CANADA AND NON-UNITED STATES CONVERTED CARBON TECHNOLOGIES CORP. (THE “CORPORATION”) SHARE SUBSCRIPTION AGREEMENT FOR CANADIAN AND NON-UNITED STATES PURCHASERS INSTRUCTION PAGE Complete the face page and sign the fourth page of the Subscription Agreement. If resident in a jurisdiction of Canada, complete and sign either Schedule A or Schedule B attached to the Subscription Agreement as follows: (i) Schedule A (if resident in a jurisdiction of Canada and subscribing under the “accredited investor” exemption under applicable securities laws); or (ii) Schedule B (if resident in a jurisdiction of Canada, other than the Province of Ontario) and subscribing under the “family, friends and business associates” exemption under applicable securities laws (including Exhibit A thereto if applicable). If not resident in Canada and not resident in the United States, complete and sign Schedule C attached to the Subscription Agreement. Delivery of Subscription Agreement: A completed and originally executed copy of this Subscription Agreement must be delivered to: Paul Ramsay 58 Marine Parade Drive, Suite 1005 Toronto, Ontario, Canada M8V 4G1 Telephone: (416) 704-3040 Email: [email protected]SUBSCRIPTION AGREEMENT FOR COMMON SHARES THE SECURITIES OFFERED HEREBY HAVE NOT BEEN AND WILL NOT BE REGISTERED UNDER THE UNITED STATES SECURITIES ACT OF 1933, AS AMENDED (THE “U.S. SECURITIES ACT”). ACCORDINGLY, SUCH SECURITIES MAY NOT BE OFFERED OR SOLD IN THE UNITED STATES OR TO, OR FOR THE ACCOUNT OR BENEFIT OF A U.S. PERSON, ABSENT AN EXEMPTION UNDER THE U.S. SECURITIES ACT AND APPLICABLE STATE LAWS. AS USED HEREIN, THE TERMS “UNITED STATES” AND “U.S. PERSON” ARE AS DEFINED IN REGULATION S UNDER THE U.S. SECURITIES ACT (“REGULATION S”). (the “Agreement”) This Agreement is made as of the ______ day of May, 2013. BETWEEN: Converted Carbon Technologies Corp., a corporation incorporated pursuant to the laws of Canada (hereinafter referred to as the “Corporation”) AND: Name: ____________________________ Add.: ____________________________ ____________________________ Ph.: ____________________________ Email: ____________________________ (hereinafter referred to as the “Subscriber”) NOTE: This agreement is only for residents of Canada and jurisdictions outside of Canada other than the United States for securities law purposes. All other persons should subscribe on an alternate form of subscription agreement, which may be obtained from Paul Ramsay at the coordinates set out above. Please contact your legal counsel to determine your eligibility to subscribe under this document.
This document was mass distributed to Algae Dynamics (formerly Converted Carbon) S1 shareholders and potential shareholders. This document is being used in legal proceedings.
Citation preview
!"#$%
&' &!()*+
$',
&' #&!")'(-"
*+$&+'
"
!"#$%&'(!)*+)(,
-+-)%
-#-+%-
./-)--01#(233.
!!)(!1)(-!1-)-0-
/42
'5!),4267348343
%-.)
9:
1919
11;
:1
&(*'
//////-0-"1234
#5
% !)(0-$!)&5)!!*%!' "$
&(*'
6% %////////////////////////////
%////////////////////////////
////////////////////////////
%////////////////////////////
%////////////////////////////
&(*'
NOTE: This agreement is only for residents of Canada and
jurisdictions outside of Canada other than the United States for
securities law purposes. All other persons should subscribe on an
alternate form of subscription agreement, which may be obtained
from Paul Ramsay at the coordinates set out above. Please contact
your legal counsel to determine your eligibility to subscribe under
this document.
