Document:

Exhibit

LU10244
Allstate Life Insurance Company 
 (herein called "We" or "Us")
Amendatory Endorsement
As used in this endorsement, "Contract" means the Contract or Certificate to which this endorsement is attached.
We have issued this endorsement as part of the Contract to which it is attached.
The following changes are made to your contract.
1. The Company name is deleted and replaced with:
Allstate Life Insurance Company
2. Home office address is deleted and replaced with:
3100 Sanders Road, Northbrook, IL 60062
Except as amended in this endorsement, the Contract remains unchanged.
[GRAPHIC OMITTED][GRAPHIC OMITTED] [GRAPHIC OMITTED][GRAPHIC OMITTED]EX-10.1

 Exhibit 10.1 

Name of
Investor:                                       
      
 SUBSCRIPTION AGREEMENT 

 
  

THIS SUBSCRIPTION AGREEMENT (the “Agreement”) by and between Paramount Gold Nevada Corp., a Nevada
corporation (the “Company”), and the undersigned corporation, limited liability company, partnership, trust or employee benefit plan executing this Agreement as the investor (the “Investor”), provides as follows:

 Recitals 

A.    This Agreement is made in connection with the Company’s proposed private placement (the
“Private Placement”) of the Company’s common stock, par value $0.01 per share (“Shares”). 

B.    The Company wishes to sell to the Investor and the Investor wishes to purchase from the Company the
number of Shares specified on the signature page hereof at the price per Share set forth in Section 2 hereof, subject to the terms, conditions, and requirements contained in this Agreement. 

C.    The Investor understands that the Company has the right, in its sole discretion, to refuse to accept
the Investor’s subscription in whole or in part at any time and for any reason, including without limitation the Company’s belief that the Investor does not meet the applicable suitability requirements for participation in the Private
Placement. 
 NOW, THEREFORE, in consideration of the foregoing and the promises and covenants contained in this Agreement,
the Company and the Investor hereby agree as follows: 
 1.    Sale of Shares. In accordance with
the terms and conditions of this Agreement, the Company hereby agrees to sell to the Investor, and the Investor hereby agrees to purchase from the Company, on or before October 12, 2017, or such later date on or before October 31, 2017,
that the Company in its sole discretion chooses (the “Closing Date”), the number of Shares indicated on the signature page hereof. The obligation of the Company to sell the Shares to the Investor is subject to, among other things,
the conditions that: (i) the Company receives approval for the listing of the Shares on the NYSE American (the “Stock Exchange”); (ii) all other necessary regulatory approvals are obtained prior to the Closing Date; and
(iii) completion of the Company’s anticipated concurrent public offering of shares of the Company’s common stock, pursuant to the Company’s registration statement on Form S-3 (File No. 333-218295) (the “Registration Statement”), the preliminary terms of which public offering shall be set forth in a prospectus supplement to be dated on or about the date hereof (the
“Public Offering”). 
 2.    Purchase Price. The purchase price
(“Purchase Price”) per Share shall be equal to the price per share in the Public Offering. The Investor shall pay such purchase price certified check or bank draft payable to the Company (or by wire transfer, per instructions to be
provided upon request) and delivered with this executed Agreement: 
  

	 	 2.1
	 a completed Investor Questionnaire (the “Investor Questionnaire”) attached hereto as Exhibit
“A” and 

  

	 	 2.2
	 any other further documentation as required under the applicable securities laws or Stock Exchange or other
regulatory authority. 

