Texas
|
86-1061005
|
(State or other jurisdiction of incorporation or organization)
|
(I.R.S. Employer Identification No.)
|
710 N Post Oak, Suite 512
Houston, Texas
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77024
|
(Address of principal executive offices)
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(Zip Code)
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Large accelerated filer
r
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Accelerated filer
r
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Non-accelerated filer
r
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Smaller Reporting Company
☒
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Emerging growth company
r
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Part I
Financial Information
|
|
|
|
|
|
Item 1.
|
3
|
|
|
|
|
Item 2.
|
11
|
|
|
|
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Item 3
|
15
|
|
Item 4.
|
15
|
|
|
|
|
Part II
Other Information
|
|
|
|
|
|
Item 1
|
16
|
|
Item 1A.
|
16
|
|
Item 2
|
16
|
|
Item 3
|
17
|
|
Item 4
|
17
|
|
Item 5
|
17
|
|
Item 6.
|
18
|
|
19
|
||
20 |
|
March 31, 2017
|
December 31, 2016
|
||||||
ASSETS
|
||||||||
Current assets
|
||||||||
Cash
|
$
|
4,387
|
$
|
68,648
|
||||
Accounts receivable
|
48,201
|
199,003
|
||||||
Other current assets
|
5,506
|
31,192
|
||||||
Total current assets
|
58,094
|
298,843
|
||||||
|
||||||||
Property & equipment
|
||||||||
Oil and gas, on the basis of full cost accounting
|
||||||||
Evaluated properties
|
14,032,580
|
13,465,387
|
||||||
Furniture, equipment & software
|
236,092
|
200,416
|
||||||
Less accumulated depreciation
|
(1,137,981
|
)
|
(1,119,708
|
)
|
||||
Net property and equipment
|
13,130,691
|
12,546,095
|
||||||
|
||||||||
Other Assets
|
||||||||
Intangible assets
|
49,886
|
49,886
|
||||||
Note receivable
|
---
|
316,800
|
||||||
|
||||||||
Total Assets
|
$
|
13,238,671
|
$
|
13,211,624
|
||||
|
||||||||
LIABILITIES & STOCKHOLDERS EQUITY
|
||||||||
|
||||||||
Current liabilities
|
||||||||
Accounts payable
|
$
|
402,343
|
$
|
352,241
|
||||
Accrued liabilities
|
584,211
|
494,983
|
||||||
Debt short term
|
275,000
|
275,000
|
||||||
Convertible debt – related party, unamortized discount of 0 and 0
|
550,000
|
550,000
|
||||||
Current maturities of installment notes payable
|
32,582
|
26,186
|
||||||
Note payable – related parties
|
1,414,480
|
1,287,980
|
||||||
Total current liabilities
|
3,258,616
|
2,986,390
|
||||||
|
||||||||
Asset retirement obligations
|
436,045
|
322,710
|
||||||
Installment note payable – long term
|
28,316
|
---
|
||||||
Note payable to related party – long term
|
2,904,020
|
2,904,020
|
||||||
Total Liabilities
|
6,626,997
|
6,213,120
|
||||||
|
||||||||
Stockholders’ Equity
|
||||||||
Preferred stock, $0.10 par value, 1,000,000 shares authorized;
No shares issued & outstanding
|
-
|
-
|
||||||
Common stock, $.001 par value; 150,000,000 shares authorized;
79,034,505 and 79,034,505 shares issued and outstanding
|
79,034
|
79,034
|
||||||
Additional paid in capital
|
14,963,530
|
14,887,090
|
||||||
Accumulated deficit
|
(8,430,890
|
)
|
(7,967,620
|
)
|
||||
Total Stockholders’ Equity
|
6,611,674
|
6,998,504
|
||||||
|
||||||||
Total Liabilities and Stockholders’ Equity
|
$
|
13,238,671
|
$
|
13,211,624
|
|
Three Months Ended
March 31, 2017
|
Three Months Ended
March 31, 2016
|
||||||
Revenue
|
$
|
$
|
||||||
