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ILthe undersi ;ng rhP NOI holder or the pe►cnn authorized to ign on behalf of the NOI <br /> holder. eclare that the information given in this NOI form is true and correct <br /> SIGNATURES MUST BE IN BLUE INK <br /> Signed and dated this j/t5 day of -z p <br /> (date) (month) (year) <br /> Signature of NOI holder or person authorized to sign: <br /> Name(typed or printed): <br /> Title/Position: CP4' <br /> M:\min\oss\sib\MineraisForms\ProspectFonnl <br /> 30 Aug 2017 <br /> Form; Page 14 of 14 <br />