 Subscriptions for Shares may be accepted or rejected by the Company for any or no reason in its
sole discretion. 
 3.    Representations and Warranties of Investor. The Investor represents and
warrants to the Company as follows (which representations and warranties shall survive the Closing Date): 
  

	 	 3.1
	 The Investor has answered the questions contained in the Investor Questionnaire made a part hereof to the best
of its knowledge and the answers thereto are complete and accurate. The Investor understands and agrees that, although such answers will be kept strictly confidential, the Company may present such Investor Questionnaire to such parties as it deems
advisable if called upon to establish the availability under applicable securities laws of an exemption from registration. The Investor agrees to indemnify the Company, its agents, officers, directors and shareholders, for any and all losses
(including without limitation attorneys’ fees and other costs of investigating, prosecuting, or defending any litigation claim) incurred by the Company as a result of its reliance on the representations and warranties of Investor made in this
Agreement or any answers contained in the Investor Questionnaire. 

  

	 	 3.2
	 The Investor is a resident of Canada and: 

 

	 	 3.2.1
	 is acquiring the Shares at an aggregate acquisition price to the Investor of not less than Cdn$150,000 paid in
cash at the time of the distribution; 

  

	 	 3.2.2
	 is not an individual; and 

 

	 	 3.2.3
	 was not created, and is not being used, solely to purchase or hold securities in reliance on an exemption from
the prospectus requirements set out in subsection 2.10 (Minimum amount investment) of National Instrument 45-106 of the Canadian Securities Administrators or under Canadian securities laws.

  

	 	 3.3
	 The Investor is a corporation, limited liability company, partnership, trust, or employee benefit plan, is
authorized to make the investment contemplated herein, and the person signing this Agreement on behalf of such entity has been duly authorized by such entity to do so. 

 

	 	 3.4
	 This Agreement has been duly authorized, executed and delivered by the Investor and constitutes the
Investor’s legal, valid and binding obligation enforceable in accordance with its terms. 

  
 2 

	 	 3.5
	 The Investor is acquiring the Shares as principal for the Investor’s own account for investment and not
with a view to resale or distribution. The Investor understands that the Shares have not been, and will not be, registered under the Securities Act of 1933, as amended (the “1933 Act”), or applicable securities laws by reason
of specific exemptions from the registration provisions of the 1933 Act and applicable state securities laws that depend upon, among other things, the bona fide nature of the investment intent and the accuracy of the Investor’s representations
and warranties as expressed in this Agreement and in the Investor Questionnaire. 

  

	 	 3.6
	 The Company has advised the Investor that the Company is relying on an exemption from the requirements under
applicable Canadian securities laws to provide the Investor with a prospectus and that no prospectus has been filed by the Company with any securities commission in Canada in connection with the Private Placement, and as a consequence:

  

	 	 3.6.1
	 the Investor is restricted from using most of the civil remedies available under applicable Canadian
securities laws and certain protections, rights and remedies provided by applicable Canadian securities laws, including statutory rights of rescission or damages, will not be available to the Investor; 

 

	 	 3.6.2
	 the Investor may not receive information that would otherwise be required to be provided to the Investor under
the applicable Canadian securities laws; and 

  

	 	 3.6.3
	 the Investor is relieved from certain obligations that would otherwise apply under the applicable Canadian
securities laws. 

  

	 	 3.7
	 The Investor: (i) has been furnished, has carefully read, understands and has relied solely on (except as
indicated in subsection (ii) below) the terms and conditions of, and the information contained in, this Agreement (including all exhibits and all amendments thereto and hereto) and the Company’s Form
10-K for the year ended June 30, 2017; (ii) has been given the opportunity to ask questions of, and receive answers from, the Company concerning the terms and conditions of this Agreement, the Shares, the
Company and its business; and (iii) has not been furnished any literature or written material relating to the Shares, the Company or its business other than this Agreement (including all exhibits and amendments thereto and hereto) and the
Company’s Form 10-K for the year ended June 30, 2017. 

