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Oil, Cn .nd Sab 0.owrto Aa <br />Form ) <br />OD. AND GAS WELLS <br />OTF~R WELLS <br />Well type/Stems / o! Wells Production <br />1000 m3 gas ~ <br />m3 <br />oillcondensate LScence Fee Rue Fee Payable Oi1IGas <br />Wells Well Type ,1 of Wells Annual Fee <br />Pcr Well Fee Payable <br />Other Wells <br />Aed+e Gn Welb f.09 per 1000 m7 p/ N.mnl Cn <br />Sia.ae {75 <br /> f.le per m] <br />candemne OMennion ft0 <br />Anhe OII Wells f.le per m] oil S•Imion Minin{ slso <br /> 6+em novae SI50 <br /> <br /> <br />ToOI (1) S (2) S <br />{I) + {2) _ • or f20, whlehever Ls greater. •Mlnlmum tee payable by operators oI aetlve oll and gas welb is S20 (J) 79e GST <br />TOTAL ENCLOSED (1)+(2)+(J) = S <br />Cheque must be payable ro OII, Gas end Sell Resources Trust <br />ANNUAL LICENCE FEE CALCULATION YEAR <br />Page 2 <br /> <br />NAME (plure print): ~ ~ SIGNATURE: ~ <br />• <br />