any of the Shares;
  or

            

    

     

    
      	
               
      

            	
              (iv)

            	
              that
      any of the Shares will be listed and posted for trading on any stock
      exchange or automated dealer quotation system or that application has been
      made to list and post any of the Shares on any stock exchange or automated
      dealer quotation system; except that the Company’s Common Stock is
      currently approved for trading on the U.S. Over the Counter Bulletin
      Board.

            

    

     

    6.2                      In
this Subscription Agreement, the term “U.S. Person” shall have the meaning
ascribed thereto in Regulation S.

     

    
      	
              7.

            	
              Representations and
      Warranties will be Relied Upon by the
  Company

            

    

     

    7.1                      The
Subscriber acknowledges that the representations and warranties contained herein
are made by it with the intention that such representations and warranties may
be relied upon by the Company and its legal counsel in determining the
Subscriber’s eligibility to purchase the Shares under applicable securities
legislation, or (if applicable) the eligibility of others on whose behalf it is
contracting hereunder to purchase the Shares under applicable securities
legislation.  The Subscriber further agrees that by accepting delivery
of the certificates representing the Shares on the Closing Date, it will be
representing and warranting that the representations and warranties contained
herein are true and correct as at the Closing Date with the same force and
effect as if they had been made by the Subscriber on the Closing Date and that
they will survive the purchase by the Subscriber of the Shares and will continue
in full force and effect notwithstanding any subsequent disposition by the
Subscriber of such Shares.

     

    
      	
              8.

            	
              Resale
      Restrictions

            

    

     

    8.1                      The
Subscriber acknowledges that any resale of the Shares will be subject to resale
restrictions contained in the securities legislation applicable to each
Subscriber or proposed transferee.  The Subscriber acknowledges that
the Shares have not been registered under the 1933 Act of the securities laws of
any state of the United States.  The Shares may not be offered or sold
in the United States unless registered in accordance with United States federal
securities laws and all applicable state securities laws or exemptions from such
registration requirements are available.

     

    8.2                      The
Subscriber acknowledges that restrictions on the transfer, sale or other
subsequent disposition of the Shares by the Subscriber may be imposed by
securities laws in addition to any restrictions referred to in Section 8.1 above.

     

    
      	
              9.

            	
              Acknowledgement and
      Waiver

            

    

     

    9.1                      The
Subscriber has acknowledged that the decision to purchase the Shares was solely
made on the basis of information available to the Subscriber on the EDGAR
database maintained by the SEC at www.sec.gov.

    
      
         

      

      
        7

        
          

        

      

      
         

      

    

     

    The
Subscriber hereby waives, to the fullest extent permitted by law, any rights of
withdrawal, rescission or compensation for damages to which the Subscriber might
be entitled in connection with the distribution of the Shares.

     

    
      	
              10.

            	
              Legending of Subject
      Shares

            

    

     

    10.1                    The
Subscriber hereby acknowledges that that upon the issuance thereof, and until
such time as the same is no longer required under the applicable securities laws
and regulations, the certificates representing any of the Shares will bear a
U.S. legend in substantially the following form (the “U.S. Legend”):

     

    
      	
               
      

            	
              “THESE SHARES WERE ISSUED IN AN
      OFFSHORE TRANSACTION TO PERSONS WHO ARE NOT U.S. PERSONS (AS DEFINED
      HEREIN) PURSUANT TO REGULATION S UNDER THE UNITED STATES SECURITIES ACT OF
      1933, AS AMENDED (THE “1933 ACT”).  ACCORDINGLY, NONE OF THE
      SHARES TO WHICH THIS CERTIFICATE RELATES HAVE BEEN REGISTERED UNDER THE
      1933 ACT, OR ANY U.S. STATE SECURITIES LAWS, AND, UNLESS SO REGISTERED,
      NONE MAY BE OFFERED OR SOLD IN THE UNITED STATES (AS DEFINED HEREIN) OR,
      DIRECTLY OR INDIRECTLY, TO U.S. PERSONS (AS DEFINED HEREIN) EXCEPT
      PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT OR PURSUANT TO AN
      EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION
      REQUIREMENTS OF THE 1933 ACT AND IN EACH CASE ONLY IN ACCORDANCE WITH
      APPLICABLE STATE SECURITIES LAWS. IN ADDITION, HEDGING TRANSACTIONS
      INVOLVING THE SHARES MAY NOT BE CONDUCTED UNLESS IN ACCORDANCE WITH THE
      1933 ACT. “UNITED STATES" AND "U.S. PERSON" ARE AS DEFINED BY REGULATION S
      UNDER THE 1933 ACT.”

            

    

     

    10.2                     The
Subscriber hereby acknowledges and agrees to the Company making a notation on
its records or giving instructions to the registrar and transfer agent of the
Company in order to implement the restrictions on transfer set forth and
described in this Subscription Agreement.

