Forty Pillars Mining Corp. — Regulatory Filings 2023

Jun 28, 2023

Note: [01 Mar 2017] – The following is a consolidation of 13-501F1. It incorporates amendments to this document that came into effect on March 1, 2017. This consolidation is provided for your convenience and should not be relied on as authoritative.

FORM 13-501F1 CLASS 1 REPORTING ISSUERS AND CLASS 3B REPORTING ISSUERS – PARTICIPATION FEE

MANAGEMENT CERTIFICATION

I, ____________________, an officer of the reporting issuer noted below have examined thisForm 13-501F1 (the Form) being submitted hereunder to the Alberta Securities Commission andcertify that to my knowledge, having exercised reasonable diligence, the information provided inthe Form is complete and accurate.
_________________________________	_________________________________
Name:Title:	Date:
Reporting Issuer Name:
End date of previous financial year:
Type of Reporting Issuer:	[] Class 1 reportingissuer	[issuer	] Class 3B reporting
Highest Trading Marketplace:
Market value of listed or quoted equity securities:
Equity Symbol
1st Specified Trading Period (dd/mm/yy)			_______________ to ______________
Closing price of the security in the class or series on thelast trading day of the specified trading period in whichsuch security was listed or quoted on the highest tradingmarketplace		(i)	$ ______________________

Number of securities in the class or series of suchsecurity outstanding at the end of the last trading day of		________________________
the specified trading period		(ii)
Market value of class or series	(i) x (ii)	(A)		$ ______________________
2nd Specified Trading Period (dd/mm/yy)				_______________ to ______________
Closing price of the security in the class or series on thelast trading day of the specified trading period in whichsuch security was listed or quoted on the highest tradingmarketplace		(iii)		$ ______________________
Number of securities in the class or series of suchsecurity outstanding at the end of the last trading day ofthe specified trading period		(iv)		______________________
Market value of class or series	(iii) x (iv)	(B)		$ ______________________
3rd Specified Trading Period (dd/mm/yy)				_______________ to ______________
Closing price of the security in the class or series on thelast trading day of the specified trading period in whichsuch security was listed or quoted on the highest tradingmarketplace		(v)		$ ______________________
Number of securities in the class or series of suchsecurity outstanding at the end of the last trading day ofthe specified trading period		(vi)		______________________
Market value of class or series	(v) x (vi)	(C)		$ ______________________

4th Specified Trading Period (dd/mm/yy)			_______________ to ______________
Closing price of the security in the class or series on thelast trading day of the specified trading period in whichsuch security was listed or quoted on the highest tradingmarketplace		(vii)	$ ______________________
Number of securities in the class or series of suchsecurity outstanding at the end of the last trading day ofthe specified trading period		(viii)	______________________
Market value of class or series	(vii) x (viii)	(D)	$ ______________________
5th Specified Trading Period (dd/mm/yy)			_______________ to ______________
Closing price of the security in the class or series on thelast trading day of the specified trading period in whichsuch security was listed or quoted on the highest tradingmarketplace		(ix)	$ ______________________
Number of securities in the class or series of suchsecurity outstanding at the end of the last trading day ofthe specified trading period		(x)	______________________
Market value of class or series	(ix) x (x)	(E)	$ ______________________
Average Market Value of Class or Series (Calculatethe simple average of the market value of the class orseries of security for each applicable specified tradingperiod (i.e. A through E above))		(1)	$ ______________________

(Repeat the above calculation for each other class or series of equity securities of the reporting issuer (and a subsidiary, if applicable) that was listed or quoted on a marketplace at the end of the previous financial year)

Fair value of outstanding debt securities:

(Provide details of how value was determined)		(2)	$ ______________________
Capitalization for the previous financial year	(1) + (2)		$ ______________________
Participation Fee			$ ______________________
Late Fee, if applicable			$ ______________________
Total Fee Payable(Participation Fee plus Late Fee)			$ ______________________