OTC Equity Issuer Notification Form

OTC Equity Issuer Notification Form
Completion of this form certifies to FINRA notification of a corporate action change request for the OTC issuer. All notifications are required to be received
by FINRA no later than 10 calendar days prior to the effective date of the corporate action. Processing for the effective time in the market place is
determined based upon the satisfactory review of and compliance with all information requested by FINRA. Please refer to the Required Documentation
section for supplemental forms and documentation required to be submitted along with this notification form.

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