Oil and gas sales
|
33,560
|
22,999
|
||||||
Equipment sales – related party
|
---
|
180,000
|
||||||
Total Revenue
|
33,560
|
202,999
|
||||||
|
||||||||
Operating expenses
|
||||||||
Lease operating expense
|
119,992
|
45,994
|
||||||
Cost of equipment sold
|
---
|
30,300
|
||||||
General and administrative expenses
|
273,668
|
338,482
|
||||||
Depreciation, depletion and amortization
|
18,273
|
17,532
|
||||||
Asset retirement obligation accretion
|
11,930
|
6,428
|
||||||
Total operating expenses
|
423,863
|
438,736
|
||||||
|
||||||||
Loss from operations
|
(390,303
|
)
|
(235,737
|
)
|
||||
|
||||||||
Other income (expense)
|
||||||||
Interest (expense)
|
(73,112
|
)
|
(73,076
|
)
|
||||
Other income
|
145
|
19,502
|
||||||
Loss on warrants issued for PORRI
|
---
|
(12,631
|
)
|
|||||
Total other income (expense)
|
(72,967
|
)
|
(66,205
|
)
|
||||
|
||||||||
Net loss
|
$
|
(463,270
|
)
|
$
|
(301,942
|
)
|
||
|
||||||||
Loss per share
(Basic and fully diluted)
|
$
|
(0.01
|
)
|
$
|
(0.01
|
)
|
||
|
||||||||
Weighted average number of common shares outstanding, basic and diluted
|
79,034,505
|
43,521,276
|
|
Three Months Ended
March 31, 2017
|
Three Months Ended
March 31, 2016
|
||||||
Cash Flows from Operating Activities
|
||||||||
Net loss
|
$
|
(463,270
|
)
|
$
|
(301,942
|
)
|
||
Adjustment to reconcile net loss to net cash provided
by/(used in) operating activities:
|
||||||||
Depreciation and amortization
|
18,273
|
17,532
|
||||||
Accretion of debt discount
|
---
|
59,177
|
||||||
ARO accretion
|
11,930
|
6,428
|
||||||
Finance fee for extension of note payable
|
31,660
|
---
|
||||||
Loss on conveyance of PORRI warrants
|
---
|
12,631
|
||||||
Stock-based compensation expense - employees
|
13,351
|
127,755
|
||||||
Stock-based compensation expense – directors
|
12,127
|
---
|
||||||
Stock-based compensation expense – consultants
|
19,302
|
---
|
||||||
Changes in operating assets and liabilities
|
||||||||
Accounts receivable
|
1,815
|
(19,049
|
)
|
|||||
Inventory
|
---
|
30,300
|
||||||
Other assets
|
25,686
|
2,268
|
||||||
Accounts payable
|
50,102
|
117,423
|
||||||
Accrued liabilities
|
89,228
|
(13,416
|
)
|
|||||
Net cash flows from operating activities
|
(189,796
|
)
|
39,107
|
|||||
|
||||||||
Cash Flows from Investing Activities
|
||||||||
Capital expenditures on oil and gas properties
|
---
|
114
|
||||||
Capital expenditures on oil and gas properties
|
---
|
(2,850
|
)
|
|||||
Conveyance of oil and gas properties
|
---
|
24,000
|
||||||
Cash flows from investing activities
|
---
|
21,264
|
||||||
|
||||||||
Cash Flows from Financing Activities
|
||||||||
Proceeds from affiliate advances
|
126,500
|
65,000
|
||||||
Payments of affiliated advances
|
---
|
(60,000
|
)
|
|||||
Payments on notes payable
|
(965
|
)
|
(1,610
|
)
|
||||
Cash flows from financing activities
|
125,535
|
3,390
|
||||||
|
||||||||
Net change in cash and cash equivalents
|
(64,261
|
)
|
63,761
|
|||||
|
||||||||
Cash and cash equivalents
|
||||||||
Beginning of period
|
68,648
|
3,091
|
||||||
|
||||||||
End of period
|
$
|
4,387
|
$
|
66,852
|
SUPPLEMENTAL DISCLOSURES
|
||||||||
Interest Paid
|
$
|
8,318
|
$
|
8,825
|
||||
NON-CASH INVESTING AND FINANCIAL DISCLOSURES
|
||||||||
Transfer to Askarii inventory
|
$
|
---
|
$
|
146,861
|
||||
Settlement of accrued accounts payable through share issuance
|
---
|
42,000
|
||||||
Purchase of Askarii