     

    
      	
              11.

            	
              Costs

            

    

     

    11.1                     The
Subscriber acknowledges and agrees that all costs and expenses incurred by the
Subscriber (including any fees and disbursements of any special counsel retained
by the Subscriber) relating to the purchase of the Shares shall be borne by the
Subscriber.

     

    
      	
              12.

            	
              Resale
      Registration.

            

    

     

    12.1                     On
or prior to the date (the “Filing Date”) that is 180
days after the Closing Date, the Company shall prepare and file with the SEC a
"resale" Registration Statement (the “Registration Statement”)
providing for the resale of the Shares for an offering to be made on a
continuous basis pursuant to Rule 415.  The Registration Statement
shall be on Form S-1 (except if the Company is not then eligible to register for
resale the Shares on Form S-1, in which case such registration shall be on
another appropriate form in accordance with the Securities Act and the rules
promulgated thereunder).  The Company shall use its commercially
reasonable efforts to cause the Registration Statement to be declared effective
under the Securities Act as promptly as possible after the filing thereof and to
keep such Registration Statement continuously effective under the Securities Act
until such date as is the earlier of (i) the date when all Shares covered by
such Registration Statement have been sold or (ii) the date on which the Shares
may be sold pursuant to Rule 144 as determined by the counsel to the Company
pursuant to a written opinion letter, addressed to the Company's transfer agent
to such effect (the "Effectiveness
Period").

     

    
      	
              13.

            	
              Registration
      Procedures.

            

    

     

    13.1                      In
connection with the Company's registration obligations hereunder, the Company
shall:

     

    
      	
               
      

            	
              (a)

            	
              (i)
      Prepare and file with the SEC such amendments, including post-effective
      amendments, to the Registration Statement as may be necessary to keep the
      Registration Statement continuously effective as to the applicable Shares
      for the Effectiveness Period and prepare and file with the Commission such
      additional Registration Statements as necessary in order to register for
      resale under the 1933 Act all of the Shares; (ii) cause the related
      prospectus to be amended or supplemented by any required prospectus
      supplement, and as so supplemented or amended to be filed pursuant to Rule
      424 (or any similar provisions then in force) promulgated under the 1933
      Act; (iii) respond as promptly as possible to any comments received from
      the SEC with respect to the

            

    

     

    
      
         

      

      
        8

        
          

        

      

      
         

      

    

     

    
      	
               
      

            	
              Registration
      Statement or any amendment thereto; and (iv) comply in all material
      respects with the provisions of the 1933 Act and the Securities Exchange
      Act of 1934 (the “Exchange Act”) with
      respect to the disposition of all Shares covered by the Registration
      Statement during the applicable period in accordance with the intended
      methods of disposition by the Subscriber thereof set forth in the
      Registration Statement as so amended or in such prospectus as so
      supplemented.

            

    

     

    
      	
               
      

            	
              (b)

            	
              Notify
      the Subscriber as promptly as possible (i)(A) when any post-effective
      amendment to the Registration Statement is filed; and (B) with respect to
      the Registration Statement or any post-effective amendment, when the same
      has become effective; (ii) of any request by the SEC or any other Federal
      or state governmental authority for post-effective amendments or
      supplements to the Registration Statement or prospectus or for additional
      information; (iii) of the issuance by the SEC of any stop order suspending
      the effectiveness of the Registration Statement covering any or all of the
      Shares or the initiation of any proceedings for that purpose; (iv) if at
      any time any of the representations and warranties of the Company
      contained in any agreement contemplated hereby ceases to be true and
      correct in all material respects; (v) of the receipt by the Company of any
      notification with respect to the suspension of the qualification or
      exemption from qualification of any of the Shares for sale in any
      jurisdiction, or the initiation or threatening of any proceeding for such
      purpose; and (vi) of the occurrence of any event that makes any statement
      made in the Registration Statement or prospectus or any document
      incorporated or deemed to be incorporated therein by reference untrue in
      any material respect or that requires any revisions to the Registration
      Statement, prospectus or other documents so that, in the case of the
      Registration Statement or the prospectus, as the case may be, it will not
      contain any untrue statement of a material fact or omit to state any
      material fact required to be stated therein or necessary to make the
      statements therein, in the light of the circumstances under which they
      were made, not misleading.

            

    

     

    
      	
               
      

            	
              (c)

            	
              Use
      its commercially reasonable efforts to avoid the issuance of, or, if
      issued, obtain the withdrawal of, (i) any order suspending the
      effectiveness of the Registration Statement or (ii) any suspension of the
      qualification (or exemption from qualification) of any of the Shares for
      sale in any jurisdiction, at the earliest practicable
    moment.

