AVRICORE HEALTH INC.
(the "Company")
Request for Annual and Interim Financial Statements
In accordance with National Instrument 51-102 of the Canadian Securities Administrators, registered and beneficial shareholders of the Company may elect annually to receive Interim Financial Statements and MD&A and/or the Annual Financial Statements and MD&A. If you wish to also receive copies of such documents by mail, please complete and return this form to:
Avricore Health Inc.
#2300 – 1177 West Hastings St.
Vancouver, B.C. V6E 2K3
Alternatively, you may choose to access the reports online at www.sedar.com. [Please check applicable box(es).]
___I wish to receive annual financial statements and MD&A of the Company for the financial year ending December 31, 2019.
___I wish to receive interim financial statements and MD&A of the Company for
each of the financial quarters in 2018 and 2019.
NAME:
ADDRESS:
E-MAIL ADDRESS:
I confirm that I am one of the following [please check applicable box]:
___a REGISTERED owner of Common Shares of the Company holding the shares directly in my own name; or
___a BENEFICIAL owner of Common Shares of the Company holding the shares
through a brokerage firm or other financial institution.
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