|
---
|
50,000
|
||||||
Initial recognition of asset retirement obligation
|
101,405
|
---
|
||||||
Settlement of accounts receivable and other assets for oil and gas properties
|
465,788
|
---
|
||||||
Note payable for vehicle purchase
|
35,677
|
---
|
|
Warrants
|
Weighted Average
Exercise Price
|
Aggregate
intrinsic value
|
Weighted average remaining contractual life (years)
|
||||||||||||
Outstanding at year ended December 31, 2016
|
16,825,527
|
$
|
0.26
|
$
|
-
|
3.20
|
||||||||||
Granted
|
507,500
|
0.14
|
-
|
3.89
|
||||||||||||
Exercised
|
-
|
-
|
-
|
-
|
||||||||||||
Expired
|
-
|
-
|
-
|
-
|
||||||||||||
Outstanding at quarter ended March 31, 2017
|
17,333,027
|
$
|
0.26
|
$
|
432,165
|
2.38
|
|
Three months ended March 31, 2017
|
Three months ended March 31, 2016
|
||||||
Revenues
|
||||||||
Oil & Gas
|
$
|
33,560
|
$
|
22,999
|
||||
Oil field services
|
-
|
180,000
|
||||||
-
|
-
|
|||||||
Net Income (Loss)
|
||||||||
Oil & Gas
|
(459,222
|
)
|
(451,642
|
)
|
||||
Oil field services
|
(4,048
|
)
|
149,700
|
|||||
Assets
|
||||||||
Oil & Gas
|
13,057,078
|
4,140,901
|
||||||
Oil field services
|
181,593
|
116,561
|
||||||
Accounts Receivable
|
||||||||
Oil & Gas
|
48,201
|
67,682
|
||||||
Oil field services
|
$
|
-
|
$
|
-
|
●
|
The sale prices of crude oil;
|
●
|
The amount of production from oil wells in which we have an interest;
|
●
|
Lease operating expenses;
|
●
|
International conflict or acts of terrorism;
|
●
|
General economic conditions; and
|
●
|
Other factors disclosed in this report.
|
Cash provided (used) in operations
|
$
|
(189,796
|
)
|
|
Proceeds from shareholder and affiliate advances
|
126,500
|
|
PETROLIA ENERGY CORPORATION
|
|
|
|
|
|
|
May 15, 2017
|
By:
|
/s/ Zel C. Khan
|
|
|
|
Zel C. Khan
|
|
|
|
Chief Executive Officer
|
|
|
|
(Principal Executive Officer
|
|
|
PETROLIA ENERGY CORPORATION
|
|
|
|
|
|
|
May 15, 2017
|
By:
|
/s/ Paul Deputy
|
|
|
|
Paul Deputy
|
|
|
|
Chief Financial Officer
|
|
|
|
(Principal Financial and Accounting Officer
|
|
Date of Conversion:
Number of Preferred Shares Held by Holder:
Prior to Conversion:
Amount Being Converted Hereby:
Common Stock Shares Due:________________
Preferred Shares Held After Conversion:
|
If stock certificates are to be issued, in the following name and to the following address:
|
If DWAC is permissible, to the following brokerage account:
|
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
|
Broker: ____________________________________
DTC No.:
___________________________________
Acct. Name:
_________________________________
For Further Credit (if applicable):
____________________________________
|
_______________________________________
(Print Name of Holder)
By/Sign: _______________________________
Print Name: ____________________________
Print Title: _____________________________
|
PROJECTS
|
USE OF PROCEEDS
|
|||
TLSAU Development Plan (Phase 1)
|
$
|
500,000.00
|
||
SUDS Development Plan (Phase II)
|
$
|
500,000.00
|
||
Noack Development Plan (Phase I)
|
$
|
100,000.00
|
||
Working Capital and Offering fees
|
$
|
900,000.00
|
Issuer:
|
Petrolia Energy Corporation., a Texas corporation (the “Company”) having an address of 710 N Post Oak Road, Suite 512, Houston, Texas 77024.
|
||||||||
Amount of Financing:
|
$2,000,000.00 (two million dollars) unless increased by the Company in its discretion, without notice to prior investors.
