Form SEC-2288 Form F-X

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

FORM F-X
APPOINTMENT OF AGENT FOR SERVICE OF
PROCESS AND UNDERTAKING
GENERAL INSTRUCTIONS

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I. Form F-X shall be filed with the Commission:
(a) By any issuer registering securities on Form F-8, F-10 or F-80 under the Securities Act of 1933;
(b) By any issuer registering securities on Form 40-F under the Securities Exchange Act of 1934;
(c) By any issuer filing a periodic report on Form 40-F, if it has not previously filed a Form F-X in connection with
the class of securities in relation to which the obligation to file a report on Form 40-F arises;
(d) By any issuer or other non-U.S. person filing tender offer documents on Schedule 13E-4F, 14D-1F or 14D9F;
(e) By any non-U.S. person acting as trustee with respect to securities registered on Form F-7, F-8, F-10, F80;
(f) By a Canadian issuer qualifying an offering statement pursuant to the provisions of Regulation A; and
(g) By any non-U.S. issuer providing Form CB to the Commission in connection with a tender offer, right soffering
or business combination.
A Form F-X filed in connection with any other Commission form should no be bound together with or be included
only as an exhibit to, such other form.

II. Six copies of the Form F-X, one of which must be manually signed, shall be filed with the Commission as its
principal office.
A. Name of issuer or person filing (“Filer”): _________________________________________________________
B.(1) This is an (check one)

original filing for the Filer

amended filing for the Filer

(2) Check following box if you are filing the Form F-X in paper in accordance with Regulation S-T Rule
101(b)(9)

Note: Regulation S-T Rule 101(b)(9) only permits the filing of the Form F-X in paper:
(a) if the party filing or submitting the Form CB is not subject to the reporting requirements of Section 13
or 15(d) of the Exchange Act; or
(b) if filed by a Canadian issuer when qualifying an offering statement pursuant to the provisions of
Regulation A (230.251 - 230.263 of this chapter).
(3) A filer may also file the Form F-X in paper under a hardship exemption provided by Regulation S-T Rule
201 or 202 (17 CFR 232.201 or 232.202). When submitting the Form F-X in paper under a hardship
exemption, a filer must provide the legend required by Regulation S-T Rule 201(a)(2) or 202(c) (17 CFR
232.201(a)(2) or 232.202(c)) on the cover page of the Form F-X.
C. Identify the filing in conjunction with which this Form is being filed:
Name of registrant _______________________________________________________
Form type ______________________________________________________________
File Number (if known) ____________________________________________________
Filed by ________________________________________________________________
(date)
Date Filed _______________________
(if filed concurrently, so indicate)

SEC 2288 (1-13)

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D. The Filer is incorporated or organized under the laws of _____________________________________________
(jurisdiction name under whose laws the issuer is organized/incorporated)

and has its principal place of business at ___________________________________________ _____________
(full address)

(telephone number)

E. The Filer designates and appoints ____________________________________ (“Agent”) located at
(name of United States person serving as agent)

_______________________________________________________ ______________ as the agent of the Filer
(full United States address)

(telephone number)

upon whom may be served any process, pleadings, subpoenas, or other papers in
(a) any investigation or administrative proceeding conducted by the Commission; and
(b) any civil suit or action brought against the Filer or to which the Filer has been joined as defendant or
respondent, in any appropriate court in any place subject to the jurisdiction of any state or of the United
States or of any of its territories or possessions or of the District of Columbia, where the investigation,
proceeding or cause of action arises out of or relates to or concerns (i) any offering made or purported
to be made in connection with the securities registered or qualified by the Filer on Form
___________________ on __________________ or any purchases or sales of any security in connection
(form name)

