Form 10: Appointment of Representative

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Canada Petroleum Resources Act (section 9)

To The Registrar:

Take notice that ______________________________, being all the holders of shares in ____________________________ No. ____ dated ________________________, hereby appoint ___________________________________, to act as Representative of the interest owner of this interest for:

1. all purposes of the Canada Petroleum Resources Act.
   
2. for the following purposes:
   

(insert description of the purposes of the appointment where applicable)

The effective date of this appointment is _____________________ .

The Representative's address for service is as follows:

(insert address of Representative)

The Representative hereby accepts the foregoing appointment.

Executed this __________________________ day of ___________________ 20 ___.

__________________________
Holders
(must be signed by every holder of the shares)

__________________________

Representative

FORM 10 - INSTRUCTIONS

1. Complete the required information.
   
   
2. Identify purpose of appointment.
   
   
3. Insert the effective date of the appointment.
   
   
4. Insert Representative's address for service.
   
   
5. This document must be signed by every holder of the shares in the licence and the new Representative and the date of execution must be inserted.