|
||||||||
Proposed Offering:
|
The Series A Preferred Stock will be sold in a private placement exempt from registration pursuant to Section 4(a)(2) and/or Rule 506 of the Securities Act of 1933, as amended (the “Securities Act”), to only ‘accredited investors’ as such term is defined in the Securities Act.
|
||||||||
Type of Securities:
|
Shares of Series A Convertible Preferred Stock (the “Series A Preferred Stock”), initially convertible into shares of common stock of the Company (“Common Stock”) on a 71.428571-for-one basis (i.e., the equivalent number of shares as would be due, based on the Original Purchase Price, if converted into common stock based on the market value of the Company’s common stock on April 11, 2017, which trading value was $0.14 per share).
|
||||||||
Price Per Share:
|
$10.00 (ten dollars) (the “Original Purchase Price”).
|
||||||||
Resulting Capitalization:
|
Existing Outstanding Common Stock
Warrant Pool
Series A Preferred Stock (after conversion)
--------------------------------------------------------
Total Fully Diluted Common Stock Post-Offering
|
79,034,505
17,035,527
14,285,714
--------------
110,355,746
|
71.6%
15.4%
13.0%
--------
100.0
|
%
|
|||||
Eligible Investors:
|
Accredited investors located in New York, Texas, California and Oklahoma.
|
Dividends:
|
The holders of Series A Preferred Stock shall be entitled to receive non-cumulative dividends in preference to any dividend paid on the Common Stock at the rate of 9% of the Series A Preferred Stock Original Purchase Price per annum, paid in cash on a semi-annual basis. The Series A Preferred Stock will also participate pro-rata, on an as-converted basis, in cash dividends paid on the Common Stock.
|
Liquidation Preference:
|
In the event of any liquidation, dissolution or winding up of the Company, the holders of the Series A Preferred Stock shall be entitled to receive, in preference to the holders of Common Stock, an amount equal to the Original Purchase Price, together with any declared but unpaid dividends.
The remaining assets will be distributed ratably among the holders of Common Stock.
|
Optional Conversion:
|
The holders of the Series A Preferred Stock shall have the right to convert the Series A Preferred Stock and accrued dividends thereon, at the option of the holder, at any time, into shares of Common Stock of the Company.
|
Automatic Conversion:
|
The Series A Preferred Stock and all accrued and unpaid dividends thereon shall be automatically converted into Common Stock, at the then applicable conversion price, upon the earliest to occur of (i) the holders of a majority of the Series A Preferred Stock then outstanding consenting to such conversion; (ii) the closing of a registered public offering of the Company’s Common Stock, but only if the price per share is at least $0.30 (subject to anti-dilution, recapitalization, and reorganization adjustments) and the gross proceeds of the offering to the Company equal or exceed $10 million (a “Qualified Public Offering”); (iii) the five year anniversary of the closing date; or (iv) the average closing price per share of the Company’s Common Stock as reported on a national securities exchange, NASDAQ, the OTCQX, the OTCQB, the OTCQX or the OTC Pink market, equals or exceeds $0.28 per share (as adjusted for any recapitalizations) during any period of thirty (30) consecutive trading days.
|
Anti-Dilution Protection:
|
The conversion price of the Series A Preferred Stock will be subject to proportional adjustment for stock splits, stock dividends, recapitalizations, and the like.
|
Voting Rights:
|
The Series A Preferred Stock will vote together with the Common Stock and not as a separate class except as specifically provided herein under “Protective Provisions” or as otherwise required by law. Each share of Series A Preferred Stock shall have a number of votes equal to the number of shares of Common Stock then issuable upon the conversion of such share of Series A Preferred Stock, subject to the Beneficial Ownership Limitation described below.
|
Protective Provisions:
|
As long as at least 20% of the original shares of the Series A Preferred Stock issued remain outstanding, consent of the holders of a majority of the Series A Preferred Stock then outstanding shall be required for any action which (i) increases or decreases the authorized number of shares of Series A Preferred Stock; or (ii) creates (by reclassification or otherwise) any new series or shares of capital stock having rights, preferences, or privileges senior to or on a parity with the Series A Preferred Stock.