            

    

     

    
      	
               
      

            	
              (d)

            	
              If
      requested by the Subscriber, (i) promptly incorporate in a prospectus
      supplement or post-effective amendment to the Registration Statement such
      information as the Company reasonably agrees should be included therein
      and (ii) make all required filings of such prospectus supplement or such
      post-effective amendment as soon as practicable after the Company has
      received notification of the matters to be incorporated in such prospectus
      supplement or post-effective
amendment.

            

    

     

    
      	
               
      

            	
              (e)

            	
              Prior
      to any public offering of the Shares, use its reasonable best efforts to
      register or qualify or cooperate with the Subscriber in connection with
      the registration or qualification (or exemption from such registration or
      qualification) of such Shares for offer and sale under the securities or
      Blue Sky laws of such jurisdictions within the United States as the
      Subscriber reasonably requests in writing, to keep each such registration
      or qualification (or exemption therefrom) effective during the
      Effectiveness Period and to use commercially reasonable efforts to enable
      the disposition in such jurisdictions of the Shares covered by the
      Registration Statement; provided, however, that
      the Company shall not be required to qualify generally to do business in
      any jurisdiction where it is not then so qualified or to take any action
      that would subject it to general service of process in any such
      jurisdiction where it is not then so subject or subject the Company to any
      material tax in any such jurisdiction where it is not then so
      subject.

            

    

     

    
      	
               
      

            	
              (f)

            	
              Cooperate
      with the Subscriber to facilitate the timely preparation and delivery of
      certificates representing Shares to be sold pursuant to a Registration
      Statement and to enable such Shares to be in such denominations and
      registered in such names as the Subscriber may request in writing at least
      five (5) business days prior to any sale of
  Shares.

            

    

     

    
      	
               
      

            	
              (g)

            	
              Upon
      the occurrence of any event contemplated by Section 13.1(b)(vi), as
      promptly as possible, prepare a supplement or amendment, including a
      post-effective amendment, to the Registration Statement or a supplement to
      the related prospectus or any document incorporated or deemed to be
      incorporated therein by reference, and file any other required document so
      that, as thereafter delivered, neither the Registration Statement nor such
      prospectus will contain an untrue statement of a material fact or omit to
      state a material fact required to be stated therein or necessary to make
      the
      statements therein, in the light of the circumstances under which they
      were made, not misleading.

            

    

     

    
      
         

      

      
        9

        
          

        

      

      
         

      

    

    
    

     

    
      	
               
      

            	
              (h)

            	
              Use
      its reasonable best efforts to cause all Shares relating to the
      Registration Statement to continue to be eligible for quotation or listing
      on the OTC Bulletin Board or any other
      securities exchange, quotation system or market, if any, on which similar
      securities issued by the Company are then listed or
  traded.

            

    

     

    
      	
               
      

            	
              (i)

            	
              Comply
      in all material respects with all applicable rules and regulations of the
      SEC;

            

    

     

    
      	
               
      

            	
              (j)

            	
              Require
      the Subscriber, where necessary, to furnish to the Company information
      regarding itself and the distribution of such Shares as is required by law
      to be disclosed in the Registration Statement, and the Company may exclude
      from such registration the Shares of the Subscriber if it fails to furnish
      such information within a reasonable time after receiving such
      request.

            

    

     

    
      	
               
      

            	
              (k)

            	
              If
      the Registration Statement refers to the Subscriber by name or otherwise
      as the holder of any securities of the Company, provide the Subscriber the
      right to require (if such reference to the Subscriber by name or otherwise
      is not required by the 1933 Act or any similar federal statute then in
      force) the deletion of the reference to it in any amendment or supplement
      to the Registration Statement filed or prepared subsequent to the time
      that such reference ceases to be
required.

            

    

     

    
      	
               
      

            	
              (l)

            	
              If
      (i) there is material non-public information regarding the Company which
      the Company's Board of Directors (the "Board") reasonably
      determines not to be in the Company's best interest to disclose and which
      the Company is not otherwise required to disclose, or (ii) there is a
      significant business opportunity (including, but not limited to, the
      acquisition or disposition of assets (other than in the ordinary course of
      business) or any merger, consolidation, tender offer or other similar
      transaction) available to the Company which the Board reasonably
      determines not to be in the Company's best interest to disclose, or, as
      the Board reasonably determines, may (x) postpone or suspend filing of a
      registration statement for a period not to exceed 30 consecutive days or
      (y) postpone or suspend effectiveness of a registration statement for a
      period not to exceed 20 consecutive days, provided that the Company may
      not postpone or suspend effectiveness of a registration statement under
      this Section 13.1(l) for more than 45 days in the aggregate during any 360
      day period, and provided, however, that no such postponement or suspension
      shall be permitted for consecutive 20 day periods arising out of the same
      set of facts, circumstances or
transactions.

