FORTUNA MINING CORP.

Regulatory Filings • Jan 23, 2017

F-X 1 d175700dfx.htm F-X F-X

U.S. SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

FORM F-X

APPOINTMENT OF AGENT FOR SERVICE

OF PROCESS AND UNDERTAKING

A.	Name of issuer or person filing (“Filer”):
B.	(1)	This is (check one):
	☒	an original filing for the Filer.
	☐	an amended filing for the Filer.
	(2)	Check the following box if you are filing the Form F-X in paper in accordance with Regulation S-T Rule
101(b)(9): ☐
C.	Identify the filing in conjunction with which this Form is being filed:
	Name of registrant:	FORTUNA SILVER MINES INC.
	Form type:	Registration Statement on Form F-10
	File Number (if known):	333-215659
	Filed by:	FORTUNA SILVER MINES INC.
	Date Filed: (if filed concurrently, so indicate)	January 23, 2017 (concurrent
herewith)
D.	The Filer is incorporated or organized under the laws of: British Columbia, Canada and has its principal place of business at: 200 Burrard Street, Suite 650 Vancouver, British Columbia, Canada V6C 3L6 (604) 484-4085
E.	The Filer designates and appoints C T Corporation System (“Agent”) located at: 111 Eighth Avenue New York, New York 10011 (212) 894-8940 as the agent of the Filer upon whom may
be served any process, pleadings, subpoenas, or other papers in: (a) Any investigation
or administrative proceeding conducted by the Commission; and (b) Any civil suit or
action brought against the Filer or to which the Filer has been joined as defendant or respondent, in any appropriate court in any place subject to the jurisdiction of any State or of the United States, or of any of its territories or possessions,
or of the District of Columbia, where the investigation, proceeding or cause of action arises out of or relates to or concerns any offering made or purported to be made in connection with the securities registered or qualified by the Filer on Form F-10 on the date hereof or any purchases or sales of any security in connection therewith. The Filer stipulates and agrees that any such civil suit or action or administrative proceeding may be commenced
by the service of process upon, and that service of an administrative subpoena shall be effected by service upon such agent for service of process, and that the service as aforesaid shall be taken and held in all courts and administrative tribunals
to be valid and binding as if personal service thereof had been made.
F.	The Filer stipulates and agrees to appoint a successor agent for service of process and file an amended Form F-X if the Filer discharges the Agent or the Agent is unwilling or
unable to accept service on behalf of the Filer at any time until six years have elapsed following the date the Filer has ceased reporting under the U.S. Securities Exchange Act of 1934. The Filer further undertakes to advise the Commission promptly
of any change to the Agent’s name or address during such period by amendment of this Form, referencing the file number of the relevant form in conjunction with which the amendment is being filed.
G.	The Filer undertakes to make available, in person or by telephone, representatives to respond to inquiries made by the Commission staff, and to furnish promptly, when requested to do so by the Commission staff,
information relating to the Form F-10, the securities to which the Form F-10 relates and the transactions in such securities.

The Filer certifies that it has duly caused this power of attorney, consent, stipulation and agreement to be signed on its behalf by the undersigned, thereunto duly authorized, in Lima, Peru on January 23, 2017.

By:
Name:	Jorge Ganoza Durant
Title:	President and Chief Executive Officer

This statement has been signed by the following person in the capacity indicated on January 23, 2017.

C T CORPORATION SYSTEM
(Agent for Service)
By:	/s/ Candice Pignataro
	Name:	Candice Pignataro
	Title:	Assistant Secretary