|
Piggyback Registration Rights:
|
The Company covenants and agrees that if, at any time prior to the Registration Rights Expiration Date (defined below), it proposes to file a registration statement with respect to any class of equity or equity-related securities (other than in connection with an offering to the Company’s employees or in connection with an acquisition, merger or similar transaction) under the Securities Act in a primary registration on behalf of the Company and/or in a secondary registration on behalf of holders of such securities, and the registration form to be used may be used for the issuance or resale of the shares of common stock issuable upon conversion of the Series A Preferred Stock (collectively, the “Registrable Securities”), the Company will either include the Registrable Securities in such registration statement or give prompt written notice to the holders of its intention to file such registration statement and will offer to include in such registration statement, such number of Registrable Securities with respect to which the Company has received written requests for inclusion therein within twenty (20) days after the giving of notice by the Company (the “Piggyback Registration Rights”). The holders shall also be required to provide the Company customary and reasonable representations and confirmations regarding the Registrable Securities held by the holders, information relating to the beneficial ownership of other securities of the Company held by such holders, information regarding the persons with voting and dispositive control over the holder and such other information as the Company or its legal counsel may reasonably request. The Company shall not be required to include Registrable Securities in a registration statement relating solely to an offering by the Company of securities for its own account if the managing underwriter or placement agent shall have advised the Company in writing that the inclusion of such securities will have a material adverse effect upon the ability of the Company to sell securities for its own account, and provided further that the holders are not treated less favorably than others seeking to have their securities included in such registration statement. Notwithstanding the obligations set forth above, if any Securities and Exchange Commission guidance sets forth a limitation on the number of securities permitted to be registered on a particular registration statement as a secondary offering, the number of Registrable Securities to be registered on such registration statement will be reduced pro rata between the holders (or other parties) whose securities are included in such registration statement. The “Registration Rights Expiration Date” is the earlier of (a) two years from the closing date; and (b) the date that the investors are eligible to sell the Registrable Securities under Rule 144.
|
Ownership Limitation:
|
The Series A Preferred Stock will contain a blocker prohibiting the conversion of the Series A Preferred Stock into Common Stock of the Company, if upon such conversion/exercise the holder thereof would beneficially own more than 4.99% of the Company’s then outstanding Common Stock, provided such limitation shall not apply in the event of an automatic conversion of the Series A Preferred Stock (the “Beneficial Ownership Limitation”). The Beneficial Ownership Limitation shall also limit the voting rights of any holders of the Series A Preferred Stock. The Beneficial Ownership Limitation may be waived by any holder with 61 days prior written notice to the Company.
|
Recapitalizations:
|
If at any time while the Series A Preferred Stock is outstanding, there shall occur any capital reorganization, recapitalization, reclassification, share exchange, restructuring, consolidation, combination or merger (subject to certain standard exceptions) involving the Company in which the Common Stock (but not the Series A Preferred Stock) is converted into or exchanged for shares of stock or other securities or property (including cash) of the Company or otherwise, a provision shall be made so that each Series A Preferred Stock holder will be entitled to receive upon conversion of the shares of Series A Preferred Stock held by such holder the kind and number of shares of stock or other securities or property (including cash or any combination thereof) of the Company or otherwise, to which a holder holding the number of shares of Common Stock into which the shares of Series A Preferred Stock held by such Series A Preferred Stock holder are convertible immediately prior to such reorganization, recapitalization, reclassification, consolidation or merger would have been entitled upon such event.
|
Expenses:
|
Irrespective of whether any closing or sale is effected, the Company and the investors shall each bear their own legal and other expenses with respect to the transaction.
|
Other Provisions:
|
The purchase agreement/subscription agreement shall include standard and customary representations and warranties of the Company and the investors, and the other agreements prepared to implement this financing shall contain other standard and customary provisions.
The Company reserves the right to terminate the offering at any time and to pay investment banking fees and other appropriate finder’s fees.
