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Ameriwest Critical Metals Inc. — Regulatory Filings 2021
Jun 3, 2021
47874_rns_2021-06-03_a712dd10-245a-4e18-a88b-83afab3d8b13.pdf
Regulatory Filings
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Form 45-106F1 Report of Exempt Distribution
ITEM 1 - REPORT TYPE
ü New report Amended report If amended, provide filing date of report that is being amended (YYYY-MM-DD)
ITEM 2 - PARTY CERTIFYING THE REPORT
Indicate the party certifying the report (select only one). For guidance regarding whether an issuer is an investment fund, refer to section 1.1 of National Instrument 81-106 Investment Fund Continuous Disclosure and the companion policy to NI 81-106.
Investment fund issuer
ü Issuer (other than an investment fund)
Underwriter
ITEM 3 - ISSUER NAME AND OTHER IDENTIFIERS
Provide the following information about the issuer, or if the issuer is an investment fund, about the fund.
Full legal name Ameriwest Lithium Inc.
Previous full legal name Oakley Ventures Inc. If the issuer’s name changed in the last 12 months, provide most recent previous legal name. Website (if applicable)
If the issuer’s name changed in the last 12 months, provide most recent previous legal name.
If the issuer has a legal entity identifier, provide below. Refer to Part B of the Instructions for the definition of “legal entity identifier”.
Legal entity identifier
If two or more issuers distributed a single security, provide the full legal name(s) of the co-issuer(s) other than the issuer named above.
Full legal name(s) of co-issuer(s) (if applicable) 4 - UNDERWRITER INFORMATIONNDERWRITER INFORMATIONINFORMATIONNFORMATION If an underwriter is completing the report, provide the underwriter’s full legal name and firm NRD number. Full legal name Firm NRD number (if applicable) If the underwriter does not have a firm NRD number, provide the head office contact information of the underwriter. Street address Municipality Province/State Country Postal code/Zip code Telephone number Website (if applicable)
ITEM 4 - UNDERWRITER INFORMATIONNDERWRITER INFORMATIONINFORMATIONNFORMATION
ITEM 5 - ISSUER INFORMATION
If the issuer is an investment fund, do not complete Item 5. Proceed to Item 6.
a) Primary industry
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Provide the issuer’s North American Industry Classification Standard (NAICS) code (6 digits only) that in your reasonable judgment most closely
corresponds to the issuer’s primary business activity.
NAICS industry code 2 1 2 2 2 0
If the issuer is in the mining industry, indicate the stage of operations. This does not apply to issuers that provide services to issuers operating in the
mining industry. Select the category that best describes the issuer’s stage of operations.
ü Exploration Development Production
Is the issuer’s primary business to invest all or substantially all of its assets in any of the following? If yes, select all that apply.
Mortgages Real estate Commercial/business debt Consumer debt Private companies
Cryptoassets
b) Number of employees
Number of employees: ü 0 - 49 50 - 99 100 - 499 500 or more
c) SEDAR profile number
Does the issuer have a SEDAR profile?
No ü Yes If yes, provide SEDAR profile number 0 0 0 4 8 8 6 2
If the issuer does not have SEDAR profile complete item 5(d) - (h).
d) Head office address
Street address Province/State
Municipality Postal code/Zip code
Country Telephone number
e) Date of formation and financial year-end
Date of formation Financial year-end
YYYY MM DD MM DD
f) Reporting issuer status
Is the issuer a reporting issuer in any jurisdication of Canada? No Yes
If yes, select the jurisdictions of Canada in which the issuer is a reporting issuer.
All AB BC MB NB NL NT
NS NU ON PE QC SK YT
g) Public listing status
If the issuer has a CUSIP number, provide below (first 6 digits only)
CUSIP number
If the issuer is publicly listed, provide the name of the exchange on which the issuer's equity securities primarily trade. Provide only the name of an
exchange and not a trading facility such as, for example, an automated trading system.
Exchange name
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h) Size of issuer's assets
Select the size of the issuer's assets based on its most recently available annual financial statements (Canadian $). If the issuer has not prepared annual financial statements for its first financial year, provide the size of the issuer's assets at the distribution end date.
$0 to under $5M
$5M to under $25M $25M to under $100M
$100M to under $500M
$500M to under $1B $1B or over
ITEM 6 - INVESTMENT FUND ISSUER INFORMATION
If the issuer is an investment fund, provide the following information.
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a) Investment fund manager information
Full legal name
Firm NRD number (if applicable)
If the investment fund manager does not have a firm NRD number, provide the head office contact information of the investment fund manager.
