FORM 13-502F1
CLASS 1 AND CLASS 3B REPORTING ISSUERS – PARTICIPATION FEE
MANAGEMENT CERTIFICATION I, Gadi Levin , an officer of the reporting issuer noted below have examined this Form 13-502F1 (the Form) being submitted hereunder to the Ontario Securities Commission and certify that to my knowledge, having exercised reasonable diligence, the information provided in the Form is complete and accurate. | |||||
/s/ Gadi Levin, CFO | April 28, 2016 | ||||
| Name: | Date: | ||||
| Title: | |||||
Reporting Issuer Name: Adira Energy Ltd.
End date of previous financial year: December 31, 2015
Type of Reporting Issuer: ☑ Class 1 reporting issuer ☐ Class 3B reporting issuer
Highest Trading Marketplace: TSX Venture
(refer to the definition of “highest trading marketplace” under OSC Rule 13-502 Fees)
Market value of listed or quoted equity securities:
(in Canadian Dollars - refer to section 7.1 of OSC Rule 13-502 Fees)
Equity Symbol ADL
1st Specified Trading Period (dd/mm/yy) January 1, 2015 to March 31, 2015
(refer to the definition of “specified trading period” under OSC Rule 13-502 Fees)
Closing price of the security in the class or series on the last trading day of the specified trading period in which such security was listed or quoted on the highest trading marketplace $0.065 (i)
Number of securities in the class or series of such security outstanding at the end of the last trading day of the specified trading period 12,292,022 (ii)
Market value of class or series (i) x (ii) $798,981.43 (A)
2nd Specified Trading Period (dd/mm/yy) April 1, 2015 to June 30, 2015
(refer to the definition of “specified trading period” under OSC Rule 13-502 Fees)
Closing price of the security in the class or series on the last trading day of the specified trading period in which such security was listed or quoted on the highest trading marketplace $0.055 (iii)
Number of securities in the class or series of such security outstanding at the end of the last trading day of the specified trading period 17,112,022 (iv)
Market value of class or series (iii) x (iv) $941,161.21 (B)
3rd Specified Trading Period (dd/mm/yy) July 1, 2015 to September 30, 2015
(refer to the definition of “specified trading period” under OSC Rule 13-502 Fees)
Closing price of the security in the class or series on the last trading day of the specified trading period in which such security was listed or quoted on the highest trading marketplace $0.04 (v)
Number of securities in the class or series of such security outstanding at the end of the last trading day of the specified trading period 17,112,022 (vi)
Market value of class or series (v) x (vi) $684,480.88 (C)
4th Specified Trading Period (dd/mm/yy) October 1, 2015 to December 31, 2015
(refer to the definition of “specified trading period” under OSC Rule 13-502 Fees)
Closing price of the security in the class or series on the last trading day of the specified trading period in which such security was listed or quoted on the highest trading marketplace $0.035 (vii)
Number of securities in the class or series of such security outstanding at the end of the last trading day of the specified trading period 17,112,022 (viii)
Market value of class or series (vii) x (viii) $598,920.77 (D)
5th Specified Trading Period (dd/mm/yy) _________________ to _________________
(if applicable - refer to the definition of “specified trading period” under OSC Rule 13-502 Fees)
Closing price of the security in the class or series on the last trading day of the specified trading period in which such security was listed or quoted on the highest trading marketplace $_______________________ (ix)
Number of securities in the class or series of such ________________________ (x)
security outstanding at the end of the last trading day of the specified trading period
Market value of class or series (ix) x (x) $N/A (E)
Average Market Value of Class or Series
(Calculate the simple average of the market value of the class or series of security for each applicable specified trading period (i.e. A through E above))
$756,000 (1)
(Repeat the above calculation for each other class or series of equity securities of the reporting issuer (and a subsidiary pursuant to paragraph 2.8(1)(c) of OSC Rule 13-502 Fees, if applicable) that was listed or quoted on a marketplace at the end of the previous financial year)
Fair value of outstanding debt securities:
(See paragraph 2.8(1)(b), and if applicable, paragraph 2.8(1)(c) of OSC Rule 13-502 Fees) $_________________________ (2)
(Provide details of how value was determined)
Capitalization for the previous financial year (1) + (2) $756,000
Participation Fee $890
(For Class 1 reporting issuers, from Appendix A of OSC Rule 13-502 Fees, select the participation fee)
(For Class 3B reporting issuers, from Appendix A.1 of OSC Rule 13-502 Fees, select the participation fee)
Late Fee, if applicable
(As determined under section 2.7 of OSC Rule 13- 502 Fees) $_________________________
Total Fee Payable
(Participation Fee plus Late Fee) $890