The Company reserves the right to issue additional Preferred stock to redeem existing indebtedness.
|
1.
|
Thoroughly read and review (a) the Preferred Stock Subscription Agreement attached hereto; (b) the term sheet, attached hereto as
Exhibit A
; (c) the draft designation of the rights and preferences of the Series A Convertible 9% Preferred Stock, attached hereto as
Exhibit B
; and (c) the Information for Residents of Certain States, attached hereto as
Exhibit C
.
|
2.
|
Complete page 2, being certain to indicate, your name, entity type, the number of Shares you will purchase and the total purchase price.
|
3.
|
Complete and execute pages 13 to 18 (as applicable), and 19 to 26, as applicable. These pages must be fully completed as applicable and signed.
|
4.
|
Wire funds to the Company:
|
5.
|
FedEx original signature pages to:
|
— |
Partnerships
provide a copy of the partnership agreement, as amended to date, showing the date of formation and giving evidence of the authority of the person(s) signing the subscription documentation to do so.
|
—
|
Corporations
provide a copy and the filing date of the articles of incorporation and bylaws, as amended to date, and a corporate resolution authorizing the purchase of the Shares and giving authority to the person(s) signing the subscription documents to do so.
|
—
|
Limited Liability Companies
provide a copy and the filing date of the articles of organization and operating agreement, as amended to date, and a resolution authorizing the purchase of the Shares and giving authority to the person(s) signing the subscription documents to do so.
|
—
|
Trusts
provide a copy of the trust agreement as amended to date, showing the date of formation and giving evidence of the authority of the person(s) signing the subscription documentation to do so.
|
(a) |
A bank, as defined in Section 3(a)(2) of the Securities Act of 1933, as amended (the “
Act,
” the “
Securities Act
” or the “
1933 Act
”) or a savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act of 1933, whether acting in an individual or a fiduciary capacity;
|
(b) |
An insurance company, as defined in Section 2(13) of the Securities Act of 1933;
|
(c) |
An investment company registered under the Investment Company Act of 1940;
|
(d) |
A business development company, as defined in Section 2(a) (48) of the Investment Company Act of 1940;
|
(e) |
A small business investment company licensed by the U.S. Small Business Administration under Section 301(c) or (d) of the Small Business Investment Act of 1958;
|
(f) |
An employee benefit plan within the meaning of Title I of the Employee Retirement Income Security Act of 1974 and the investment is made by Subscriber as a plan fiduciary, as defined in Section 3(21) of such Act, and Subscriber is a bank, insurance company or a registered investment advisor, or has total assets in excess of $5 million;
|
(g) |
A private business development company as defined in Section 202(a) (22) of the Investment Advisers Act of 1940;
|
(h) |
An organization described in Section 501 (c)(3) of the Internal Revenue Code, a corporation, a Massachusetts or similar business trust, or a partnership, not formed for the specific purpose of acquiring Securities, with total assets in excess of $5 million;
|
(i) |
An irrevocable trust with total assets in excess of $5,000,000 not formed for the specific purpose of acquiring Securities, whose purchase is directed by a person with such knowledge and experience in financial and business matters that (s)he is capable of evaluating the merits and risks of the prospective investment;
|
(j) |
A revocable trust that is revocable by its grantors, each of whose grantors is an accredited investor, qualifies as an accredited investor for the purposes of the subscription (each grantor should complete the individual accredited information questionnaire, and describe the fact that they are grantors of the trust on such individual questionnaire below); or
|
(k) |
An entity
in which all of the equity owners are Accredited
Investors; or
|
• |
Any natural person resident in the United States;
|
• |
Any partnership or corporation organized or incorporated under the laws of the United States;
|
• |
Any estate of which any executor or administrator is a U.S. person;
|
• |
Any trust of which any trustee is a U.S. person;
|
• |
Any agency or branch of a foreign entity located in the United States;
|
• |
Any non-discretionary account or similar account (other than an estate or trust) held by a dealer or other fiduciary for the benefit or account of a U.S. person;
|
• |
Any discretionary account or similar account (other than an estate or trust) held by a dealer or other fiduciary organized, incorporated, or (if an individual) resident in the United States; and
|
• |
Any partnership or corporation if organized or incorporated under the laws of any foreign jurisdiction; and formed by a U.S. person principally for the purpose of investing in securities not registered under the Act, unless it is organized or incorporated, and owned, by accredited investors (as defined in Rule 501(a)) who are not natural persons, estates or trusts;
|
(a)
|
Subscriber is in receipt of and has carefully and thoroughly read and reviewed and understands (i) the term sheet, attached hereto as
Exhibit A
; (ii) the draft designation of the rights and preferences of the Series A Convertible 9% Preferred Stock, attached hereto as
Exhibit B
; and (iii) the Information for Residents of Certain States, attached hereto as
Exhibit C
.
