BEMA GOLD CORPORATION
(the “Corporation”)
2005 Request for Annual and Interim Financial Statements
National Instrument 51-102 requires the Corporation to send annually to the registered holders and beneficial owners of its securities (“Securityholders”) a form to allow Securityholders to request a copy of the Corporation’s annual financial statements and related MD&A, interim financial statements and related MD&A, or both. If you wish to receive such mailings, please complete and return this form to:
Computershare Trust Company of Canada
100 University Avenue
9th Floor
Toronto, ON M5J 2Y1
The undersigned Securityholder hereby elects to receive:
| ¨ | Interim Financial Statements for the first, second and third financial quarters of 2005 and the related MD&A; |
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| ¨ | Annual Financial Statements for the fiscal year ended December 31, 2005 and related MD&A; or |
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| ¨ | BOTH – Interim financial statements and MD&A and the annual financial statements and related MD&A for the 2005 financial year. |
Please note that a request form will be mailed each year and Securityholders must return such form each year to receive the documents indicated above.
| Name: | |
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| Address: | |
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I confirm that I am aregistered / beneficial (circle one) securityholder of the Corporation.
Signature of
Securityholder: | | | Date: | |
CUSIP: 08135F107
SCRIP CORPORATION CODE: BGOQ