  

	 	 3.8
	 The Investor recognizes that (i) the purchase of the Shares involves a high degree of risk and has taken
full cognizance of and understands such risks, (ii) that all information provided, if any, by the Company relating to its use of proceeds, financial forecasts, and other information which is not of an historical nature (“Forward-looking
Information”), represents only the Company’s good faith assessment of such Forward-looking Information, and is based upon assumptions which the Company believes are reasonable, although no assurance exists that such

  
 3 

 Forward-looking Information is accurate or will be fulfilled, and
(iii) that the Company has relied on the representations of the Investor as set forth in this Agreement, in the Investor Questionnaire in determining materiality for purposes of satisfying the disclosure obligations of the Company and in
determining the availability of exemptions from (a) registration requirements under applicable United States federal and state securities laws; and (b) prospectus requirements under applicable Canadian securities laws. 

 

	 	 3.9
	 The Investor is resident in the jurisdiction set out on the execution page of the Investor Questionnaire,
which address is the Investor’s residence or principal place of business, and such address was not obtained or used solely for the purpose of acquiring the Shares. 

 

	 	 3.10
	 The Investor fully understands and agrees that the Investor must bear the economic risk of the purchase of the
Shares for an indefinite period of time because, among other reasons, the Shares have not been registered under the 1933 Act, or the securities laws of any state, and therefore cannot be sold, pledged, assigned or otherwise disposed of unless they
are subsequently registered under the 1933 Act and applicable state securities laws or exemptions from such registration requirements are available. The Investor further understands and agrees that the Company will not honor any attempt by the
Investor to sell, pledge, transfer, or otherwise dispose of all or any portion of the Shares in the absence of an effective registration statement under the 1933 Act and applicable state securities laws or an unqualified opinion of counsel,
satisfactory in form and substance to the Company and its counsel, and obtained at the expense of the Investor, that exemptions are available therefrom with respect to such attempted disposition. 

 

	 	 3.11
	 The Investor acknowledges that the certificates representing the Shares purchased by the Investor will bear a
legend as of the Closing Date substantially in the following form (and with the necessary information inserted) and may be subject to stop-transfer instructions consistent therewith: 

THE SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR
APPLICABLE STATE SECURITIES LAWS. THE SECURITIES HAVE BEEN ACQUIRED FOR INVESTMENT AND MAY NOT BE OFFERED FOR SALE, SOLD, TRANSFERRED OR ASSIGNED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT FOR THE SECURITIES UNDER THE SECURITIES ACT OF
1933, AS AMENDED, OR APPLICABLE STATE SECURITIES LAWS, UNLESS SOLD PURSUANT TO: (1) RULE 144 UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR (2) AN OPINION OF HOLDER’S COUNSEL, IN A CUSTOMARY FORM, THAT REGISTRATION IS NOT REQUIRED
UNDER SAID ACT OR APPLICABLE STATE SECURITIES LAWS. 

  
 4 

 [●UNLESS PERMITTED UNDER SECURITIES LEGISLATION, THE
HOLDER OF THIS SECURITY MUST NOT TRADE THE SECURITY BEFORE THE DATE THAT IS 4 MONTHS AND A DAY AFTER [INSERT THE DISTRIBUTION DATE]]. 
  

	 	 3.12
	 The Investor (i) can bear the risk of losing the entire investment in the Shares; (ii) has overall
commitments to other investments which are not readily marketable that are not disproportionate to its net worth and the investment in the Shares will not cause such overall commitments to become excessive; (iii) has adequate means of providing
for current needs and contingencies and has no need for liquidity in the investment in the Shares; and (iv) has sufficient knowledge and experience in financial and business matters such that the Investor is capable of evaluating the risks and
merits of investing in the Shares. 

  

	 	 3.13
	 The Investor acknowledges that the Company proposes to concurrently enter into substantially this same form of
Subscription Agreement with one or more other investors and expects to complete sales of Shares to them. 

