-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, WAupTyGHYtPpxl5DVLmXeGKrLG9piQV1aPXU1RDpg4N+BAGELWAZbLGki7CzXWCp SjGSiRtG92T9XwNDg81KeQ== 0000950123-11-009157.txt : 20110204 0000950123-11-009157.hdr.sgml : 20110204 20110204135701 ACCESSION NUMBER: 0000950123-11-009157 CONFORMED SUBMISSION TYPE: SC 13D/A PUBLIC DOCUMENT COUNT: 2 FILED AS OF DATE: 20110204 DATE AS OF CHANGE: 20110204 GROUP MEMBERS: RIO TINTO INTERNATIONAL HOLDINGS LIMITED SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: IVANHOE MINES LTD CENTRAL INDEX KEY: 0001158041 STANDARD INDUSTRIAL CLASSIFICATION: METAL MINING [1000] IRS NUMBER: 000000000 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-79590 FILM NUMBER: 11573827 BUSINESS ADDRESS: STREET 1: SUITE 654 STREET 2: 999 CANADA PLACE CITY: VANCOUVER STATE: A1 ZIP: V6C 3E1 BUSINESS PHONE: 604 688 5755 MAIL ADDRESS: STREET 1: 654-999 CANADA PLACE CITY: VANCOUVER BC CANADA STATE: A1 ZIP: V6C 3E1 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: RIO TINTO PLC CENTRAL INDEX KEY: 0000863064 STANDARD INDUSTRIAL CLASSIFICATION: METAL MINING [1000] IRS NUMBER: 000000000 STATE OF INCORPORATION: X0 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D/A BUSINESS ADDRESS: STREET 1: 2 EASTBOURNE TERRACE CITY: LONDON, W2 6LG STATE: X0 ZIP: 00000 BUSINESS PHONE: 44 20 7781 1623 MAIL ADDRESS: STREET 1: RIO TINTO SERVICES INC. STREET 2: 80 STATE STREET CITY: ALBANY STATE: NY ZIP: 12207-2543 FORMER COMPANY: FORMER CONFORMED NAME: RTZ CORPORATION PLC DATE OF NAME CHANGE: 19950522 SC 13D/A 1 u10566sc13dza.htm SC 13D/A sc13dza
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13D/A
Under the Securities Exchange Act of 1934
(Amendment No. 10)*
Ivanhoe Mines Ltd.
 
(Name of Issuer)
Common Shares, without par value
 
(Title of class of securities)
46579N
 
(CUSIP Number)
Ben Mathews
Rio Tinto plc
2 Eastbourne Terrace
London W2 6LG
United Kingdom
+44 (0) 20 7781 2058
 
(Name, Address and Telephone Number of Person Authorised to Receive Notices and Communications)
with copy to:
Thomas B. Shropshire, Jr.
Linklaters LLP
One Silk Street
London EC2Y 8HQ
United Kingdom
+44 (0) 20 7456 3223
February 2, 2011
 
(Date of Event which Requires Filing of this Statement)
If the filing person has previously filed a statement on Schedule 13G to report the acquisition that is the subject of this Schedule 13D, and is filing this schedule because of §§ 240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the following box. o
Note: Schedules filed in paper format shall include a signed original and five copies of the schedule, including all exhibits.
See § 240.13d-7 for other parties to whom copies are to be sent.
 
*   The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page.
The information required on the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
 
 


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CUSIP No.
 
46579N 
 

 

           
1   NAME OF REPORTING PERSON.

Rio Tinto plc
     
     
2   CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS)

  (a)   o 
  (b)   þ (See Item 4) 
     
3   SEC USE ONLY
   
   
     
4   SOURCE OF FUNDS (SEE INSTRUCTIONS)
   
  WC
     
5   CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEM 2(d) OR 2(e)
   
  o
     
6   CITIZENSHIP OR PLACE OF ORGANISATION
   
  England and Wales
       
  7   SOLE VOTING POWER
     
NUMBER OF   0
       
SHARES 8   SHARED VOTING POWER
BENEFICIALLY    
OWNED BY   356,253,920 (see Items 3 and 5)
       
EACH 9   SOLE DISPOSITIVE POWER
REPORTING    
PERSON   0
       
WITH 10   SHARED DISPOSITIVE POWER
     
    356,253,920 (see Items 3 and 5)
     
11   AGGREGATE AMOUNT BENEFICIALLY OWNED BY REPORTING PERSON
   
  356,253,920 (see Items 3 and 5)
     
12   CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
   
  o
     
13   PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
   
  48.5 per cent (see Item 5)
     
14   TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
   
  HC, CO

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CUSIP No.
 
