(the “Company”)
2013 Annual Request Form
National Instrument 51-102 Continuous Disclosure Obligations requires the Company to send annually to the registered holders and beneficial owners of its securities (“Securityholders”) a form to allow Securityholders to request a paper copy of the Company’s annual financial statements and related management discussion and analysis (“MD&A”), interim financial statements and related MD&A, or both (the “Documents”).
The Company’s interim and annual financial statements and related MD&A are made available on the Company’s website immediately upon filing of such documents with SEDAR and EDGAR as required by securities regulations, and Securityholders are encouraged to access these documents electronically atwww.pacrim-mining.com,www.sedar.com, orwww.sec.gov.
If you wish toreceive paper copies of any or all of the Documentsby mail, please complete this form and return it to the Company via mail, fax or email to:
| If by Mail: | Pacific Rim Mining Corp.
Suite 1050, 625 Howe Street
Vancouver, BC Canada V6C 2T6 |
| If by Fax: | 604-689-1978 |
| If by Email (pdf documents only) | general@pacrim-mining.com |
The undersigned Securityholder hereby requests to be put on the Supplemental Mailing List for the Company and elects to receive the documents as indicated below:
| [ ] | Interim Financial Statements and the related MD&A; or |
| [ ] | Annual Financial Statements and related MD&A; or |
| [ ] | BOTH – Interim Financial Statements and MD&A and Annual Financial Statements and related MD&A. |
Please note that a request form will be mailed each year and security holdersmust return such form each year to receive the documents requested.
(Please print clearly):
| Name: | |
| Address: | |
| | |
| Postal Code: | |
I confirm that I am aregisteredor beneficialshareholder (circle one) of the Company.
| Signature of | | | |
| Securityholder: | | Date: | |
| CUSIP: 694915208 | | | |
| SCRIP COMPANY CODE: PFGQ | | | |