            

    

     

     

    13.2                        
The Subscriber agrees and covenants:

     

    
      	
               
      

            	
              (a)

            	
              that
      (i) it will not sell any Shares under the Registration Statement until the
      Registration Statement has been declared effective and the Company has
      filed a prospectus with the Securities and Exchange Commission pursuant to
      Rule 172 of the SEC promulgated under the 1933 Act and has sent to the
      Subscriber notice of such filing and (ii) it and its officers, directors
      or Affiliates, if any, will comply with the prospectus delivery
      requirements of the 1933 Act as applicable to them in connection with
      sales of Shares pursuant to the Registration
  Statement.

            

    

     

    
      	
               
      

            	
              (b)

            	
              by
      its acquisition of such Shares that, upon receipt of a notice from the
      Company of the occurrence of any event of the kind described in Section
      13.1(b)(ii), 13.1(b)(iii), 13.1(b)(iv), 13.1(b)(v), 13.1(b)(vi) or
      13.1((l), the Subscriber will forthwith discontinue disposition of such
      Shares under the Registration Statement until the Subscriber's receipt of
      the copies of the supplemented prospectus and/or amended Registration
      Statement contemplated by Section 13.1(g), or until it is advised in
      writing by the Company that the use of the applicable prospectus may be
      resumed, and, in either case, has received copies of any additional or
      supplemental filings that are incorporated or deemed to be incorporated by
      reference in such prospectus or Registration
  Statement.

            

    

     

    13.3                        
The obligations of the Company under this Agreement shall terminate and be of no
further effect upon the earliest to occur of the following:

     

    
      	
               
      

            	
              (a)

            	
              when
      all Shares shall have been sold pursuant to Rule 144 (or any successor
      provision) under the 1933 Act;

            

    

    
      
         

      

      
        10

        
          

        

      

      
         

      

    

     

    
      	
               
      

            	
              (b)

            	
              when
      all Shares shall have been otherwise transferred and a new certificate(s)
      for such Shares not bearing a legend restricting further transfer shall
      have been delivered by The Company;
and

            

    

     

    
      	
               
      

            	
              (c)

            	
              that
      day that is two (2) years following the original issue date of the
      Shares.

            

    

     

    13.4                      
 If the holder of the Subscriber desires to sell some or all of the Shares
pursuant to the effective Registration Statement and it has delivered to the
Company, in a form set forth as Exhibit B hereto, a representation letter (the
“Registered Sale
Notice”) in which the Subscriber shall covenant with the Company that it
will resell the Shares pursuant to the plan of distribution described in the
effective Registration Statement, the Company shall cause its transfer agent to
remove the U.S. legend from the certificates evidencing the Shares within five
(5) business days.  If the Company so requests, the Registered Sale
Notice shall contain such additional covenants from the holder as may be
reasonably required in order to enable the Company to remove the Canadian or the
U.S. legend from the certificates.

     

     

    
      	
              14.

            	
              Registration
      Expenses.

            

    

     

    14.1                       
All fees and expenses incident to the preparation and filing of the Registration
Statement by the Company, except as and to the extent specified in this Section
14.3, shall be borne by the Company whether or not the Registration Statement is
filed or becomes effective and whether or not any Shares are sold pursuant to
the Registration Statement.  The fees and expenses referred to in the
foregoing sentence shall include, without limitation, (i) all registration and
filing fees (including, without limitation, fees and expenses (A) with respect
to filings required to be made with any securities exchange or market on which
Shares are required hereunder to be listed, (B) with respect to filing fees
required to be paid to the National Association of Securities Dealers, Inc. and
the NASD Regulation, Inc. and (C) in compliance with state securities or Blue
Sky laws, (ii) printing expenses (including, without limitation, expenses of
printing certificates for Shares and of printing prospectuses if the printing of
prospectuses is requested by the Subscriber), (iii) messenger, telephone and
delivery expenses, (iv) fees and disbursements of counsel for the Company, (v)
1933 Act liability insurance, if the Company so desires such insurance, and (vi)
fees and expenses of all other persons retained by the Company in connection
with the consummation of the transactions contemplated by this Agreement,
including, without limitation, the Company's independent public accountants
(including the expenses of any comfort letters or costs associated with the
delivery by independent public accountants of a comfort letter or comfort
letters).  In addition, the Company shall be responsible for all of
its internal expenses incurred in connection with the consummation of the
transactions contemplated by this Agreement (including, without limitation, all
salaries and expenses of its officers and employees performing legal or
accounting duties), the expense of any annual audit, the fees and expenses
incurred in connection with the listing of the Shares on any securities exchange
as required hereunder.

     

    
      	
              15.

            	
              Indemnification.