46579N 
 

 

           
1   NAME OF REPORTING PERSON.

Rio Tinto International Holdings Limited
     
     
2   CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS)

  (a)   o 
  (b)   þ (See Item 4) 
     
3   SEC USE ONLY
   
   
     
4   SOURCE OF FUNDS (SEE INSTRUCTIONS)
   
  AF
     
5   CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEM 2(d) OR 2(e)
   
  o
     
6   CITIZENSHIP OR PLACE OF ORGANISATION
   
  England and Wales
       
  7   SOLE VOTING POWER
     
NUMBER OF   0
       
SHARES 8   SHARED VOTING POWER
BENEFICIALLY    
OWNED BY   356,253,920 (see Items 3 and 5)
       
EACH 9   SOLE DISPOSITIVE POWER
REPORTING    
PERSON   0
       
WITH 10   SHARED DISPOSITIVE POWER
     
    356,253,920 (see Items 3 and 5)
     
11   AGGREGATE AMOUNT BENEFICIALLY OWNED BY REPORTING PERSON
   
  356,253,920 (see Items 3 and 5)
     
12   CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
   
  o
     
13   PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
   
  48.5 per cent (see Item 5)
     
14   TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
   
  HC, CO

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Item 1. "Security and Issuer
Item 3. Source and Amount of Funds or Other Consideration
Item 5. Interest in Securities of the Issuer
Item 7. Materials to be Filed as Exhibits
SIGNATURES
EXHIBIT INDEX
EX-99.A


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Item 1. Security and Issuer
This Amendment No. 10 to Schedule 13D amends and supplements the statement on Schedule 13D originally filed by Rio Tinto plc (“Rio Tinto”) and Rio Tinto International Holdings Limited (“RTIH”) on November 3, 2006, and amended on September 12, 2007, October 26, 2007, January 7, 2008, April 10, 2008, October 30, 2009, March 4, 2010, July 7, 2010, September 13, 2010, and December 14, 2010 (as amended and supplemented, the “Schedule 13D”) with the Securities and Exchange Commission (the “SEC”), relating to the common shares, without par value (the “Shares”), of Ivanhoe Mines Ltd., a corporation continued under the laws of the Yukon Territory, Canada (the “Company”).
Item 3. Source and Amount of Funds or Other Consideration
Item 3 of the Schedule 13D is amended and supplemented as follows:
The Company concluded the Rights Offering on February 2, 2011, and pursuant to the December 2010 Heads of Agreement:
(i)   on February 2, 2010, following the completion of the Rights Offering, RTIH acquired 34,387,776 Shares at US$13.88 per Share or US$477,302,330.88 in aggregate;
 
(ii)   RTIH’s existing Warrants were amended as a result of the Rights Offering so that the number of Shares acquirable upon the exercise of the Series B Warrants is 14,070,182 at an exercise price of US$8.43, of the Series C Warrants is 40,224,365 at an exercise price of US$9.49 and the Type B, Series 1 Warrants is 827,706 at an exercise price of Cdn$2.9853; and
 