|
(b)
|
Prior to the Subscriber’s entry into this Agreement, Subscriber has had an opportunity to review the Company’s reports, schedules, forms, statements and other documents filed by the Company with the United States Securities and Exchange Commission (the “
SEC Reports
”) (which filings can be accessed by going to
http://www.sec.gov/edgar/searchedgar/companysearch.html
, typing
Petrolia
” in the “
Company name
” field, and clicking the “
Search
” button), including, but not limited to the Company’s latest Annual Report on Form 10-K and Quarterly Report on Form 10-Q, as well as its Current Reports on Form 8-K that have been filed since its latest periodic report filing.
|
(c) |
The Subscription hereunder is irrevocable by Subscriber, and, except as required by law, Subscriber is not entitled to cancel, terminate or revoke this Agreement or any agreements of Subscriber hereunder and that this Subscription Agreement and such other agreements shall survive the death or disability of Subscriber and shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors, legal representatives and permitted assigns. If Subscriber is more than one person, the obligations of Subscriber hereunder shall be joint and several and the agreements, representations, warranties and acknowledgments herein contained shall be deemed to be made by and be binding upon each such person and his or her heirs, executors, administrators, successors, legal representatives and permitted assigns.
|
(d) |
No federal or state agency has made any findings or determination as to the fairness of the terms of this Offering for investment purposes; or any recommendations or endorsements of the Securities.
|
(e) |
The Offering is intended to be exempt from registration under the Securities Act by virtue of Section 4(a)(2) of the Securities Act and the provisions of Rule 506(b) of Regulation D and/or Regulation S thereunder, which is in part dependent upon the truth, completeness and accuracy of the statements made by the Subscriber herein.
|
(f) |
It is understood that in order not to jeopardize the Offering’s exempt status under Section 4(a)(2) and/or Rule 506(b) of the Securities Act and Regulation D or Regulation S, any transferee may, at a minimum, be required to fulfill the investor suitability requirements thereunder.
|
(g) |
The Company may pay broker’s, finder’s or similar fees of up to 10% of the total gross amount of the Offering.
|
(h) |
Subscriber, as required by the Internal Revenue Code, certifies under penalty of perjury that 1) the Social Security Number or Federal Identification Number provided below is correct and 2) Subscriber is not subject to backup withholding either because Subscriber has not been notified that Subscriber is subject to backup withholding as a result of a failure to report interest or dividends, or because the Internal Revenue Service has notified Subscriber that Subscriber is no longer subject to backup withholding.
|
(i) |
IN MAKING AN INVESTMENT DECISION, SUBSCRIBER MUST RELY ON HIS, HER, OR ITS OWN EXAMINATION OF THE COMPANY AND THE TERMS OF THE OFFERING, INCLUDING THE MERITS AND RISKS INVOLVED. THE SECURITIES HAVE NOT BEEN RECOMMENDED BY ANY FEDERAL OR STATE SECURITIES COMMISSION OR REGULATORY AUTHORITY. ANY REPRESENTATION TO THE CONTRARY IS A CRIMINAL OFFENSE.
|
(j) |
THIS SUBSCRIPTION DOES NOT CONSTITUTE AN OFFER OR SOLICITATION IN ANY STATE OR JURISDICTION IN WHICH SUCH AN OFFER OR SOLICITATION IS NOT PERMITTED UNDER APPLICABLE LAW OR TO ANY FIRM OR INDIVIDUAL THAT DOES NOT POSSESS THE QUALIFICATIONS PRESCRIBED IN THIS SUBSCRIPTION.
|
INDIVIDUAL OWNERSHIP (one signature required)
|
JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign)
|
COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names)
|
TENANTS IN COMMON (both or all parties must sign)
|
GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement)
|
LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER autho-rized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized)
|
LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agreement and any other documents necessary to show the investment is authorized.)
|
CORPORATION (fill out all documents in the name of the CORPORATION, by the President or other officer authorized to sign, and include a copy of the Corporation’s Articles and certified Corporate Resolution authorizing the signature)
|
TRUST (fill out all documents in the name of the TRUST, by the Trustee, and include a copy of the instrument creating the trust and any other documents necessary to show the investment by the Trustee is authorized. The date of the trust must appear on the Notarial where indicated.)