            

    

     

    15.1                      
 Indemnification
by the Company.  The Company shall, notwithstanding any
termination of this Agreement, indemnify and hold harmless the Subscriber, the
officers, directors, agents, brokers (including brokers who offer and sell
Shares as principal as a result of a pledge or any failure to perform under a
margin call of Common Stock), investment advisors and employees of the
Subscriber, each person who controls the Subscriber (within the meaning of
Section 15 of the 1933 Act or Section 20 of the Exchange Act) and the officers,
directors, agents and employees of each such controlling person, to the fullest
extent permitted by applicable law, from and against any and all losses, claims,
damages, liabilities, costs (including, without limitation, costs of preparation
and attorneys' fees) and expenses (collectively, "Losses"), as incurred,
arising out of or relating to any untrue or alleged untrue statement of a
material fact contained in the Registration Statement, any prospectus or any
form of prospectus or in any amendment or supplement thereto or in any
preliminary prospectus, or arising out of or relating to any omission or alleged
omission of a material fact required to be stated therein or necessary to make
the statements therein (in the case of any prospectus or form of prospectus or
supplement thereto, in the light of the circumstances under which they were
made) not misleading, except to the extent, but only to the extent, that (i)
such untrue statements or omissions are based solely upon information regarding
the Subscriber furnished to the Company by or on behalf of the Subscriber
expressly for use therein, and (ii) that the foregoing indemnity agreement is
subject to the condition that, insofar as it relates to any untrue statement,
allegedly untrue statement, omission or alleged omission made in any preliminary
prospectus but eliminated or remedied in the final prospectus (filed pursuant to
Rule 172 or Rule 424 of the 1933 Act), such indemnity agreement shall not inure
to the benefit of the Subscriber or any underwriter, broker or other person
acting on behalf of holders of the Shares, from whom the person asserting any
loss, claim, damage, liability or expense purchased the Shares which are the
subject thereof, if a copy of such final prospectus had been made available to
such person and the Subscriber or such underwriter, broker or other person
acting on behalf of the

    
      
         

      

      
        11

        
          

        

      

      
         

      

    

     

    Subscriber
and such final prospectus was not delivered to such person with or prior to the
written confirmation of the sale of such Shares to such person.  The
Company shall notify the Subscriber promptly of the claim, threat or assertion
of any proceeding of which the Company is aware in connection with the
transactions contemplated by this Agreement.

     

    15.2                      Indemnification by
Subscriber.  The Subscriber shall, severally and not jointly,
indemnify and hold harmless the Company, its directors, officers, agents and
employees, each person who controls the Company (within the meaning of Section
15 of the 1933 Act and Section 20 of the Exchange Act), and the directors,
officers, agents and employees of such controlling persons, to the fullest
extent permitted by applicable law, from and against all Losses (as determined
by a court of competent jurisdiction in a final judgment not subject to appeal
or review), as incurred, arising out of or based upon any untrue statement of a
material fact contained in the Registration Statement, any prospectus, or any
form of prospectus, or arising out of or based upon any omission of a material
fact required to be stated therein or necessary to make the statements therein
(in the case of any prospectus or form of prospectus or supplement thereto, in
the light of the circumstances under which they were made) not misleading, to
the extent, but only to the extent, that such untrue statement or omission is
contained in any information so furnished by the Subscriber to the Company
specifically for inclusion in the Registration Statement or such
prospectus.

     

    15.3                      Contribution.  If
a claim for indemnification under Section 15.1 or 15.2 is unavailable to an
indemnified party because of a failure or refusal of a governmental authority to
enforce such indemnification in accordance with its terms (by reason of public
policy or otherwise), then each indemnifying party, in lieu of indemnifying such
indemnified party, shall contribute to the amount paid or payable by such
indemnified party as a result of such Losses, in such proportion as is
appropriate to reflect the relative benefits received by the indemnifying party
on the one hand and the indemnified party on the other from the offering of the
Shares.  If, but only if, the allocation provided by the foregoing
sentence is not permitted by applicable law, the allocation of contribution
shall be made in such proportion as is appropriate to reflect not only the
relative benefits referred to in the foregoing sentence but also the relative
fault, as applicable, of the indemnifying party and indemnified party in
connection with the actions, statements or omissions that resulted in such
Losses as well as any other relevant equitable considerations.  The
relative fault of such indemnifying party and indemnified party shall be
determined by reference to, among other things, whether any action in question,
including any untrue or alleged untrue statement of a material fact or omission
or alleged omission of a material fact, has been taken or made by, or relates to
information supplied by, such indemnifying party or indemnified party, and
the parties'
relative intent, knowledge, access to information and opportunity to correct or
prevent such action, statement or omission.  The amount paid or
payable by a party as a result of any Losses shall be deemed to include any
reasonable attorneys' or other reasonable fees or expenses incurred by such
party in connection with (i) any proceeding to the extent such party would have
been indemnified for such fees or expenses if the indemnification provided for
in this Section was available to such party in accordance with its terms or (ii)
enforcing any rights under this Section 15.

