15713382 CANADA INC. (DBA: Canada’s Medical Clinic)
Class B Non-Voting Common Shares

$0.55 per share

Subscription Agreement

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

City

State / Province / Region

Postal Code

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Investing as a corporation

I would like to make the investment in the name of a corporation

Amount to Invest ($CAD)? *

Min $1000 --- Max $2,500

RISK ACKNOWLEDGEMENT

FORM 45-110F2

WARNING

BUYER BEWARE: This investment is risky.

Don't invest unless you can afford to lose all the money you pay for this investment.

1. Risk acknowledgement

Risk of loss – Do you understand that this is a risky investment and that you may lose all the money you pay for this investment? *

Liquidity risk – Do you understand that you may never be able to sell this investment? *

Lack of information – Do you understand that you may receive little ongoing information about the issuer and/or this investment? *

No income – Do you understand that you may not earn any income, such as dividends or interest, on this investment? *

2. No approval and no advice

No approval – Do you understand that this investment has not been reviewed or approved in any way by a securities regulatory authority? *

No advice – Do you understand that you will not receive advice about whether this investment is suitable for you to purchase? *

3. Limited legal rights

Limited legal rights – Do you understand that you will not have the same rights as if you purchased under a prospectus or through a stock exchange? If you want to know more, you may need to seek professional legal advice. *

4. Purchaser’s acknowledgement

Investment risks – Have you read this form and do you understand the risks of making this investment? *

Offering document – Before you invest, you should read the offering document carefully. The offering document contains important information about this investment. If you have not read the offering document or if you do not understand the information in it, you should not invest. Have you read and do you understand the information in the offering document? *

5. Additional information

You have two days to cancel your purchase by sending a notice to the funding portal at: team@backers.ca If you want more information about your local securities regulation, go to www.securities-administrators.ca. Securities regulators do not provide advice on investment.

Name (copy) (copy) *

First

Last

Date *

Electronic signature: By checking the ‘I confirm & Sign’ box, I acknowledge that I am signing this form electronically and agree that this is the legal equivalent of my handwritten signature. I will not at any time in the future claim that my electronic signature is not legally binding. The date of my electronic signature is the same as my acknowledgement.

I confirm & Sign *

I confirm & Sign

Payment

eTransfer *

eTransfer

Send eTransfer to: invest@backers.ca

After placing your order, Please Login to your online banking platform and send an e-Transfer to Backers Securities Inc.Send eTransfer to: invest@backers.ca

Please Note: You will need to add a new recipient with the information below if you have not done so already. Your deposit must be from a bank account in your name, using the same email address indicated on the subscription agreement. Third party funding is not permitted

Recipient Name: Backers Securities

Recipient Email Address: invest@backers.ca

Security Question: (Put The Name Of The Company You're Investing In Here) example: WXYZ Widgets Inc.

Security Answer: Backers

Identity Verification

Driver License Upload (Front) *

Click or drag a file to this area to upload.

Backers Securities Inc. is operating this Funding Portal under the Start-Up Crowdfunding Portal - Exemption in Ontario (OSC), Alberta (ASC), and British Columbia (BCSC). Backers Securities Inc. ("Backers") provides the following disclosures: Backers is not registered under securities legislation in any jurisdiction of Canada. We operate under the exemption from the dealer registration requirement in accordance with specific rules and regulations applicable to our operations. Backers guarantees the safety and security of every investor's assets. We ensure to maintain each purchaser's assets separate and apart from our own, held in trust for the benefit of the purchaser. Any cash assets will be held in a designated trust account at a reputable Canadian financial institution. In the unlikely event that Backers becomes insolvent or discontinues operations, we have established clear policies and procedures to ensure transparency and a smooth transition for our investors. Upon any such occurrences, each purchaser will be notified promptly. We will also provide detailed instructions on the process by which we will return the purchaser’s assets in accordance with our policies and procedures.

You are entering an online platform operated by a Funding Portal that is operated by Backers Securities Inc. under the Start-Up Crowdfunding Portal – Exemption in Ontario (OSC), Alberta (ASC), and British Columbia (BCSC)

I acknowledge that a distribution posted on this funding portal’s online platform;
(i) has not been reviewed or approved in any way by a securities regulatory authority or regulator, and
(ii) is risky and may result in the loss of all or most of an investment;

15713382 CANADA INC. (DBA: Canada’s Medical Clinic)Class B Non-Voting Common Shares