(iii)   on February 3, 2010, RTIH acquired 1,500,000 Citi Additional Shares at US$13.88 per Share or US$20,820,000 in aggregate.
The funds for the purchase of the Shares pursuant to the Rights Offering and the purchase of the Citi Additional Shares were obtained by RTIH from the working capital of Rio Tinto.
Item 5. Interest in Securities of the Issuer
Item 5 of the Schedule 13D is hereby amended and restated in its entirety as follows:
The responses of Rio Tinto and RTIH to Rows (11) through (13) of the cover pages of this Schedule 13D and the information set forth in Item 3 are hereby incorporated by reference in this Item 5.
Pursuant to the Private Placement Agreement, on the First Closing Date, RTIH acquired 37,089,883 Shares, representing upon completion 9.95 per cent of the Company’s outstanding Shares, and on the Second Closing Date, RTIH acquired an additional 46,304,473 Shares. The Shares acquired were originally intended to produce an aggregate interest of 19.9 per cent of the Company’s outstanding Shares but, as a result of Share issues under employee share plans, the aggregate interest has been diluted to 19.7 per cent of the Company’s outstanding Shares. Pursuant to RTIH’s anti-dilution rights under the Private Placement Agreement (as described in Item 4), RTIH also acquired on December 4, 2008 an additional 243,772 Shares, Type A, Series 1 warrants having the same expiry date as the Series A Warrants and which were exercisable to purchase an additional 720,203 Shares at a price of Cdn$3.1465 per share and Type B, Series 1 Warrants having the same expiry date as the Series B Warrants and which are exercisable to purchase an additional 720,203 Shares at a price of Cdn$3.1465 per share.

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Also pursuant to the Private Placement Agreement, on the First Closing Date, RTIH acquired the Series A Warrants and the Series B Warrants which are exercisable to purchase an additional 92,053,044 Shares. On the Funding Date, RTIH acquired the Series C Warrants which are exercisable to purchase an additional 35,000,000 Shares.
Pursuant to the Acquisition, RTIH acquired 15,000,000 Shares, representing upon issuance 2.7 per cent of the outstanding Shares.
Pursuant to the exercise of the Series A Warrants, RTIH acquired 46,026,522 Shares.
Pursuant to the conversion of the Loan Amount at a price of US$10 per share on September 13, 2010, RTIH acquired 40,083,206 Shares.
Pursuant to the exercise of the Type A, Series 1 Warrants, RTIH acquired 720,203 Shares.
Pursuant to the exercise of the 33,783,784 Series B Warrants and completion of the purchase of the RMF Shares and the Citi Base Shares, RTIH acquired 53,783,784 Shares.
Pursuant to the Rights Offering RTIH acquired 34,387,776 Shares at a price of US$13.88 per Share, and pursuant to the December 2010 Heads of Agreement RTIH acquired 1,500,000 Citi Additional Shares at a price US$13.88 per Share.
Therefore, each of Rio Tinto and RTIH is deemed to beneficially own 356,253,920 Shares which, assuming the exercise of the remaining Series B Warrants, Series C Warrants and Type B, Series 1 Warrants, the exercise of the Subscription Right , in addition to the 37,089,883 Shares acquired by RTIH on the First Closing Date, the 46,304,473 Shares acquired by RTIH on the Second Closing Date, 243,772 Shares acquired by RTIH on December 4, 2008, the 15,000,000 Shares from the completion of the Acquisition, the 46,026,522 Shares acquired by RTIH pursuant to the exercise of the Series A Warrants, the 40,083,206 Shares conversion acquired following the conversion of the Loan Amount, the 720,203 Shares acquired by RTIH pursuant to the exercise of the Type A, Series 1 Warrants, the exercise of 33,783,784 Series B Warrants, completion of the purchase of 10,000,000 RMF Shares and 10,000,000 Citi Base Shares, the 34,387,776 Shares from the completion of the Rights Issue and the purchase of 1,500,000 Citi Additional Shares, would represent 48.5 per cent of the Company’s outstanding Shares on a fully diluted basis.
The percentage of the class of securities identified pursuant to Item 1 beneficially owned by each of Rio Tinto and RTIH is based on 653,428,340 Shares, which represents the number of outstanding as of the closing of the Rights Offering. Assuming the exercise of 18.8 million incentive stock options in the Company’s Shares outstanding, as contained in the Company’s Quarterly Financial Report for the Three and Nine Months Ended September 2010, each of Rio Tinto and RTIH would be deemed to beneficially own 47.3 per cent of the Company’s outstanding Shares on a fully diluted basis.
In addition, the Shares deemed beneficially owned by each of Rio Tinto and RTIH with respect to which such person (i) has sole voting power, (ii) shares voting power, (iii) has sole dispositive power and (iv) shares dispositive power are listed in the responses to Items 7, 8, 9 and 10, respectively, of the cover page of this Schedule 13D relating to such person.
Except as disclosed in this Schedule 13D, neither Rio Tinto nor RTIH nor, to the best of their knowledge, any of the persons listed in Schedule A hereto, beneficially owns any Shares or has the right to acquire any Shares.
Except as disclosed in this Schedule 13D, neither Rio Tinto nor RTIH nor, to the best of their knowledge, any of the persons listed in Schedule A hereto, presently has the power to vote or to