     

    The
parties hereto agree that it would not be just and equitable if contribution
pursuant to this Section 15.3 were determined by pro rata allocation or by any
other method of allocation that does not take into account the equitable
considerations referred to in the immediately preceding paragraph.  No
person guilty of fraudulent misrepresentation (within the meaning of Section
11(f) of the 1933 Act) shall be entitled to contribution from any person who was
not guilty of such fraudulent misrepresentation.

     

    The
indemnity and contribution agreements contained in this Section are in addition
to any liability that the indemnifying parties may have to the indemnified
parties.

     

     

    
      	
              16.

            	
              Governing
      Law

            

    

     

    16.1                        This
Subscription Agreement is governed by the laws of the State of Nevada and the
federal laws of the United States applicable therein.

     

    
      	
              17.

            	
              Survival

            

    

     

    17.1                       
This Subscription Agreement, including without limitation the representations,
warranties and covenants contained herein, shall survive and continue in full
force and effect and be binding upon the parties hereto notwithstanding the
completion of the purchase of the Shares by the Subscriber pursuant
hereto.

    
      
         

      

      
        12

        
          

        

      

      
         

      

    

     

    18.                         
Assignment

     

    18.1                       
This Subscription Agreement is not transferable or assignable.

     

    
      	
              19.

            	
              Severability

            

    

     

    19.1                       
The invalidity or unenforceability of any particular provision of this
Subscription Agreement shall not affect or limit the validity or enforceability
of the remaining provisions of this Subscription Agreement.

     

    
      	
              20.

            	
              Entire
      Agreement

            

    

     

    20.1                       
 Except as expressly provided in this Subscription Agreement and in the
agreements, instruments and other documents contemplated or provided for herein,
this Subscription Agreement contains the entire agreement between the parties
with respect to the sale of the Shares and there are no other terms, conditions,
representations or warranties, whether expressed, implied, oral or written, by
statute or common law, by the Company or by anyone else.

     

    
      	
              21.

            	
              Notices

            

    

     

    21.1                        
All notices and other communications hereunder shall be in writing and shall be
deemed to have been duly given if mailed or transmitted by any standard form of
telecommunication.  Notices to the Subscriber shall be directed to the
address on the signature page of this Subscription Agreement and notices to the
Company shall be directed to it at Big Bear Mining 110 S. Fairfax Ave., Los
Angeles 90036 Attention: President.

     

    
      	
              22.

            	
              Counterparts and
      Electronic Means

            

    

     

    22.1                        
This Subscription Agreement may be executed in any number of counterparts, each
of which, when so executed and delivered, shall constitute an original and all
of which together shall constitute one instrument.  Delivery of an
executed copy of this Subscription Agreement by electronic facsimile
transmission or other means of electronic communication capable of producing a
printed copy will be deemed to be execution and delivery of this Subscription
Agreement as of the date hereinafter set forth.

     

    
      	
              23.

            	
              Delivery
      Instructions

            

    

    

    23.1                        
The Subscriber hereby directs the Company to deliver the Certificate evidencing
the Shares to:

    

     

      
        

      

    

    (name)

     

      
        

      

    

    (address)

    

    23.2                      The
Subscriber hereby directs the Company to cause the Shares to be registered on
the books of the Company as follows:

     

    
 

    
      
        

      

      (name)

       

        
          

        

      

      (address)

      
 

    

    23.3                      The
undersigned hereby acknowledges that it will deliver to the Company all such
additional completed forms in respect of the Subscriber’s purchase of the Shares
as may be required for filing with the appropriate securities commissions and
regulatory authorities.

     

    IN WITNESS WHEREOF the
Subscriber has duly executed this Subscription Agreement as of the date of
acceptance by the Company.

     

    

     

    
    

     

    
      	 	 	 	 
	 	 	 	Print Name of
      Subscriber
	 	 	 	 
	 	 	 	By: 
	 	 	 	
              (Signature
      and, if applicable, Office)

            
	 	 	 	 
	 	 	 	Print Address of
      Subscriber:
	 	 	 	 
	 	 	 	 
	 	 	 	 

    

     

     

     

                                                                 

      
        
           

        

        
          13

          
            

          

        

        
           

        

      

    

    A
C C E P T A N C E

     

    The
above-mentioned Subscription Agreement in respect of the Shares is hereby
accepted by Big Bear Mining Corp.

     

    DATED at
_____________________________________, the ________ day of __________,
2010.

     

    BIG
BEAR MINING CORP.