(date)

therewith; (ii) the securities in relation to which the obligation to file an annual report on Form 40-F arises,
or any purchases or sales of such securities; (iii) any tender offer for the securities of a Canadian issuer
with respect to which filings are made by the Filer with the Commission on Schedule 13E-4F, 14D-1F or
14D-9F; or (iv) the securities in relation to which the Filer acts as trustee pursuant to an exemption under
Rule 10a-5 under the Trust Indenture Act of 1939. The Filer stipulates and agrees that any such civil suit
or action or administrative proceeding may be commenced by the service of process upon, and that service
of an administrative subpoena shall be effected by service upon such agent for service of process, and
that service as aforesaid shall be taken and held in all courts and administrative tribunals to be valid and
binding as if personal service thereof had been made.
F. Each person filing this Form in connection with:
(a) the use of Form F-10, 40-F or Schedule 13E-4F, 14D-1F or 14D-9F stipulates and agrees to appoint a
successor agent for service of process and file an amended Form F-X if the Filer discharges the Agent or
the Agent is unwilling or unable to accept service on behalf of the Filer at any time until six years have
elapsed from the date the issuer of the securities to which such Forms and Schedules relate has ceased
reporting under the Exchange Act;
(b) the use of Form F-8, Form F-80 or Form CB stipulates and agrees to appoint a successor agent for service
of process and file an amended Form F-X if the Filer discharges the Agent or the Agent is unwilling
or unable to accept service on behalf of the Filer at any time until six years have elapsed following the
effective date of the latest amendment to such Form F-8, Form F-80 or Form CB;
(c) its status as trustee with respect to securities registered on Form F-7, F-8, F-10, F-80 stipulates and agrees
to appoint a successor agent for service of process and file an amended Form F-X if the Filer discharges the
Agent or the Agent is unwilling or unable to accept service on behalf of the Filer at any time during which
any of the securities subject to the indenture remain outstanding; and
(d) the use of Form 1-A or other Commission form for an offering pursuant to Regulation A stipulates and
agrees to appoint a successor agent for service of process and file an amended Form F-X if the Filer
discharges the Agent or the Agent is unwilling or unable to accept service on behalf of the Filer at any time
until six years have elapsed from the date of the last sale of securities in reliance upon the Regulation A
exemption.
Each filer further undertakes to advise the Commission promptly of any change to the Agent’s name or address
during the applicable period by amendment of this Form, referencing the file number of the relevant form in
conjunction with which the amendment is being filed.
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G. Each person filing this Form, other than a trustee filing in accordance with General Instruction I. (a) of this
Form, undertakes to make available, in person or by telephone, representatives to respond to inquiries made by
the Commission staff, and to furnish promptly, when requested to do so by the Commission staff, information
relating to: the Forms, Schedules and offering statements described in General Instructions I. (a), I. (b), I. (c), I.
(d) and I. (f) of this Form, as applicable; the securities to which such Forms, Schedules and offering statements
relate; and the transactions in such securities.
The Filer certifies that it has duly caused this power of attorney, consent, stipulation and agreement to be signed
on its behalf by the undersigned, thereunto duly authorized, in the City of _______________________________
(city name)

Country of _______________________________________ this _______  day of ______________,  _______.
(country name)

(day of month)

(month)

(year)

Filer: ___________________________________________ by _______________________________________
(filer’s name)

(signature and title)

This statement has been signed by the following persons in the capacities and on the dates indicated.
________________________________________________
(signature)

___________________
(date)

________________________________________________
(title)

Instructions
1. The power of attorney, consent, stipulation and agreement shall be signed by the Filer and its
authorized Agent in the United States.
2. The name of each person who signs Form F-X shall be typed or printed beneath such person’s
signature. Any person who occupies more than one of the specified positions shall indicate each
capacity in which such person signs Form F-X. If any name is signed pursuant to a board resolution,
a copy of the resolution shall be filed with each copy of Form F-X. A certified copy of such resolution
shall be filed with the manually signed copy of Form F-X. If any name is signed pursuant to a power
of attorney, a copy of the power of attorney shall be filed with each copy of Form F-X. A manually
signed copy of such power of attorney shall be filed with the manually signed copy of Form F-X.
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