Form 62-103F3 Required Disclosure by an Eligible Institutional Investor under Part 4

Certificate

The certificate must state the following:

I, as the eligible institutional investor, certify, or I, as the agent filing this report on behalf of the eligible institutional investor, certify to the best of my knowledge, information and belief, that the statements made in this report are true and complete in every respect.

Date

Signature

Name/Title