  

	 	 3.14
	 The Investor acknowledges that the Company expects to enter into an Underwriting Agreement, dated
October 3, 2017 (the “Underwriting Agreement”), with the underwriters of the Public Offering (the “Underwriters”) that contains certain representations, warranties, covenants and agreements of the Company that
may be relied upon by the Underwriters in respect of the sale of Shares by the Company to the Investor and other investors in the Private Placement, but that neither the Company nor any of the Underwriters is obligated to enter into the Underwriting
Agreement or consummate the Public Offering; the Investor further acknowledges (for the avoidance of doubt) that, notwithstanding the use herein of the term “Underwriters,” the Private Placement does not constitute a public offering under
the Securities Act or Canadian securities laws, the Underwriters are not serving as “underwriters” with respect to the Private Placement, the Shares are being offered and sold directly by the Company to the Investor and the other investors
in the Private Placement, and the Underwriters will in no event have any obligation to purchase any Shares in the Private Placement. 

  

	 	 3.15
	 The Investor has not incurred, and will not incur, directly or indirectly, as a result of any action taken by
the Investor, any liability for brokerage or finder’s fees or agent’s commissions or any similar charges in connection with this Agreement. The Investor acknowledges that the Company will pay to the Underwriters a fee of 5.0% of the
aggregate Purchase Price in respect of the sale of Shares by the Company to the Investor and to any other investor purchasing Shares in the Private Placement. 

 

	 	 3.16
	 The Investor acknowledges that since the time at which the Company first contacted the Investor about the
Private Placement, the Investor has not disclosed any information regarding the Private Placement or the Public Offering to any third parties (other than its legal, accounting and other advisors) and has not engaged in 

  
 5 

 any transactions involving the securities of the Company (including, without
limitation, any short sales involving the Company’s securities). 
  

	 	 3.17
	 The Investor acknowledges that it must depend entirely upon its own advisors for tax advice concerning an
investment in the Company, that the Company has not provided any information on tax matters, and that any information provided to Investor by, or on behalf of, the Company is not to be construed as tax advice to Investor from the Company or counsel
to the Company. The Investor will rely solely on its own advisors and not on any statements or representations of the Company or any of its agents and understands that the Investor (and not the Company) shall be responsible for the Investor’s
own tax liability that may arise as a result of this investment or the transactions contemplated by this Agreement. 

  

	 	 3.18
	 The Investor understands and agrees that the Company is issuing the Shares to the Investor pursuant to the
exemptions from federal and state securities registration requirements under the 1933 Act. In connection therewith, the Investor represents and warrants that the Investor qualifies as an “Accredited Investor” as such term is defined
under Rule 501 of the 1933 Act (a “U.S. Accredited Investor”) and has confirmed that on the Investor Questionnaire attached hereto as Exhibit “A”. 

 

	 	 3.19
	 The Investor agrees to comply with all securities laws and with the policies of the Stock Exchange concerning
the purchase of, the holding of, and the resale restrictions applicable to, the Shares. The Investor recognizes that the securities laws and regulations of certain jurisdictions, which may include the jurisdiction of which the Investor is a
resident, may impose additional requirements relating to this Private Placement and the Investor’s purchase of the Shares. The Investor hereby agrees to execute and to comply with the terms of any additions, supplements or amendments to this
Agreement which are required by the Company. 

  

	 	 3.20
	 The funds representing the aggregate purchase price in respect of the Shares which will be advanced by the
Investor to the Company hereunder will not represent proceeds of crime for the purpose of the Proceeds of Crime (Money Laundering) and Terrorist Financing Act (Canada) (the “PCMLTF Act”) or the United States Uniting
and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act (the “PATRIOT Act”) and the Investor acknowledges that the Company may in the future be required by law to disclose the
Investor’s name and other information relating to this Agreement and the Investor’s subscription hereunder, on a confidential basis, pursuant to the PCMLTF Act or the PATRIOT Act; to the best of the Investor’s knowledge, none of the
subscription funds to be provided hereunder (i) have been or will be obtained or derived, directly or indirectly, from or related to any activity that is deemed illegal under the laws of Canada or the United States or any other jurisdiction, or
(ii) are being tendered on behalf of a person or entity who has not been identified to the Investor; the Investor shall promptly notify the Company if he discovers that any such representation ceases to be true, and shall provide the Company
with appropriate information in connection therewith. 