Street address
Municipality Province/State
Country Postal code/Zip code
Telephone number Website (if applicable)
b) Type of investment fund
Type of investment fund that most accurately identifies the issuer (select only one) .
Money market Equity Fixed income Balanced
Alternative strategies Cryptoasset Other (describe)
Indicate whether one or both of the following apply to the investment fund .
Invests primarily in other investment fund issuers
Is a UCITs Fund¹
¹Undertaking for the Collective Investment of Transferable Securities funds (UCITs Funds) are investment funds regulated by the European Union
(EU) directives that allow collective investment schemes to operate throughout the EU on a passport basis on authorization from one member state.
c) Date of formation and financial year-end of the investment fund
Date of formation Financial year-end
YYYY MM DD MM DD
d) Reporting issuer status of the investment fund
Is the investment fund a reporting issuer in any jurisdication of Canada? No Yes
If yes, select the jurisdictions of Canada in which the investment fund is a reporting issuer.
All AB BC MB NB NL NT
NS NU ON PE QC SK YT
e) Public listing status of the investment fund
If the investment fund has a CUSIP number, provide below (first 6 digits only)
CUSIP number
If the investment fund is publicly listed, provide the name of the exchange on which the investment fund's securities primarily trade. Provide only the
name of an exchange and not a trading facility such as, for example, an automated trading system.
Exchange name
f) Net asset value (NAV) of the investment fund
Select the NAV range of the investment fund as of the date of the most recent NAV calculation (Canadian $).
$0 to under $5M $5M to under $25M $25M to under $100M
$100M to under $500M $500M to under $1B $1B or over Date of NAV calculation:
YYYY MM DD
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ITEM 7 - INFORMATION ABOUT THE DISTRIBUTION
| ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION | ITEM 7 - INFORMATIONABOUT THEDISTRIBUTION |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| If an issuer located outside of Canada completes a distribution in a jurisdiction of Canada, include in Item 7 and Schedule 1 information about purchasers resident in that jurisdiction of Canada only. Do not include in Item 7 securities issued as payment of commissions or finder’s fees in connection with the distribution, which must be disclosed in Item 8. The information provided in Item 7 must reconcile with the information provided in Schedule 1 of the report. |
|||||||||||||||||
| a) Currency | |||||||||||||||||
| Select the currency or currencies in which the distribution was made. All dollar amounts provided in the report must be in Canadian dollars. ü Canadian dollar US dollar Euro Other (describe) |
|||||||||||||||||
| b) Distribution date(s) | |||||||||||||||||
| State the distribution start and end dates. If the report is being filed for securities distributed on only one distribution date, provide the distribution date as both the start and end dates. If the report is being filed for securities distributed on a continuous basis, include the start and end dates for the distribution period covered by the report. Start date 2021 05 28 YYYY MM DD End date 2021 05 28 YYYY MM DD |
|||||||||||||||||
| c) Detailed purchaser information | |||||||||||||||||
| Complete Schedule 1 of this form for each purchaser and attach the schedule to the completed report. | |||||||||||||||||
| d) Types of securities distributed | |||||||||||||||||
| Provide the following information for all distributions reported on a per security basis. Refer to Part A(12) of the Instructions for how to indicate the security code. If providing the CUSIP number, indicate the full 9-digit CUSIP number assigned to the security being distributed. Canadian $ Security code CUSIP number (if applicable) Description of security Number of securities Single or lowest price Highest price Total amount U B S Units comprised of one common share and one common share purchase warrant. 12,083,000.00 0.5000 6,041,500.00 |
|||||||||||||||||
| Canadian $ | |||||||||||||||||
| Security code |
CUSIP number (if applicable) |
Description of security | Number of securities |
Single or lowest price |
Highest price | Total amount | |||||||||||
| U | B | S | Units comprised of one common share and one common share purchase warrant. |
12,083,000.00 | 0.5000 | 6,041,500.00 | |||||||||||
| e) Details of rights and convertible/exchangeable securities | |||||||||||||||||
| If any rights (e.g. warrants, options) were distributed, provide the exercise price and expiry date for each right. If any convertible/exchangeable securities were distributed, provide the conversion ratio and describe any other terms for each convertible/exchangeable security. Convertible / exchangeable security code Underlying security code Exercise price (Canadian $) Expiry date (YYYY- MM-DD) Conversion ratio Describe other items (if applicable) Lowest Highest W N T C M S 0.7500 2023-05-28 Warrants exercisable into a common share at C$0.75 until May28,2023. |
|||||||||||||||||
| Convertible / exchangeable security code |
Underlying security code |
Exercise price (Canadian $) |
Expiry date (YYYY- MM-DD) |
Conversion ratio |
Describe other items (if applicable) | ||||||||||||
| Lowest | Highest | ||||||||||||||||
| W | N | T | C | M | S | 0.7500 | 2023-05-28 | Warrants exercisable into a common share at C$0.75 until May28,2023. |
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| f) Summary of the distribution by jurisdiction and exemption | |||||||||||||||||
| State the total dollar amount of securities distributed and the number of purchasers for each jurisdiction of Canada and foreign jurisdiction where a purchaser resides and for each exemption relied on in Canada for that distribution. However, if an issuer located outside of Canada completes a distribution in a jurisdiction of Canada, include distributions to purchasers resident in that jurisdiction of Canada only. This table requires a separate line item for: (i) each jurisdiction where a purchaser resides, (ii) each exemption relied on in the jurisdiction where a purchaser resides, if a purchaser resides in a jurisdiction of Canada, and (iii) each exemption relied on in Canada, if a purchaser resides in a foreign jurisdiction. |
For jurisdictions within Canada, state the province or territory, otherwise state the country.
