Instructions. 1. If the issuer is a mining company, substitute for captions (e), (f) and (g) the following captions: “Road building," "Exploration expense (other than drilling)," "Exploratory drilling" and "Mine development." 2. If the issuer is an oil or gas company, substitute for captions (e), (f) and (g) the following caption: "Exploratory and other drilling." 8. State briefly the nature and extent of each type of the issuer's principal activity to date. Instruction. Mining companies shall include exploratory activity, showing the aggregate footage of exploratory drilling and number of holes drilled. Oil and gas companies shall include the number of wells drilled and their depth. Other companies shall include information as to plant construction, development, production and sales. 9. State whether the offering has been discontinued, and if so, state the date and describe briefly the reasons for such discontinuance: 10. List the names and addresses of all brokers and dealers who have, to the knowledge of the issuer or underwriters, participated in the distribution of the securities offered during the period covered by this report. Instruction. In reports made subsequent to the initial report, the information need be given only with respect to persons not previously reported. 11. State the number of shares held by each promoter, director, officer or controlling person of the issuer, if different from the amount stated in the offering circular. *At least one copy of the report shall be signed manually by each person whose signature is required. Any copies not manually signed shall bear typed or printed signatures. UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 3-A OMB APPROVAL OMB Number: 3235-0286 IRREVOCABLE APPOINTMENT BY INDIVIDUAL OF AGENT FOR SERVICE OF PROCESS, PLEADINGS AND OTHER PAPERS (Pursuant to Regulation A under Securities Act of 1933) 1. I (Name) of (Address) hereby designate and appoint, without power of revocation, the United States Securities and Exchange Commission as my agent upon whom may be served all process, pleadings and other papers in any civil suit or action brought against me arising out of any offering made or purported to be made under Regulation A, adopted by the United States Securities and Exchange Commission under the Securities Act of 1933, or any purchase or sale of any securities in connection therewith, in any court of competent jurisdiction, Federal, State or Territorial, located in the United States or in its territories. 2. I hereby consent, stipulate and agree, without power of revocation (a) that any civil suit or action brought against me arising out of any offering made or purported to be made under Regulation A, adopted by the United States Securities and Exchange Commission under the Securities Act of 1933, or any purchase or sale of any securities in connection therewith, may be commenced against me in any court of competent jurisdiction, Federal, State, or Territorial, located in the United States or in its territories as defined by the Securities Act of 1933, by service of process upon the United States Securities and Exchange Commission; (b) that service of process, pleadings or other papers upon the United States Securities and Exchange Commission, as aforesaid, shall be taken and held in all courts to be as valid and as binding upon me as if due personal service had been made upon me; and (c) that service upon the United States Securities and Exchange Commission may be effected by delivering copies of said process, pleadings, or other papers to the Secretary of the said Commission or any other person designated by it for such purpose, and that the certificate of the Secretary of the United States Securities and Exchange Commission or of such other person reciting that said process, pleadings or other papers were received by the United States Securities and Exchange Commission and that a copy of each such process, pleading, or other paper was forwarded to me at the last address supplied by me shall constitute evidence of such service upon me. IN WITNESS WHEREOF, I have executed this irrevocable power of attorney, consent, stipulation and agreement at this day of A.D. 19 (Seal) *Notary Public or other official authorized by law to administer oaths. Note: The person executing this irrevocable power of attorney, consent, stipulation and agreement should appear before a person authorized to administer acknowledgments in the jurisdiction in which it is executed and acknowledge that he executed it as his free and voluntary act. The acknowledgment should be in the form prescribed by the law of the jurisdiction in which it is executed. The form of acknowledgment suggested should be used only if it is consistent with the requirements of the law of such jurisdiction. The failure of any acknowledgment to meet applicable requirements shall not affect the validity or effect of the foregoing irrevocable power of attorney, consent, stipulation and agreement. and for said County in the State (or Province) aforesaid, do hereby certify that Agent for Service) (Name of Individual Appointing personally appeared before me this day and signed and sealed the above instrument as his free and voluntary act for the uses and purposes therein set forth. UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4-A OMB APPROVAL OMB Number: 3235-0286 IRREVOCABLE APPOINTMENT BY CORPORATION* OF AGENT FOR SERVICE OF PROCESS, PLEADINGS, AND OTHER PAPERS (Pursuant to Regulation A under Securities Act of 1933) 1. The (Name of Corporation) (Name of State or Province) and existing by virtue of the laws of hereby designates and appoints, without power of revocation, the United States Securities and Exchange Commission, as the agent of said corporation upon whom may be served all process, pleadings and other papers in any civil suit or action brought against said corporation arising out of any offering made or purported to be made under Regulation A, adopted by the United States Securities and Exchange Commission under the Securities Act of 1933, or any purchase or sale of any securities in connection therewith, in any court of competent jurisdiction, Federal, State, or Territorial, located in the United States or in its territories. 2. Said corporation, hereby consents, stipulates and agrees, without power of revocation (Name of Corporation) (a) that any civil suit or action brought against it arising out of any offering made or purported to be made under Regulation A, adopted by the United States Securities and Exchange Commission under the Securities Act of 1933, or any purchase or sale of any securities in connection therewith, may be commenced against it in any court of competent jurisdiction, Federal, State, or Territorial, located in the United States or in its territories as defined by the Securities Act of 1933, by service of process upon the United States Securities and Exchange Commission; (b) that service of process, pleadings or other papers upon the United States Securities and Exchange Commission, as aforesaid, shall be taken and held in all courts to be as valid and as binding upon it as if due personal service thereof had been duly made upon it; and (c) that service upon the United States Securities and Exchange Commission may be effected by delivering copies of said process, pleadings, or other papers to the Secretary of the said Commission or any other person designated by it for such purpose, and that the certificate of the Secretary of the United States Securities and Exchange Commission or of such other person reciting that said process, pleadings or other papers were received by the United States Securities and Exchange Commission and that a copy of each such process, pleading, or other paper was forwarded to this corporation at the last address supplied by it shall constitute evidence of such service upon this corporation. IN WITNESS WHEREOF, the President and Secretary of (Name of Corporation) *In the case of an association or other form of organization, appropriate revisions should be made. **Notary Public or other official authorized by law to administer oaths. Note: The person (or persons) executing this irrevocable power of attorney, consent, stipulation and agreement should appear before a person authorized to administer acknowledgments in the jurisdiction in which it is executed and acknowledge that he (or they) executed it as his (or their) free and voluntary act. The acknowledgment should be in the form prescribed by the law of the jurisdiction in which it is executed. The form of acknowledgment suggested should be used only if it is consistent with the requirements of the law of such jurisdiction. The failure of any acknowledgment to meet applicable requirements shall not affect the validity or effect of the foregoing irrevocable power of attorney, consent, stipulation and agreement. by the authority and direction of the Board of Directors of said corporation, have executed this irrevocable power of attorney, and consent, stipulation and agreement, for and on behalf of the said corporation, at and for said County in the State (or Province) aforesaid, do hereby certify that and (Name of Secretary) President and Secretary of the (Official Position)** named in the foregoing instrument as the President and Secretary of said corporation and that they have been duly authorized to execute said instrument for the corporation, and signed and sealed said instrument for and on behalf of said corporation as its free and voluntary act for the uses and purposes therein set forth. |