  
 6 

	 	 3.21
	 The Investor has a pre-existing substantive relationship with the
Company (including as a current shareholder of the Company) and initiated discussions with the Company relating to the purchase and sale of the Shares contemplated by this Agreement on an unsolicited basis prior to the date of this Agreement; the
Investor did not initiate or engage in such discussions, nor did the Investor decide to enter into this Agreement, as a result of any “directed selling efforts” (as defined in Regulation S under the 1933 Act) or “general solicitation
or general advertising” (within the meaning of Rule 502(c) under the 1933 Act or applicable Canadian securities laws), including, without limitation, (i) the Company’s filing of the Registration Statement, any prospectus supplement
relating to the Public Offering or any other prospectus (preliminary, final, free writing or otherwise) contained in or relating to the Registration Statement, (ii) the Company’s filing of a short-form prospectus (preliminary, final or
otherwise) in Canada or any province thereof relating to the Public Offering or (ii) any press release or other public communication relating to the Public Offering. 

 

	 	 3.22
	 The Investor is not in the United States, was not offered the Shares in the United States, is not purchasing
the Shares in the United States, did not execute this Agreement in the United States and is not a “U.S. person” (within the meaning of Regulation S under the 1933 Act). 

 

	 	 3.23
	 The Investor acknowledges that no agency, stock exchange or governmental agency, securities commission or
similar regulatory authority or other entity has reviewed or passed on or made any finding or determination as to the merits of or made any recommendation or endorsement with respect to the Shares. 

 

	 	 3.24
	 The Investor acknowledges that there is no government or other insurance covering the Shares.

  

	 	 3.25
	 The Investor acknowledges that no representation or warranty is made by any of the Underwriters or their
affiliates as to the accuracy or completeness of any materials provided to the Investor; the Investor further acknowledges that none of the Underwriters or their affiliates has made any representation or given any information to it with respect to
the Company or the offering or sale of the Shares by the Company and that the Investor is not relying upon any statements made (or not made) by any of the Underwriters or their affiliates in making its decision to enter into this Agreement and
purchase the Shares. 

  

	 	 3.26
	 The representations and warranties made in this Agreement, the Investor Questionnaire, as well as all other
information that the Investor has provided to the Company, either directly or indirectly, concerning the Investor’s financial position and knowledge of financial and business matters, is correct and complete as of the date hereof, and if there
should be any material change in such information prior to the issuance to Investor of the Shares, Investor will immediately notify the Company. 

  
 7 

 4.    Hold Period; Restricted Securities. The Investor
acknowledges that (a) the Shares purchased by the Investor will be subject to a four month hold period in Canada under applicable Canadian securities laws, regardless of whether or not the Company has filed and have declared effective by the
Securities and Exchange Commission (the “SEC”) a registration statement registering the resale in the United States by the Investor of the Shares, (b) the Shares purchased by the Investor will constitute “restricted
securities” (as defined in Rule 144 under the 1933 Act), and (c) the Company is under no obligation, and has no intention, to register the Shares purchased by the Investor for resale in the United States. 

5.    Applicable Law; Venue. This Agreement shall be construed in accordance with and governed by
the laws of the State of New York without reference to the choice of law principles of any jurisdiction. THE INVESTOR IRREVOCABLY AND UNCONDITIONALLY CONSENTS TO THE EXCLUSIVE JURISDICTION OF THE COURTS OF THE STATE OF NEW YORK AND OF THE UNITED
STATES LOCATED IN THE CITY OF NEW YORK, NEW YORK, IN CONNECTION WITH ANY SUIT, ACTION OR PROCEEDING RELATING TO THIS AGREEMENT OR THE PRIVATE PLACEMENT AND AGREES NOT TO COMMENCE ANY SUIT, ACTION, OR PROCEEDING RELATING THERETO EXCEPT IN SUCH
COURTS. 
 6.    Binding Effect. Except as otherwise provided herein, this Agreement shall be
binding upon and inure to the benefit of the parties and their respective heirs, executors, administrators, successors, legal representatives and assigns 

