Exhibit 99.3
GOLD RESERVE INC.
(the “Corporation”)
Supplemental Mailing List Return Card
Fiscal Year: 2023
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 43006
Providence, RI 02940-3006
Rather than receiving the financial statements and MD&A by mail, you may choose to view these documents on the Corporation’s SEDAR profile at www.sedarplus.ca.
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:
PLEASE PRINT
FIRST NAME LAST NAME
ADDRESS
CITY PROVINCE/ STATE POSTAL / ZIP CODE
_________________________________________
COUNTRY
SIGNED: ____________________________
(Signature of Securityholder)
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IF THIS IS AN ADDRESS CHANGE, PLEASE CHECK HERE:
(Please provide previous address below)