|
1. | Name: |
3.
|
Social Security Number:_____________________
|
5.
|
I prefer to have communications sent to:
|
(a) | Ownership of stocks, bonds, and other securities |
(b) | Investment in partnerships, joint ventures and other syndicates |
(c) | Other direct or partnership investments (such as real estate, oil and gas, equipment leasing, research and development, agriculture or commodities syndications) |
7. |
Method of Investment Evaluation
|
☐ |
have a net worth (either individually or jointly with spouse) in excess of $1,000,000 in United States Dollars (“
USD
”) (not including my principal residence); or
|
☐ |
am an individual who had an individual income (NOT including joint income with spouse) in excess of USD $200,000 in each of the two most recent tax years and reasonably expects individual income in excess of $200,000 during the current tax year; or
|
2. |
Business
|
3. |
Accredited Investor Status of Entity
|
_____ (a) |
A bank, as defined in Section 3 (a)(2) of the Securities Act of 1933, or any savings and loan association or other institution as defined in Section
3(a)(5)(A)
of the Securities Act of 1933, whether you are acting in an individual or a fiduciary capacity.
|
_____ (b) |
An insurance company, as defined in Section 2(13) of theSecurities Act of 1933.
|
_____ (c) |
An investment company registered under the Investment Company Act of 1940.
|
_____ (d) |
A business development company, as defined in Section (a)(48) of the Investment Company Act of 1940.
|
_____ (e) |
A small business investment company licensed by the U.S. Small Business Administration under Section 301(c) or (d) of the Small Business Investment Act of 1958.
|
_____ (f) |
An employee benefit plan within the meaning of Title I of the Employee Retirement Income Security Act of 1974 and the investment is made by you as a plan fiduciary, as defined in Section 3(21) of such Act, and you are a bank, insurance company or a registered investment advisor, or you have total assets in excess of $5 million.
|
_____ (g) |
A private business development company as defined in Section 202(a)(22) of the Investment Advisers Act of 1940.
|
_____ (h) |
An organization described in Section 501 (c)(3) of the Internal Revenue Code, a corporation, a Massachusetts or similar business trust, or a partnership, not formed for the specific purpose of acquiring Securities, with total assets in excess of $5
million.
|
_____ | (i) | An entity (other than a trust, which must meet the requirements set forth in Section (j), below) in which all of the equity owners are accredited investors and meet at least one of the criteria listed in Part I, Section 8 of this Questionnaire. |
_____ (j) |
A trust with total assets in excess of $5,000,000 not formed for the specific purpose of acquiring Securities, whose purchase is directed by a person with such knowledge and experience in financial and business matters that (s)he is capable of evaluating the merits and risks of the prospective investment.
|
(4) |
Represent that each equity owner qualifies individually to Part I, Section 9 of this Questionnaire by printing each equity owners name below (you may include an additional sheet if necessary):
|
(5) |
Please confirm that the entity was not formed solely for the purpose of subscribing for Securities in the Offering by initialing below:
|
4. |
Non “U.S. Person Status”
|
________ |
The Entity is organized and has a principal place of business outside of the United States and is not a “
U.S. person
” as such term is defined under Regulation S as promulgated by the SEC under authority of the 1933 Act. The Entity was not solicited for an investment in the Offering by the Company or any person or entity acting on its behalf within the United States and has not entered into the Subscription Agreement inside the United States. To enable the Company to avoid withholding interest paid, the Entity certifies under penalty of perjury that it is neither a citizen nor a resident of the United States and that its address set forth above is correct. At the time the buy order for the Securities was originated, Subscriber was outside the United States. Subscriber is purchasing the Securities for its own account and not on behalf of any U.S. person, and the sale has not been pre-arranged with a purchaser in the United States. The Entity further agrees to comply with Regulation S of the 1933 Act.
|
(1) |
The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and
|
(2) |
The information contained in the Report fairly presents, in all material respects the financial condition and results of operations of the Company.
|
(1) |
The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and
|
(2) |
The information contained in the Report fairly presents, in all material respects the financial condition and results of operations of the Company.
|