Form 5: Security Notice

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Accessibility Notice

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Canada Petroleum Resources Act (section 88)

To The Registrar:

From _____________________________________________ (the "Secured Party")

  1. The Secured Party hereby claims the following security interest: (describe the nature of the security interest claimed and the Frontier lands to which the claim relates; if insufficient space attach a schedule)
  2. The security interest arises under and by virtue of the following transaction: (describe the type of transaction, documents giving rise to the Security Notice and give the date and the person from whom the security interest was acquired)
  3. The Secured Party requests that the particulars of the security interest be registered and entered in the abstract of the following interest(s): (describe the interest(s) by type, number and date)
  4. The Secured Party's address for service is: Executed this _____________________ day of ______________________ 20 ___.

______________
Secured Party

Form 5 - Instructions

  1. Complete the required information.
  2. The appropriate fees required according to section 15 of the Frontier Lands Registration Regulations must be submitted with the Security Notice.
  3. Insert the Secured Party's address for service.
  4. This Security Notice document must be signed by the Secured Party and the date of execution must be inserted.

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