EXHIBIT 99.3
GOLD RESERVE INC.
(the “Corporation”)
Supplemental Mailing List Return Card
Fiscal Year: 2018
Under securities regulations and in accordance with National Instrument 51-102 –Continuous Disclosure Obligations,registered and beneficial securityholders of the Corporation may elect annually to receive a copy of the Corporation’s annual financial statements and corresponding management discussion and analysis (“MD&A”) or interim financial statements and the corresponding MD&A, or both.
If you wish to receive these documents by mail, please return this completed form to:
Computershare Investor Services
P.O. Box 505000
Louisville, KY 40233
Rather than receiving the financial statements and MD&A by mail, you may choose to view these documents on the Corporation’s SEDAR profile atwww.sedar.com.
I HEREBY CERTIFY that I am a registered and/or beneficial securityholder of the Corporation, and as such, request that my name be placed on the Corporation’s Mailing List in respect of its annual and/or interim financial statements and the corresponding MD&A for the current financial year.
| Please send me: ¨ | Annual Financial Statements and MD&A | |
| (Mark this box if you would like to receive the Annual Financial Statements | ||
| and associated MD&A by mail) | ||
| ¨ | Interim Financial Statements and MD&A | |
| (Mark this box if you would like to receive the Interim Financial Statements | ||
| and associated MD&A by mail) | ||
| PLEASE PRINT | ||
| FIRST NAME | LAST NAME | |
| ADDRESS | ||
| CITY | PROVINCE/ STATE | POSTAL / ZIP CODE |
| COUNTRY | ||
SIGNED: ____________________________
(Signature of Securityholder)
IF THIS IS AN ADDRESS CHANGE, PLEASE CHECK HERE:¨
(Please provide previous address below)