BRIDGEPORT VENTURES INC. |
SUPPLEMENTAL MAILING LIST FORM |
National Instrument 51-102 -Continuous Disclosure Obligations mandates that Bridgeport Ventures Inc. (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 Instruments 54-101-Communication 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 our transfer agent at the following address:
Valiant Trust Company
710 - 130 King St W
Toronto Ontario M5X 1A9
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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Please put my name on your Supplemental Mailing List to receive |
the Statements (as indicated) of Bridgeport Ventures Inc. |
(Please PRINT your name and address) |
_______________Interim Financial Statements and MD&A |
_______________Annual Financial Statements and MD&A |
(First Name and Surname) |
(Number and Street) (Apartment/Suite) |
(City) (Province/State) |
(Postal Code) |
Signed: |
(Signature of Shareholder) |