| Province or country |
Exemption relied on | Number of unique²ª purchasers |
Total amount (Canadian $) |
|---|---|---|---|
| Alberta | NI 45-106 2.3 [Accredited investor] | 12 | 234,000.00 |
| Alberta | NI 45-106 2.5 [Family, friends and business associates] |
1 | 150,000.00 |
| British Columbia | NI 45-106 2.10 [Minimum amount investment] | 2 | 500,000.00 |
| British Columbia | NI 45-106 2.3 [Accredited investor] | 79 | 3,196,500.00 |
| British Columbia | NI 45-106 2.5 [Family, friends and business associates] |
2 | 125,000.00 |
| Manitoba | NI 45-106 2.3 [Accredited investor] | 1 | 20,000.00 |
|---|---|---|---|
| Ontario | NI 45-106 2.3 [Accredited investor] | 11 | 646,000.00 |
| Australia | NI 45-106 2.3 [Accredited investor] | 1 | 45,000.00 |
| Barbados | NI 45-106 2.3 [Accredited investor] | 1 | 500,000.00 |
| Germany | NI 45-106 2.3 [Accredited investor] | 1 | 25,000.00 |
| United Arab Emirates | NI 45-106 2.3 [Accredited investor] | 1 | 170,000.00 |
| Hong Kong | NI 45-106 2.3 [Accredited investor] | 1 | 100,000.00 |
| Paraguay | NI 45-106 2.3 [Accredited investor] | 1 | 50,000.00 |
| Peru | NI 45-106 2.3 [Accredited investor] | 2 | 60,000.00 |
| Switzerland | NI 45-106 2.3 [Accredited investor] | 1 | 100,000.00 |
| United Kingdom | NI 45-106 2.3 [Accredited investor] | 1 | 30,000.00 |
| United States | NI 45-106 2.3 [Accredited investor] | 6 | 90,000.00 |
| Total dollar amount of securities distributed | 6,041,500.00 | ||
| Total number of unique purchasers²ᵇ | 124 |
- 2a In calculating the number of unique purchasers per row, count each purchaser only once. Joint purchasers may be counted as one purchaser.
2b In calculating the total number of unique purchasers to which the issuer distributed securities, count each purchaser only once, regardless of whether the issuer distributed multiple types of securities to, and relied on multiple exemptions for, that purchaser.
g) Net proceeds to the investment fund by jurisdiction
If the issuer is an investment fund, provide the net proceeds to the investment fund for each jurisdiction of Canada and foreign jurisdiction where a purchaser resides.³ If an issuer located outside of Canada completes a distribution in a jurisdiction of Canada, include net proceeds for that jurisdiction of Canada only. For jurisdictions within Canada, state the province or territory, otherwise state the country.
Net proceeds Province or country (Canadian $) Total net proceeds to the investment fund ³“Net proceeds” means the gross proceeds realized in the jurisdiction from the distributions for which the report is being filed, less the gross redemptions that occurred during the distribution period covered by the report.
h) Offering materials - This section applies only in Saskatchewan, Ontario, Québec, New Brunswick and Nova Scotia.
If a distribution has occurred in Saskatchewan, Ontario, Québec, New Brunswick or Nova Scotia, complete the table below by listing the offering materials that are required under the prospectus exemption relied on to be filed with or delivered to the securities regulatory authority or regulator in those jurisdictions.
