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    Application For A T100 Identification Number (Tin) On The Exercise of Flow-Through Warrants (FTWS) and Details of The Ftws Exercised

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    This document is an application form for a T100 identification number related to the exercise of flow-through warrants. It includes instructions for corporations to complete when exercising flow-through warrants to request a TIN number and details of the warrants exercised. The form requests general information about the corporation, the identification number previously issued, information pertaining to the exercise of the warrants including number exercised and proceeds to be spent on eligible expenditures, and a list of investors who exercised warrants with their details. It concludes with a certification to be signed by an authorized officer of the corporation.

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    Application For A T100 Identification Number (Tin) On The Exercise of Flow-Through Warrants (FTWS) and Details of The Ftws Exercised

    Uploaded by

    tstscribd
    79 views2 pages
    This document is an application form for a T100 identification number related to the exercise of flow-through warrants. It includes instructions for corporations to complete when exercising flow-through warrants to request a TIN number and details of the warrants exercised. The form requests general information about the corporation, the identification number previously issued, information pertaining to the exercise of the warrants including number exercised and proceeds to be spent on eligible expenditures, and a list of investors who exercised warrants with their details. It concludes with a certification to be signed by an authorized officer of the corporation.

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    t100c-04e

    Original Title

    t100c-04e

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    This document is an application form for a T100 identification number related to the exercise of flow-through warrants. It includes instructions for corporations to complete when exercising flow-through warrants to request a TIN number and details of the warrants exercised. The form requests general information about the corporation, the identification number previously issued, information pertaining to the exercise of the warrants including number exercised and proceeds to be spent on eligible expenditures, and a list of investors who exercised warrants with their details. It concludes with a certification to be signed by an authorized officer of the corporation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    79 views2 pages

    Application For A T100 Identification Number (Tin) On The Exercise of Flow-Through Warrants (FTWS) and Details of The Ftws Exercised

    Uploaded by

    tstscribd
    This document is an application form for a T100 identification number related to the exercise of flow-through warrants. It includes instructions for corporations to complete when exercising flow-through warrants to request a TIN number and details of the warrants exercised. The form requests general information about the corporation, the identification number previously issued, information pertaining to the exercise of the warrants including number exercised and proceeds to be spent on eligible expenditures, and a list of investors who exercised warrants with their details. It concludes with a certification to be signed by an authorized officer of the corporation.

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    Canada Customs

    and Revenue Agency

    Agence des douanes


    et du revenu du Canada

    T100C
    FLOW-THROUGH SHARE INFORMATION

    APPLICATION FOR A T100 IDENTIFICATION NUMBER (TIN)


    ON THE EXERCISE OF FLOW-THROUGH WARRANTS (FTWs) AND
    DETAILS OF THE FTWs EXERCISED
    z

    If you need the instructions, ask for Form T100 Instructions for the Flow-through Share
    Program or visit our Website at www.cra.gc.ca.

    To request a TIN on the exercise of FTWs, complete this form.

    A corporation filing Form T100C should send it directly to: Canada Revenue Agency,
    Other Programs Unit, Data Assessment & Evaluation Programs Division, 875 Heron Road,
    Ottawa ON K1A 1A2

    Do not use this area

    On this form, legislative references are to the Income Tax Act, and regulatory references are to the Income Tax Act Regulations.

    The assignment of the identification number is for identification purposes only. It does not imply that the shares are flow-through shares,
    that the agreement or the expenses meet all or any of the requirements of the Income Tax Act with respect to flow-through shares, or that
    we accept the allocation of the price between the shares and the warrants. The corporation may be subject to an audit.

    Complete Application Checklist


    Filing a complete application will speed up its processing. Before sending your application, check if you have:
    1. Used the current version of Form T100C for the application.
    2. Signed and dated Form T100C in the "CERTIFICATION" area.
    3. Provided a complete listing of the investors who exercised their FTWs in the format shown in Part 3.
    4. Used the SITIN that was issued on the filing of Form T100A to identify the agreement to which the FTWs relate. The SITIN must not
    be used to renonce expenditures for the FTWs identified on this form.

    Part 1 General Information (please print)


    Name of corporation

    Corporation account number

    R C
    Corporation address

    City

    Mailing address (if different)

    Province

    Location of records (if different)

    City

    Postal code

    same as corporation
    same as mailing
    Province

    Postal code

    City

    Postal code

    Province

    Contact person and title

    Telephone

    FAX

    Part 2 Exercise of the FTWs

    Step 1 Identification number previously issued


    Enter the identification number that was issued on the initial filing of Form T100A. The number is required for the Canada Revenue Agency
    (CRA) to identify the agreement that is related to the exercise of the FTWs. The number issued for Form T100A must not be used to
    renounce expenditures for the FTWs identified on this form.

    Step 2 Information pertaining to the exercise of the FTWs


    Actual number of FTWs exercised
    Exercise price per FTW
    Total proceeds from the exercise of the FTWs to be spent on eligible expenditures (45) X (46)
    T100C E (04)

    (Ce formulaire existe en franais.)

    (45)
    (46) $
    (47) $

    Part 3 List of investor who exercised their FTWs


    No agent's name should appear in this list.
    SIN , CORP. OR
    PARTNERSHIP NO.

    INVESTORS' NAME

    DATE OF EXERCISE
    (MM/DD/YYYY)

    NUMBER OF FTWs
    EXERCISED

    TOTAL (TOTAL AMOUNT INVESTED must be equal to line 47)

    If additional space is required, please attach a list using the same format as on this form.
    No agent's name should appear in this list.
    The renunciations should be made in the name of the shareholders and not the agent.

    CERTIFICATION
    I certify that the information given on this form is to the best of my knowledge, true, correct and complete in every respect.

    Date (mm/dd/yyyy)

    Signature of Authorized Officer


    Printed in Canada

    Name of Authorized Officer (Print)

    Position or Title (Print)

    TOTAL AMOUNT
    INVESTED

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