HIP ENERGY CORPORATION
SUPPLEMENTAL MAILING LIST FORM
National Instrument 51-102Continuous Disclosure Obligationsmandates that HIP Energy Corporation (the “Company”) send annually a request form to registered holders and beneficial owners of securities to enable such holders and owners to request a copy of the Company’s annual financial statements and related MD&A and/or interim financial statements and related MD&A (collectively, the “Statements”), in accordance with the procedures set out in National Instrument 54-101Communication with Beneficial Owners of Securities of a Reporting Issuer. If you wish to receive either or both of the Statements, you must complete this form and forward it to the Company’s transfer agent at the following address:
COMPUTERSHARE
510 Burrard Street, 2nd Floor
Vancouver, BC V6C 3B9
Please note that both registered holders and beneficial owners should return the form; registered holders will not automatically receive the Statements (registered holders are those with shares registered in their name; beneficial owners have their shares registered in an agent, broker, or bank’s name).
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If you wish to receive Statements of the Company, please complete below and return. Yes, I would like to receive:
| | | Interim Financial Statements and MD&A |
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| | | Annual Financial Statements and MD&A |
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| | | (PleasePRINTyour name and address) |
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| | | (First Name and Surname) |
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| | | (Number and Street) (Apartment/Suite) |
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| | | (City, Province/State) |
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| | | (Postal Code) |
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| | | (Email Address) |
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| Signed: | | |
| | | (Signature of Shareholder) |
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| Dated: | | |