In Ontario, if the offering materials listed in the table are required to be filed with or delivered to the Ontario Securities Commission (OSC), attach an electronic version of the offering materials that have not been previously filed with or delivered to the OSC.
| Description | Date of document or other material (YYYY-MM-DD) |
Previously filed with or delivered to regulator? (Y/N) |
Date previously filed or delivered (YYYY-MM-DD) |
|---|---|---|---|
ITEM 8 - COMPENSATION INFORMATION
Provide information for each person (as defined in NI 45-106) to whom the issuer directly provides, or will provide, any compensation in connection with the distribution. Complete additional copies of this page if more than one person was, or will be, compensated.
Indicate whether any compensation was paid, or will be paid, in connection with the distribution.
No ü Yes If yes, indicate number of persons compensated. 7
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a) Name of person compensated and registration status
Indicate whether the person compensated is a registrant. No ü Yes
If the person compensated is an individual, provide the name of the individual.
Full legal name of individual
Family name First given name Secondary given names
If the person compensated is not an individual, provide the following information.
Full legal name of non-individual PI Financial Corp.
Firm NRD number 5 2 9 0 (if applicable)
Indicate whether the person compensated facilitated the distribution through a funding portal or an internet-based portal. ü No Yes
b) Business contact information
If a firm NRD number is not provided in Item 8 (a), provide the business contact information of the person being compensated.
Street address
Municipality Province/State
Country Postal code/Zip code
Email address Telephone number
c) Relationship to issuer or investment fund manager
Indicate the person’s relationship with the issuer or investment fund manager (select all that apply). Refer to the meaning of “connected” in Part B(2) of
the Instructions and the meaning of “control” in section 1.4 of NI 45-106 for the purposes of completing this section.
Connect with the issuer or investment fund manager Insider of the issuer (other than an investment fund)
Director or officer of the investment fund or investment fund manager Employee of the issuer or investment fund manager
ü None of the above
d) Compensation details
Provide details of all compensation paid, or to be paid, to the person identified in Item 8(a) in connection with the distribution. Provide all amounts in
Canadian dollars. Include cash commissions, securities-based compensation, gifts, discounts or other compensation. Do not report payments for services
incidental to the distribution, such as clerical, printing, legal or accounting services. An issuer is not required to ask for details about, or report on, internal
allocation arrangements with the directors, officers or employees of a non-individual compensated by the issuer.
Cash commissions paid 24,500.00
Security code 1 Security code 2 Security code 3
Value of all securities W N T
distributed as compensation⁴ Security codes
Describe terms of warrants, options or other rights 49,000 broker warrants. Each broker warrant entitles the holder
to purchase a Unit at $0.75 per Unit for until May 28, 2023.
Other compensation⁵ Describe
Total compensation paid 24,500.00
Check box if the person will or may receive any deferred compensation (describe the terms below)
⁴ Provide the aggregate value of all securities distributed as compensation, excluding options, warrants or other rights exercisable to acquire
additional securities of the issuer. Indicate the security codes for all securities distributed as compensation, includingoptions, warrants or other
rights exercisable to acquire additional securities of the issuer.
⁵ Do not include deferred compensation.
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a) Name of person compensated and registration status
Indicate whether the person compensated is a registrant. No ü Yes
If the person compensated is an individual, provide the name of the individual.
Full legal name of individual
Family name First given name Secondary given names
If the person compensated is not an individual, provide the following information.
Full legal name of non-individual Haywood Securities Inc.
Firm NRD number 1 6 3 0 (if applicable)
Indicate whether the person compensated facilitated the distribution through a funding portal or an internet-based portal. ü No Yes
b) Business contact information
If a firm NRD number is not provided in Item 8 (a), provide the business contact information of the person being compensated.
Street address
Municipality Province/State
Country Postal code/Zip code
Email address Telephone number
c) Relationship to issuer or investment fund manager
Indicate the person’s relationship with the issuer or investment fund manager (select all that apply). Refer to the meaning of “connected” in Part B(2) of
the Instructions and the meaning of “control” in section 1.4 of NI 45-106 for the purposes of completing this section.
Connect with the issuer or investment fund manager Insider of the issuer (other than an investment fund)
Director or officer of the investment fund or investment fund manager Employee of the issuer or investment fund manager
ü None of the above
d) Compensation details
Provide details of all compensation paid, or to be paid, to the person identified in Item 8(a) in connection with the distribution. Provide all amounts in
Canadian dollars. Include cash commissions, securities-based compensation, gifts, discounts or other compensation. Do not report payments for services
incidental to the distribution, such as clerical, printing, legal or accounting services. An issuer is not required to ask for details about, or report on, internal
allocation arrangements with the directors, officers or employees of a non-individual compensated by the issuer.