7.    Notice. All notices and other communications required or permitted hereunder or necessary or
convenient in connection herewith shall be in writing and shall be deemed to have been given three business days after the date mailed when mailed by registered or certified mail, postage prepaid, or the next business day if sent by special courier
such as FedEx (except that notice of change of address shall be deemed given only when received), to the address shown on the Company’s records, in the case of the Investor, and of the Company’s registered office, in the case of the
Company, or to such other names or addresses as the Company or the Investor, as the case may be, shall designate by notice to the other party in the manner specified in this Section. 

8.    Severability. If any provision of this Agreement or application thereof to anyone or under
any circumstances is adjudicated to be invalid or unenforceable in any jurisdiction, such invalidity or unenforceability shall not affect any other provisions or applications of this Agreement that can be given effect without the invalid or
unenforceable provision or application and shall not invalidate or render unenforceable the invalid or unenforceable provision in any other jurisdiction or under any other circumstance. 

9.    Entire Agreement. This Agreement, and the Shares purchased hereunder, constitute the entire
agreement by and between the parties pertaining to the subject matter hereof and supersede all prior and contemporaneous understandings of the parties. 

10.    Counterparts. This Agreement may be executed in any number of counterparts, and any party
hereto may execute such counterpart, each of which when so executed and delivered (which may be by facsimile or other form of electronic transmission) shall be deemed an original and all of which taken together shall constitute one and the same
instrument. This Agreement shall 

  
 8 

 
become binding when either this Agreement or two or more counterparts hereto shall have been executed and delivered by the parties hereto. 

11.    Variation in Pronouns. All pronouns shall be deemed to refer to masculine, feminine, neuter,
singular, or plural, as the identity of the person or persons may require. 
 12.    Survival of
Representations, Warranties and Agreements; Third Party Beneficiary. Notwithstanding any investigation made by any party to this Agreement or by the Underwriters, all covenants, agreements, representations and warranties made by the Company and the
Investor herein will survive the execution of this Agreement, the delivery to the Investor of the Shares being purchased and the payment therefor. The Investor and the Company understand and confirm that the Underwriters can rely on the
acknowledgements, representations and warranties and the statements and answers contained in this Agreement and the Investor Questionnaire. 

13.    Counsel. This Agreement and all other agreements related to the Private Placement (the
“Offering Agreements”) have been prepared by Duane Morris LLP, as counsel to the Company (“Counsel”), after full disclosure of its representation of the Company and with the consent and direction of the Company and
the Investor. The Investor has reviewed the contents of the Offering Agreements and fully understands their terms. The Investor acknowledges that it is fully aware of the Investor’s right to the advice of counsel independent from that of the
Company, that Counsel has advised the Investor of such right and disclosed to the Investor the risks in not seeking such independent advice, and that the Investor understands the potentially adverse interests of the parties with respect to the
Offering Agreements. The Investor further acknowledges that no representations have been made with respect to the tax or other consequences of the Offering Agreements to the Investor and that it has been advised of the importance of seeking
independent counsel with respect to such consequences. By executing this Agreement, the Investor represents that it has, after being advised of the potential conflicts between the Investor and the Company with respect to the future consequences of
the Offering Agreements, either consulted independent legal counsel or elected, notwithstanding the advisability of seeking such independent legal counsel, not to consult such independent legal counsel. 

[SIGNATURES APPEAR ON THE FOLLOWING PAGES] 

  
 9 

 IN WITNESS WHEREOF, this Agreement has been duly executed by the duly authorized
officer of the Company and the undersigned Investor or its duly authorized officer, as the case may be, as of the date first written beneath the signature of such officer of the Company below. 

