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I the undersigned,being the NOI holder or the person authorized to sign on behalf of the NOI <br /> holder, declare that the information given in this NOI form is true and correct. <br /> SIGNATURES MUST BE IN BLUE INK <br /> /- r, <br /> Signed and dated this day of ; , <br /> (date) (month) (year) <br /> Signature of NOI holder or person authorized to sign: --- <br /> Name (typed or printed): �J <br /> Title/Position: / <br /> 11i� �z/°�OhAtl��tJ. AL/p�✓1�r1 a�•rv�I Llb� <br /> M:\min\oss\slb\MineralsForms\ProspectForm1 <br /> 30 Aug 2017 <br /> Form 1—DRMS Use and Confidential File Page 14 of 14 <br />