Cash commissions paid 9,100.00
Security code 1 Security code 2 Security code 3
Value of all securities W N T
distributed as compensation⁴ Security codes
Describe terms of warrants, options or other rights 18,200 broker warrants. Each broker warrant entitles the holder
to purchase a Unit at $0.75 per Unit for until May 28, 2023.
Other compensation⁵ Describe
Total compensation paid 9,100.00
Check box if the person will or may receive any deferred compensation (describe the terms below)
⁴ Provide the aggregate value of all securities distributed as compensation, excluding options, warrants or other rights exercisable to acquire
additional securities of the issuer. Indicate the security codes for all securities distributed as compensation, includingoptions, warrants or other
rights exercisable to acquire additional securities of the issuer.
⁵ Do not include deferred compensation.
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a) Name of person compensated and registration status
Indicate whether the person compensated is a registrant. No ü Yes
If the person compensated is an individual, provide the name of the individual.
Full legal name of individual
Family name First given name Secondary given names
If the person compensated is not an individual, provide the following information.
Full legal name of non-individual Research Capital Corporation
Firm NRD number 3 0 7 0 (if applicable)
Indicate whether the person compensated facilitated the distribution through a funding portal or an internet-based portal. ü No Yes
b) Business contact information
If a firm NRD number is not provided in Item 8 (a), provide the business contact information of the person being compensated.
Street address
Municipality Province/State
Country Postal code/Zip code
Email address Telephone number
c) Relationship to issuer or investment fund manager
Indicate the person’s relationship with the issuer or investment fund manager (select all that apply). Refer to the meaning of “connected” in Part B(2) of
the Instructions and the meaning of “control” in section 1.4 of NI 45-106 for the purposes of completing this section.
Connect with the issuer or investment fund manager Insider of the issuer (other than an investment fund)
Director or officer of the investment fund or investment fund manager Employee of the issuer or investment fund manager
ü None of the above
d) Compensation details
Provide details of all compensation paid, or to be paid, to the person identified in Item 8(a) in connection with the distribution. Provide all amounts in
Canadian dollars. Include cash commissions, securities-based compensation, gifts, discounts or other compensation. Do not report payments for services
incidental to the distribution, such as clerical, printing, legal or accounting services. An issuer is not required to ask for details about, or report on, internal
allocation arrangements with the directors, officers or employees of a non-individual compensated by the issuer.
Cash commissions paid 9,100.00
Security code 1 Security code 2 Security code 3
Value of all securities W N T
distributed as compensation⁴ Security codes
Describe terms of warrants, options or other rights 18,200 broker warrants. Each broker warrant entitles the holder
to purchase a Unit at $0.75 per Unit for until May 28, 2023.
Other compensation⁵ Describe
Total compensation paid 9,100.00
Check box if the person will or may receive any deferred compensation (describe the terms below)
⁴ Provide the aggregate value of all securities distributed as compensation, excluding options, warrants or other rights exercisable to acquire
additional securities of the issuer. Indicate the security codes for all securities distributed as compensation, includingoptions, warrants or other
rights exercisable to acquire additional securities of the issuer.
⁵ Do not include deferred compensation.
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a) Name of person compensated and registration status
Indicate whether the person compensated is a registrant. No ü Yes
If the person compensated is an individual, provide the name of the individual.
Full legal name of individual
Family name First given name Secondary given names
If the person compensated is not an individual, provide the following information.
Full legal name of non-individual Leede Jones Gable
Firm NRD number 5 7 7 0 (if applicable)
Indicate whether the person compensated facilitated the distribution through a funding portal or an internet-based portal. ü No Yes
b) Business contact information
If a firm NRD number is not provided in Item 8 (a), provide the business contact information of the person being compensated.
Street address
Municipality Province/State
Country Postal code/Zip code
Email address Telephone number
c) Relationship to issuer or investment fund manager
Indicate the person’s relationship with the issuer or investment fund manager (select all that apply). Refer to the meaning of “connected” in Part B(2) of
the Instructions and the meaning of “control” in section 1.4 of NI 45-106 for the purposes of completing this section.
Connect with the issuer or investment fund manager Insider of the issuer (other than an investment fund)
Director or officer of the investment fund or investment fund manager Employee of the issuer or investment fund manager
ü None of the above
d) Compensation details
Provide details of all compensation paid, or to be paid, to the person identified in Item 8(a) in connection with the distribution. Provide all amounts in
Canadian dollars. Include cash commissions, securities-based compensation, gifts, discounts or other compensation. Do not report payments for services
incidental to the distribution, such as clerical, printing, legal or accounting services. An issuer is not required to ask for details about, or report on, internal
allocation arrangements with the directors, officers or employees of a non-individual compensated by the issuer.