INVESTOR SIGNATURE: 
  

					
	 	  		  	 
	 Name of Corporation, Company, Trust or Benefit Plan
	  		  	 Taxpayer Identification Number or Canada Revenue Agency Business Number

  

			
		
	 By:
	 	 
	 (Signature of Person Making Investment Decision)

  

			
	 Print Name:
	 	 

			
		
	 Its:
	 	 
	 (describe office or position held)

  

			
	 Date:
	 	 

  
 10 

 Print Investor’s Full Name(s): 

 

	
	
	   

  

							
				
	 Number of Shares subscribed for by Investor
	 		 	   
	 	  

  

	 ACCEPTED BY THE COMPANY: 
	
                 PARAMOUNT GOLD NEVADA 
CORP. 

			
		
	 By (Signature):
	 	 

 
					
		
	 Print Name:
	 	 

 
					
		
	 Title:
	 	 
		
	 Date:
	 	 

  
 11 

 EXHIBIT “A” 

INVESTOR QUESTIONNAIRE 

(See Attached.) 

 INVESTOR QUESTIONNAIRE 

 
  

THIS QUESTIONNAIRE DOES NOT CONSTITUTE AN OFFER TO SELL OR A SOLICITATION OF AN OFFER TO BUY A SECURITY. The sole
purpose of this questionnaire is to establish whether the entity on whose behalf this questionnaire is completed (the “Investor”) is a qualified investor to whom securities of Paramount Gold Nevada Corp., a Nevada corporation (the
“Company”), may be offered and sold under applicable federal and state securities laws. The completed statement should indicate whether the Investor has or can be attributed with such knowledge and experience in financial and
business matters as to be able to evaluate the merits and risks of an investment and whether the Investor has the financial means to bear the economic risks involved. 

IMPORTANT: This form of Investor Questionnaire has been prepared for use by entities such as
partnerships, corporations and trusts. When completed, this questionnaire should provide information regarding the entity and not particular partners, officers, directors, trustees or beneficiaries of the entity, unless specifically requested.
Notwithstanding the foregoing, in the case of partnerships, corporations and trusts formed specifically for the purpose of participating in this investment, a questionnaire must be completed by each partner, shareholder, and beneficiary. 

 

							
	 1.
	 	 INVESTOR

				
		 	 a.
	 	 Name of entity:
	 	      

							
				
		 	 b.
	 	 Form of entity:
	 	      

		 		 	 (partnership, corporation, trust, etc.)

							
				
		 	 c.
	 	 Date of organization of entity:
	 	      

							
				
		 	 d.
	 	 Address of entity:
	 	      

							
		 		 	      

							
				
		 	 e.
	 	
Telephone number of entity: (            )
	 	      

							
				
		 	 f.
	 	
Fax number of entity: (            )
	 	      

							
				
		 	 g.
	 	 Email address of entity:
	 	      

							
			
		 	 h.
	 	 Please name the authorized representative(s) of the entity who will be acting for the entity in connection with
its potential investment in the Company:

			
		 		 	      

				
		 	 i.
	 	 Type of business entity is engaged in:
	 	      

			
		 		 	      

		
	 2.
	 	 Please state the amount, in United States dollars, of the Investor’s potential investment in the
Company:

  
 A-2 

					
		 	
$                       
                                   .
	 	

  

					
	 3.
	 	 The Investor is one or more of the following:

			
		 	
                 

	  	 a natural person who had an individual income in excess of $200,000 in each of the two most recent years or joint income
with a spouse in excess of $300,000 in each of those years and who reasonably expects to reach the same income level in the current year;

			
		 	
                 

	  	 a natural person whose individual net worth, or joint net worth with that person’s spouse, at the time of purchase
exceeds $1,000,000, excluding the value of the primary residence of such natural person, calculated by subtracting from the estimated fair market value of the property the amount of debt secured by the property, up to the estimated fair market value
of the property;

			
		 	
