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[null,null,null,null,null,null,null,null,null,null,null,null,null,"Synergy Capital\n(version:  2021-03)"]
["Instructions – Authorized Placement Certificate / Share Issuance Report"]
[]
["The \"Share Issuance Report\" must be filed upon completion of the issue of shares of the capital stock of a corporation for which the Authorized Placement Certificate was issued by Investissement Québec or following receipt of a request from Investissement Québec to file such report. Also, the \"Share Issuance Report\" must be filed by the filing date of the \"Authorized Placement Monitoring\" form for the taxation or fiscal year in which the application for the Authorized Placement Certificate in question is filed."]
[]
["AGREEMENT ON THE EXCHANGE OF INFORMATION"]
["On October 7, 2009, Investissement Québec and Revenu Québec entered into an agreement entitled \"Entente portant sur l'échange de renseignements nécessaires à l'administration de mesures fiscales ou à l’application d’une loi fiscale\" [agreement on the exchange of information required for the administration of fiscal measures or the enforcement of tax legislation]. Under that agreement, the two organizations can share information required to carry out their respective mandates without being required to ask for the consent of the individual in question. Information is shared with Revenu Québec only under this agreement. The Commission d'accès à l'information du Québec approved this agreement, after reviewing the nature of the information provided and the reasons for disclosure, and ensuring that appropriate security and confidentiality measures are in place."]
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["MAILING ADDRESSES AND METHOD FOR SUBMITTING THE APPLICATION / SHARE ISSUANCE REPORT\n"]
["To expedite processing, we recommend that you send your signed Share Issuance Report by e-mail. Please enclose the duly signed form in PDF format. \n"]
["In any event, be sure to send the electronic file of the Share Issuance Report in Excel format.\n"]
["For corporations whose head office is in one of the following regions:\n\nBas-Saint-Laurent;\nCapitale-Nationale;\nChaudière-Appalaches;\nCentre-du-Québec;\nCôte-Nord;\nEstrie;\nGaspésie–Îles-de-la-Madeleine;\nLanaudière;\nMauricie;\nMontérégie;\nNord-du-Québec;\nSaguenay–Lac-Saint-Jean."]
[]
["Investissement Québec\nDirection, Mesures fiscales (Québec)\nÉdifice Iberville 1\n1195, avenue Lavigerie, bureau 060\nQuébec (Québec)  G1V 4N3"]
[" -","by e-mail to: mfquebec@invest-quebec.com"]
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["For corporations whose head office is in one of the following regions:\n\nAbitibi-Témiscamingue;\nLaval;\nLaurentides;\nMontréal;\nOutaouais."]
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["Investissement Québec\nDirection, Mesures fiscales (Montréal)\n1001, boulevard Robert-Bourassa, bureau 1000\nMontréal (Québec)  H3B 4L4"]
[" -","by e-mail to: mfmontreal@invest-quebec.com"]

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[null,null,null,null,"Synergy Capital \nVersion: 2021-03"]
[null," Authorized Placement Certificate"]
[null,"Share Issuance Report"]
["Provide the list of investors to whom your corporation issued shares of its capital stock for which an Authorized Placement Certificate attestation was issued to it by Investissement Québec."]
[null,"Name of the corporation",null,null,null,null,null,null,null,null,null,null,null,"IQ file number"]
[]
[]
[null,"Issue date of the Authorized Placement Certificate",null,null,null,"format à ajuster","Issue date of the Authorized Placement Certificate "]
[]
[null,null,null,"Authorized amount"]
[]
[null,"Name of Investor","NEQ","Address of Investor's principal establishment in Québec ","Issue date",null,"Number of shares issued",null,null,null,"Class of shares issued",null,"Montant payé","Amount paid by the investor","Amount of the authorized placement attributed to the investor "]
[null,"Example: ABC Inc.",1234567890,"303-1165 rue Lavigerie, Québec City, Québec  G1V 4N3","2021-03-31",null,100,null,null,null,"Common",null,null,750000,null,500000]
[null,"Example: XYZ Inc",1234567809,"900 rue De Mézy, Québec City, Québec  G1X 2T3","2021-03-31",null,50,null,null,null,"Common",null,null,375000,null,250000]
[]
[]
[]
[]
[]
[]
[null,"Total amount attributed in respect of the Authorized Placement Certificate (must correspond to the amount indicted on the certificate).",null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[]
["DECLARATION OF THE THE CORPORATION'S AUTHORIZED REPRESENTATIVE OR AGENT"]
[]
["I, the undersigned, a duly authorized representative or agent of the corporation, hereby declare that the information provided in this Share Issuance Report is complete and accurate in all respects."]
["I, the undersigned, a duly authorized representative or agent of the corporation, hereby declare that the corporation has been sure to comply with all its obligations under the Securities Act and that it acknowledges that Investissement Québec has incurred no liability in this respect."]
[]
[]
[null,"Signature of the duly authorized representative or agent of the corporation",null,null,null,null,"Date"]