     

    

     

    Per:       _________________________    

                
Authorized Signatory

    
      
         

      

      
        14

        
          

        

      

      
         

      

    

    EXHIBIT
A

     

    ACCREDITED
INVESTOR QUESTIONNAIRE

     

    FOR
CANADIAN INVESTORS ONLY

    

    NATIONAL INSTRUMENT
45-106

    

    The
purpose of this Questionnaire is to assure Big Bear Mining Corp. (the “Issuer”)
that the undersigned (the “Subscriber”) will meet certain requirements for the
registration and prospectus exemptions provided for under National Instrument
45-106 (“NI 45-106”), as adopted by the members of the Canadian Securities
Administrators, in respect of a proposed private placement of securities by the
Issuer (the “Transaction”).  The Issuer will rely on the information
contained in this Questionnaire for the purposes of such
determination.

    

    The
undersigned Subscriber covenants, represents and warrants to the Issuer
that:

    

    
      	
               
      

            	
              1.

            	
              The
      Subscriber has such knowledge and experience in financial and business
      matters as to be capable of evaluating the merits and risks of the
      Transaction and the Subscriber is able to bear the economic risk of loss
      arising from such Transaction;

            

    

    

    
      	
               
      

            	
              2.

            	
              the
      Subscriber satisfies one or more of the categories of “accredited
      investor” (as that term is defined in NI 45-106) indicated below (please
      check the appropriate box):

            

    

    

    
      	
               
      

            	o	
              (a)
      a Canadian financial institution as defined in National Instrument 14-101,
      or an authorized foreign bank listed in Schedule III of the Bank Act
      (Canada);

            

    

    

    
      	
               
      

            	o	
              (b)
      the Business Development Bank of Canada incorporated under the Business Development Bank
      Act (Canada);

            

    

    

    
      	
               
      

            	o	
              (c)
      a subsidiary of any person referred to in any of the foregoing categories,
      if the person owns all of the voting securities of the subsidiary, except
      the voting securities required by law to be owned by directors of that
      subsidiary;

            

    

    

    
      	
               
      

            	o	
              (d)
      an individual registered or formerly registered under securities
      legislation in a jurisdiction of Canada, as a representative of a person
      or company registered under securities legislation in a jurisdiction of
      Canada, as an adviser or dealer, other than a limited market dealer
      registered under the Securities Act
      (Ontario) or the Securities Act
      (Newfoundland);

            

    

    

    
      	
               
      

            	o	
              (e)
      an individual registered or formerly registered under the securities
      legislation of a jurisdiction of Canada as a representative of a person
      referred to in paragraph (d);

            

    

    

    
      	
               
      

            	o	
              (f)
      the government of Canada or a province, or any crown corporation or agency
      of the government of Canada or a
province;

            

    

    

    
      	
               
      

            	o	
              (g)
      a municipality, public board or commission in Canada and a metropolitan
      community, school board, the Comite de gestion de la taxe scholaire de
      l’ile de Montreal or an intermunicipal management board in
      Québec;

            

    

    

    
      	
               
      

            	o	
              (h)
      a national, federal, state, provincial, territorial or municipal
      government of or in any foreign jurisdiction, or any agency
      thereof;

            

    

    

    
      	
               
      

            	o	
              (i)
      a pension fund that is regulated by either the Office of the
      Superintendent of Financial Institutions (Canada) or a pension commission
      or similar regulatory authority of a jurisdiction of
    Canada;

            

    

    

    
      	
               
      

            	o	
              (j)
      an individual who either alone or with a spouse beneficially owns,
      directly or indirectly, financial assets (as defined in NI 45-106) having
      an aggregate realizable value that, before taxes but net of any related
      liabilities, exceeds CDN$1,000,000;

            

    

    

    
      	
               
      

            	o	
              (k)
      an individual whose net income before taxes exceeded CDN$200,000 in each
      of the two more recent calendar years or whose net income before taxes
      combined with that of a spouse exceeded $300,000 in each of those years
      and who, in either case, reasonably expects to exceed that net income
      level in the current calendar
year;

            

    

    
      
         

      

      
        15

        
          

        

      

      
         

      

    

    
      	
               
      

            	o	
              (l)
      an individual who, either alone or with a spouse, has net assets of at
      least CDN $5,000,000;

            

    

    

    
      	
               
      

            	o	
              (m)
      a person, other than a person or investment fund, that had net assets of
      at least CDN$5,000,000 as reflected on its most recently prepared
      financial statements;

            

    

    

    
      	
               
      

            	o	
              (n)
      an investment fund that distributes it securities only to persons that are
      accredited investors at the time of distribution, a person that acquires
      or acquired a minimum of CDN$150,000 of value in securities, or a person
      that acquires or acquired securities under Sections 2.18 or 2.19 of NI
      45-106;

            

    

    

    
      	
               
      

            	o	
              (o)
      an investment fund that distributes or has distributed securities under a
      prospectus in a jurisdiction of Canada for which the regulator or, in
      Québec, the securities regulatory authority, has issued a
      receipt;