Cash commissions paid 17,675.00
Security code 1 Security code 2 Security code 3
Value of all securities W N T
distributed as compensation⁴ Security codes
Describe terms of warrants, options or other rights 35,350 broker warrants. Each broker warrant entitles the holder
to purchase a Unit at $0.75 per Unit for until May 28, 2023.
Other compensation⁵ Describe
Total compensation paid 17,675.00
Check box if the person will or may receive any deferred compensation (describe the terms below)
⁴ Provide the aggregate value of all securities distributed as compensation, excluding options, warrants or other rights exercisable to acquire
additional securities of the issuer. Indicate the security codes for all securities distributed as compensation, includingoptions, warrants or other
rights exercisable to acquire additional securities of the issuer.
⁵ Do not include deferred compensation.
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a) Name of person compensated and registration status
Indicate whether the person compensated is a registrant. No ü Yes
If the person compensated is an individual, provide the name of the individual.
Full legal name of individual
Family name First given name Secondary given names
If the person compensated is not an individual, provide the following information.
Full legal name of non-individual Canaccord Genuity Corp.
Firm NRD number 9 0 0 (if applicable)
Indicate whether the person compensated facilitated the distribution through a funding portal or an internet-based portal. ü No Yes
b) Business contact information
If a firm NRD number is not provided in Item 8 (a), provide the business contact information of the person being compensated.
Street address
Municipality Province/State
Country Postal code/Zip code
Email address Telephone number
c) Relationship to issuer or investment fund manager
Indicate the person’s relationship with the issuer or investment fund manager (select all that apply). Refer to the meaning of “connected” in Part B(2) of
the Instructions and the meaning of “control” in section 1.4 of NI 45-106 for the purposes of completing this section.
Connect with the issuer or investment fund manager Insider of the issuer (other than an investment fund)
Director or officer of the investment fund or investment fund manager Employee of the issuer or investment fund manager
ü None of the above
d) Compensation details
Provide details of all compensation paid, or to be paid, to the person identified in Item 8(a) in connection with the distribution. Provide all amounts in
Canadian dollars. Include cash commissions, securities-based compensation, gifts, discounts or other compensation. Do not report payments for services
incidental to the distribution, such as clerical, printing, legal or accounting services. An issuer is not required to ask for details about, or report on, internal
allocation arrangements with the directors, officers or employees of a non-individual compensated by the issuer.
Cash commissions paid 41,580.00
Security code 1 Security code 2 Security code 3
Value of all securities W N T
distributed as compensation⁴ Security codes
Describe terms of warrants, options or other rights 83,160 broker warrants. Each broker warrant entitles the holder
to purchase a Unit at $0.75 per Unit for until May 28, 2023.
Other compensation⁵ Describe
Total compensation paid 41,580.00
Check box if the person will or may receive any deferred compensation (describe the terms below)
⁴ Provide the aggregate value of all securities distributed as compensation, excluding options, warrants or other rights exercisable to acquire
additional securities of the issuer. Indicate the security codes for all securities distributed as compensation, includingoptions, warrants or other
rights exercisable to acquire additional securities of the issuer.
⁵ Do not include deferred compensation.
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a) Name of person compensated and registration status
Indicate whether the person compensated is a registrant. No ü Yes
If the person compensated is an individual, provide the name of the individual.
Full legal name of individual
Family name First given name Secondary given names
If the person compensated is not an individual, provide the following information.
Full legal name of non-individual Terra Cotta Investment Counsel Inc.
Firm NRD number 5 6 0 2 0 (if applicable)
Indicate whether the person compensated facilitated the distribution through a funding portal or an internet-based portal. ü No Yes
b) Business contact information
If a firm NRD number is not provided in Item 8 (a), provide the business contact information of the person being compensated.
Street address
Municipality Province/State
Country Postal code/Zip code
Email address Telephone number
c) Relationship to issuer or investment fund manager
Indicate the person’s relationship with the issuer or investment fund manager (select all that apply). Refer to the meaning of “connected” in Part B(2) of
the Instructions and the meaning of “control” in section 1.4 of NI 45-106 for the purposes of completing this section.
Connect with the issuer or investment fund manager Insider of the issuer (other than an investment fund)
Director or officer of the investment fund or investment fund manager Employee of the issuer or investment fund manager
ü None of the above
d) Compensation details
Provide details of all compensation paid, or to be paid, to the person identified in Item 8(a) in connection with the distribution. Provide all amounts in
Canadian dollars. Include cash commissions, securities-based compensation, gifts, discounts or other compensation. Do not report payments for services
incidental to the distribution, such as clerical, printing, legal or accounting services. An issuer is not required to ask for details about, or report on, internal
allocation arrangements with the directors, officers or employees of a non-individual compensated by the issuer.
