Form 15: Summary Form

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(Notification of an Agreement/Arrangement that is or may result in a Transfer)

Canada Petroleum Resources Act (section 85)

Where an interest holder of an interest or any share therein enters into an agreement or arrangement that is or may result in a transfer, assignment or other disposition of the interest or any share therein, the interest holder shall give notice of the agreement or arrangement to the Minister, together with a copy of the agreement or arrangement or, if the Minister approves, a summary of its terms and conditions or, on the request of the Minister, a copy of the agreement or arrangement.

EFFECTIVE DATE OF AGREEMENT

GRANTOR (OPTIONORS) FARMORS

GRANTEES (OPTIONEES) FARMEES

AGREEMENT LANDS

TYPE OF AGREEMENT

CONSIDERATION

COMMENCEMENT DATE

FURTHER OPTIONS BY GRANTEE

OTHER BENEFITS:

A copy of the Agreement in all its parts is available on request from:
(insert name and address where Agreement can be obtained)

______________________________
Signature of Submitter

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