Financials Request

In accordance with National Instrument 51-102 ”Continuous Disclosure Obligations”, a reporting issuer must send annually a request form to the registered holders and beneficial owners of its securities that allows the registered holders and beneficial owners to request a copy of the reporting issuer’s annual financial statements and management’s discussion & analysis (“MD&A”), interim financial statements and MD&A, or both.  If you wish to receive any of these materials this year, please complete and return the form below.

You will not automatically receive copies of Los Andes Copper’s financial statement(s) unless you complete and return this card.  Copies of all previously issued annual and interim financial statements and related MD&A are available to the public on the SEDAR website at

In order to benefit the environment by saving paper and to reduce delivery expenses, the Company recommends that you select email as your preferred method of communication and provide your current email address and your consent to electronic delivery.  To provide your consent, please complete the Consent to Electronic Delivery form below.

Shareholders that return this card in the mail and have requested delivery of statements via email must at some time before the mailing, complete the Consent Form at the above noted URL, or the statements will be sent by mail.


The undersigned certifies that he/she/it is a registered holder and/or beneficial owner of securities (other than debt instruments) of the Company and requests that he/she/it be placed on Los Andes Copper’s Mailing List for delivery of its annual and/or interim financial statements and MD&A for the current financial year.

Please select one or both of the following options:

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