            

    

    

    
      	
               
      

            	o	
              (p)
      a trust company or trust corporation registered or authorized to carry on
      business under the Trust
      and Loan Companies Act (Canada) or under comparable legislation in
      a jurisdiction of Canada or a foreign jurisdiction, acting on behalf of a
      fully managed account managed by the trust company or trust corporation,
      as the case may be;

            

    

    

    
      	
               
      

            	o	
              (q)
      a person acting on behalf of a fully managed account managed by that
      person, if that person (i) is registered or authorized to carry on
      business as an adviser or the equivalent under the securities legislation
      of a jurisdiction of Canada or a foreign jurisdiction, and (ii) in
      Ontario, is purchasing a security that is not a security of an investment
      fund;

            

    

    

    
      	
               
      

            	o	
              (r)
      a registered charity under the Income Tax Act (Canada)
      that, in regard to the trade, has obtained advice from an eligibility
      advisor or an advisor registered under the securities legislation of the
      jurisdiction of the registered charity to give advice on the securities
      being traded;

            

    

    

    
      	
               
      

            	o	
              (s)
      an entity organized in a foreign jurisdiction that is analogous to any of
      the entities referred to in paragraphs (a) to (d) or paragraph (i) in form
      and function;

            

    

    

    
      	
               
      

            	o	
              (t)
      a person in respect of which all of the owners of interests, direct,
      indirect or beneficial, except the voting securities required by law are
      persons or companies that are accredited
  investors.

            

    

    

    
      	
               
      

            	o	
              (u)
      an investment funds that is advised by a person registered as an advisor
      or a person that is exempt from registration as an advisor;
    or

            

    

    

    
      	
               
      

            	o	
              (v)
      a person that is recognized or designated by the securities regulatory
      authority as an accredited investor or, in Alberta or B.C., an exempt
      purchaser,

            

    

    

    The
Subscriber acknowledges and agrees that the Subscriber may be required by the
Issuer to provide such additional documentation as may be reasonably required by
the Issuer and its legal counsel in determining the Subscriber’s eligibility to
acquire the Shares under relevant Legislation.

    

    IN WITNESS WHEREOF, the undersigned has
executed this Questionnaire as of the ________ day of __________________,
2010.

    

    

    

    
      	If
      a Corporation, Partnership or Other Entity: 	 	
              
                If
      an Individual:

                 

              

            
	 	 	 
	
              Print
      or Type Name of Entity

            	 	
              Signature

            
	   	 	 
      
	
              Signature
      of Authorized Signatory

            	 	
              Print
      or Type Name

            
	   	 	 
      
	
              Type
      of Entity

            	 	 
      

    

    
      
         

      

      
        
        

        
          

        

      

      
         

      

    

    EXHIBIT
B

    Form of
Registered Sale Notice

    Big Bear
Mining Corp.

     

    

     

    Dear
Sirs/Mesdames:

     

    I propose
to sell _________________ common shares (the “Shares”) in the capital of
Big Bear MiningCorp.  (the “Company”), through  (the “Broker”), which Shares were
registered for resale on a Registration Statement on Form S-1 (No. __________)
(the “Registration Statement”).   In order to induce W.L.
Macdonald Law Corporation to render its opinion to the Company, and also to
enable the Company’s transfer agent to remove the restrictive legends, the
undersigned hereby represents and warrants to Big Bear Mining Corp. that the
undersigned has complied with the prospectus delivery requirements of the
Securities Act of 1933, as amended, and the Plan of Distribution set forth in
the Registration Statement.

     

    The
following certificate(s) for Shares of the Company’s common stock have been
delivered with this Letter of Instruction, accompanied by the appropriate stock
power with a signature guarantee medallion stamp:

     

    
      	
              Certificate
      No.

            	
              Name
      of Registered Owner

            	
              No.
      of Shares

            
	 
      	 
      	 
      
	 
      	 
      	 
      

    

     

    Please
deliver certificate(s) representing shares of common stock of the Company,
without the restrictive legend, to the following person(s) in the specified
amounts:

     

    
      	
              Name
      and address of

              New
      Registered Owner

            	
               

              No.
      of Shares

            	
               

              Date
      of Purchaser

            
	 
      	 
      	 
      
	 
      	 
      	 
      

    

     

    Thank you
for your assistance in this matter.

    
      	 
      	
              Dated:    ___________________________________

                                                                              

            
	 
      	
              Signature:  _________________________________      

                                                                    

            
	 
      	
              Print
      Name: ________________________________     

                                                                           

            
	 
      	
              Address:  __________________________________                                                                

            
	 
      	__________________________________________
	 
      	
              __________________________________________

               

            
	 
      	
              Phone:  (   )_________________________________

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