Cash commissions paid 28,770.00
Security code 1 Security code 2 Security code 3
Value of all securities W N T
distributed as compensation⁴ Security codes
Describe terms of warrants, options or other rights 57,540 broker warrants. Each broker warrant entitles the holder
to purchase a Unit at $0.75 per Unit for until May 28, 2023.
Other compensation⁵ Describe
Total compensation paid 28,770.00
Check box if the person will or may receive any deferred compensation (describe the terms below)
⁴ Provide the aggregate value of all securities distributed as compensation, excluding options, warrants or other rights exercisable to acquire
additional securities of the issuer. Indicate the security codes for all securities distributed as compensation, includingoptions, warrants or other
rights exercisable to acquire additional securities of the issuer.
⁵ Do not include deferred compensation.
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a) Name of person compensated and registration status
Indicate whether the person compensated is a registrant. ü No Yes
If the person compensated is an individual, provide the name of the individual.
Full legal name of individual
Family name First given name Secondary given names
If the person compensated is not an individual, provide the following information.
Full legal name of non-individual Cascadia Industries Ltd.
Firm NRD number (if applicable)
Indicate whether the person compensated facilitated the distribution through a funding portal or an internet-based portal. ü No Yes
b) Business contact information
If a firm NRD number is not provided in Item 8 (a), provide the business contact information of the person being compensated.
Street address 590 – 1122 Mainland Street
Municipality Vancouver Province/State British Columbia
Country Canada Postal code/Zip code V6B 5L1
Email address [email protected] Telephone number 7785224105
c) Relationship to issuer or investment fund manager
Indicate the person’s relationship with the issuer or investment fund manager (select all that apply). Refer to the meaning of “connected” in Part B(2) of
the Instructions and the meaning of “control” in section 1.4 of NI 45-106 for the purposes of completing this section.
Connect with the issuer or investment fund manager Insider of the issuer (other than an investment fund)
Director or officer of the investment fund or investment fund manager Employee of the issuer or investment fund manager
ü None of the above
d) Compensation details
Provide details of all compensation paid, or to be paid, to the person identified in Item 8(a) in connection with the distribution. Provide all amounts in
Canadian dollars. Include cash commissions, securities-based compensation, gifts, discounts or other compensation. Do not report payments for services
incidental to the distribution, such as clerical, printing, legal or accounting services. An issuer is not required to ask for details about, or report on, internal
allocation arrangements with the directors, officers or employees of a non-individual compensated by the issuer.
Cash commissions paid 120,000.00
Security code 1 Security code 2 Security code 3
Value of all securities
distributed as compensation⁴ Security codes
Describe terms of warrants, options or other rights
Other compensation⁵ Describe
Total compensation paid 120,000.00
Check box if the person will or may receive any deferred compensation (describe the terms below)
⁴ Provide the aggregate value of all securities distributed as compensation, excluding options, warrants or other rights exercisable to acquire
additional securities of the issuer. Indicate the security codes for all securities distributed as compensation, includingoptions, warrants or other
rights exercisable to acquire additional securities of the issuer.
⁵ Do not include deferred compensation.
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ITEM 9 - DIRECTORS, EXECUTIVE OFFICERS AND PROMOTERS OF THE ISSUER
If the issuer is an investment fund, do not complete Item 9. Procced to Item 10 .
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Indicate whether the issuer is any of the following (select the one that applies - if more than one applies, select only one).
ü Reporting issuer in any jurisdiction of Canada
Foreign public issuer
Wholly owned subsidiary of a reporting issuer in any jurisdiction of Canada⁶
Provide name of reporting issuer
Wholly owned subsidiary of a foreign public issuer⁶
Provide name of foreign public issuer
Issuer distributing only eligible foreign securities and the distribution is to permitted clients only⁷
If the issuer is at least one of the above, do not complete Item 9(a) – (c). Proceed to Item 10.
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⁶ An issuer is a wholly owned subsidiary of a reporting issuer or a foreign public issuer if all of the issuer’s outstanding voting securities, other than securities that are required by law to be owned by its directors, are beneficially owned by the reporting issuer or the foreign public issuer, respectively. ⁷ Check this box if it applies to the current distribution even if the issuer made previous distributions of other types of securities to non-permitted clients. Refer to the definitions of “eligible foreign security” and “permitted client” in Part B(1) of the Instructions.