                 

	  	 a trust, with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring the securities
offered, whose purchase is directed by a person who has such knowledge and experience in financial and business matters that he is capable of evaluating the merits and risks of the prospective investment;

			
		 	
                 

	  	 a bank as defined in Section 3(a)(2) of the Securities Act of 1933 (the “Act”) or a savings
and loan association or other institution as defined in Section 3(a)(5)(A) of the Act whether acting in its individual or fiduciary capacity;

			
		 	
                 

	  	 a broker-dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934;

			
		 	
                 

	  	 an insurance company as defined in Section 2(13) of the Act;

			
		 	
                 

	  	 an investment company registered under the Investment Company Act of 1940 or a business development company as
defined in Section 2(a)(48) of the Investment Company Act of 1940;

			
		 	
                 

	  	 a Small Business Investment Company licensed by the U.S. Small Business Administration under Section 301(c) or
(d) of the Small Business Investment Act of 1958;

			
		 	
                 

	  	 a plan established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or
its political subdivisions, for the benefit of its employees, where such plan has total assets in excess of $5,000,000.

			
		 	
                 

	  	 an employee benefit plan within the meaning of Title 1 of the Employee Retirement Income Security Act of 1974, where
the investment decision is made by a plan fiduciary, as defined in Section 3(21) of such Act, which is either a bank, savings and loan association, insurance company, or registered investment adviser, or an employee benefit plan that has total
assets in excess of $5,000,000, or if a

  
 A-3 

					
		 		  	 self-directed plan the investment decisions are made solely by persons that are accredited investors;

			
		 	
                 

	  	 a private business development company, as defined in Section 202(a)(22) of the Investment Advisers Act of
1940;

			
		 	
                 

	  	 an organization described in Section 501(c)(3) of the Internal Revenue Code, a corporation, a Massachusetts or similar
business trust, a limited liability company or a partnership, not formed for the specific purpose of acquiring the securities offered, with total assets in excess of $5,000,000;

			
		 	
                 

	  	 a director or executive officer of the Company;

			
		 	
                 

	  	 an entity in which all of the equity investors is a person described above.

		
	 4.
	 	 Additionally, the Investor is a resident of Canada and is:

			
	 	 	
                 

	  	 a non-individual purchasing as principal such number of Shares having an
acquisition cost to the Investor of not
less than Cdn$150,000 paid in cash at the time of Closing.

			
	 	 	
                 

	  	 a registrant pursuant to applicable Canadian securities laws; and/or

			
	 	 	
                 

	  	 an insider of the Company pursuant to applicable Canadian securities laws.

							
		
	 5.
	 	 In furnishing the above information, the Investor, and if the Investor is an entity, the individual
executing and delivering this questionnaire on behalf of the entity, acknowledge that the Company will be relying thereon in determining, among other things, whether there are reasonable grounds to believe that the Investor qualifies as a purchaser
of shares of the Company’s securities. To the best of the Investor’s information and belief, the above information supplied by the Investor is true and correct in all respects and the Investor represents and warrants to the Company as
follows:

			
		 	 (a)
	 	 The answers to the above questions may be relied upon by the Company in determining whether the offering in
which the Investor proposes to participate is exempt from registration under the Act and from registration or qualification under the securities laws of various states.

			
		 	 (b)
	 	 The Investor will notify the Company immediately of any material change in any statement made herein occurring
prior to the closing of any purchase by the Investor of securities of the Company.

		
	 6.
	 	 The Investor is able to bear the economic risk of the proposed investment and at the present time could
afford a complete loss of such investment.

  
 A-4 

 IN WITNESS WHEREOF, the undersigned has executed this Investor Questionnaire as of
                                    , 2017. 

 

	
	 INVESTOR:

	
	 
	 (Name of Investor- Please Print)

  

			
		
	 By:
	 	 
		
	 Name
	 	 
		
	 Title
	 	 

  
 A-5

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