If the issuer is none of the above, check this box and complete Item 9(a) - (c).
a) Directors, executive officers and promoters of the issuer
Provide the following information for each director, executive officer and promoter of the issuer. For locations within Canada, state the province or territory; otherwise state the country. For “Relationship to issuer”, “D” – Director, “O” – Executive Officer, “P” – Promoter.
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Business location of
non-individual or
residentail Relationship to issuer
Secondary given (select all that apply)
Organization or company name Family name First given name names jurisdiction of
individual
Province or country D O P
b) Promoter information
If the promoter listed above is not an individual, provide the following information for each director and executive officer of the promoter. For locations
within Canada, state the province or territory; otherwise state the country. For “Relationship to promoter”, “D” – Director, “O” – Executive Officer.
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| Organization or company name Family name |
First given name | Secondary given names |
Residential jurisdiction of individual |
Relationship to promoter (select one or both if applicable) |
||
|---|---|---|---|---|---|---|
| Province or country |
D O |
|||||
| c) Residential address of each individual | ||||||
| Complete Schedule 2 of this form providing the full | residential address for each individual listed in Item | 9(a) and (b) and attach to the | ||||
| completed report. Schedule 2 also requires information to be provided about control persons. |
ITEM 10 - CERTIFICATION
Provide the following certification and business contact information of an officer, director or agent of the issuer or underwriter. If the issuer or underwriter is not a company, an individual who performs functions similar to that of a director or officer may certify the report. For example, if the issuer is a trust, the report may be certified by the issuer's trustee. If the issuer is an investment fund, a director or officer of the investment fund manager (or, if the investment fund manager is not a company, an individual who performs similar functions) may certify the report if the director or officer has been authorized to do so by the investment fund.
The certification may be delegated, but only to an agent that has been authorized by an officer or director of the issuer or underwriter to prepare and certify the report on behalf of the issuer or underwriter. If the report is being certified by an agent on behalf of the issuer or underwriter, provide the applicable information for the agent in the boxes below.
If the individual completing and filing the report is different from the individual certifying the report, provide the name and contact details for the individual completing and filing the report in Item 11.
The signature on the report must be in typed form rather than handwritten form. The report may include an electronic signature provided the name of the signatory is also in typed form.
Securities legislation requires an issuer or underwriter that makes a distribution of securities under certain prospectus exemptions to file a completed report of exemt distribution.
By completing the information below, I certify, on behalf of the issuer/underwriter/investment fund manager, to the securities regulatory authority or regulator, as applicable, that I have reviewed this report and to my knowledge, having exercised reasonable diligence, the information provided in this report is true and, to the extent required, complete.
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Name of issuer/underwriter/
Ameriwest Lithium Inc.
investment fund manager/agent
Full legal name Eskandari Saman
Family name First given name Secondary given names
Title CFO
Telephone number 6047823510 Email address [email protected]
Signature "Saman Eskandari" Date 2021 06 02
YYYY MM DD
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ITEM 11- CONTACT PERSON
Provide the following business contact information for the individual that the securities regulatory authority or regulator may contact with any questions regarding the contents of this report, if different than the individual certifying the report in Item 10.
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ü Same as individual certifying the report
Full legal name Title
Family name First given name Secondary given names
Name of company
Telephone number Email address
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Notice - Collection and use of personal information
The personal information required under this form is collected on behalf of and used by the securities regulatory authority or regulator under the authority granted in securities legislation for the purposes of the administration and enforcement of the securities legislation.
If you have any questions about the collection and use of this information, contact the securities regulatory authority or regulator in the local jurisdiction(s) where the report is filed, at the address(es) listed at the end of this form.
The attached Schedules 1 and 2 may contain personal information of individuals and details of the distribution(s). The information in Schedules 1 and 2 will not be placed on the public file of any securities regulatory authority or regulator. However, freedom of information legislation may require the securities regulatory authority or regulator to make this information available if requested.
By signing this report, the issuer/underwriter confirms that each individual listed in Schedule 1 or 2 of the report who is resident in a jurisdiction of Canada:
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a) has been notified by the issuer/underwriter of the delivery to the securities regulatory authority or regulator of the information pertaining to the individual as set out in Schedules 1 or 2, that this information is being collected by the securities regulatory authority or regulator under the authority granted in securities legislation, that this information is being collected for the purposes of the administration and enforcement of the securities legislation of the local jurisdiction, and of the title, business address and business telephone number of the public official in the local jurisdiction, as set out in this form, who can answer questions about the security regulatory authority’s or regulator’s indirect collection of the information, and
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b) has authorized the indirect collection of the information by the securities regulatory authority or regulator.