5


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direct the vote or to dispose or direct the disposition of any of the Shares which they may be deemed to beneficially own.
Except as disclosed in this Schedule 13D, neither Rio Tinto nor RTIH nor, to the best of their knowledge, any of the persons listed in Schedule A hereto, has effected any transaction in the Shares during the past 60 days.
To the best knowledge of Rio Tinto and RTIH, no other person has the right to receive or the power to direct the receipt of dividends from, or the proceeds from the sale of, the Shares beneficially owned by Rio Tinto and RTIH.
Item 7. Materials to be Filed as Exhibits
     
Exhibit    
Number   Description
 
   
A
  Joint Filing Agreement between Rio Tinto plc and Rio Tinto International Holdings Limited
 
   
B
  Private Placement Agreement between Ivanhoe Mines Ltd. and Rio Tinto International Holdings Limited*
 
   
C
  Shareholders’ Agreement between Robert M Friedland and Rio Tinto International Holdings Limited*
 
   
D
  Registration Rights Agreement by and between Ivanhoe Mines Ltd. and Rio Tinto International Holdings Limited*
 
   
E
  Amending Agreement between Rio Tinto International Holdings Limited and Ivanhoe Mines Ltd.**
 
   
F
  Heads of Agreement between Rio Tinto International Holdings Limited and Ivanhoe Mines Ltd.**
 
   
G
  Amending and Additional Rights Agreement between Rio Tinto International Holdings Limited and Ivanhoe Mines Ltd.***
 
   
H
  Credit Agreement between Rio Tinto International Holdings Limited and Ivanhoe Mines Ltd.***
 
   
I
  Heads Of Agreement between Ivanhoe Mines Ltd. and Rio Tinto International Holdings Limited dated December 8, 2010****
 
*   Filed as an exhibit to the original Schedule 13D on November 3, 2006.
 
**   Filed as an exhibit to the amended Schedule 13D on September 12, 2007.
 
***   Filed as an exhibit to the amended Schedule 13D on October 26, 2007.
 
****   Filed as an exhibit to the amended and restated Schedule 13D on December 14, 2010.

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SIGNATURES
After reasonable inquiry and to the best of my knowledge and belief, each of the undersigned certifies that the information set forth in this statement is true, complete and correct.
Dated: February 4, 2011
         
Rio Tinto plc    
 
       
By:
  /s/ Ben Mathews
 
Signature
   
 
       
 
  Ben Mathews / Company Secretary
 
Name/Title
   
 
       
Rio Tinto International Holdings Limited    
 
       
By:
  /s/ Ben Mathews
 
Signature
   
 
       
 
  Ben Mathews / Director
 
Name/Title
   

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SCHEDULE A
The response set forth in Schedule A of the Schedule 13D is hereby amended and restated in its entirety with the information below:
Rio Tinto plc
Directors and Executive Officers
             
    Present Principal        
Name   Occupation   Business Address   Citizenship
Directors
           
 
           
Jan du Plessis
  Chairman of Rio Tinto    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United Kingdom
 
           
Tom Albanese
  Chief Executive of Rio Tinto    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United States of America
 
           
Guy Elliott
  Finance Director of Rio Tinto    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United Kingdom
 
           
Sam Walsh
  Chief Executive of the Iron Ore Group    120 Collins Street
 Melbourne Victoria 3000
 Australia
  Australia
 
           
Robert Brown
  Company Director    1188 Sherbrooke Street
 West, Montreal, Quebec
 H3A 3G2, Canada
  Canada
 
           
Vivienne Cox
  Company Director    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United Kingdom
 
           
Sir Rod Eddington
  Company Director    120 Collins Street
 Melbourne
 Victoria 3000
 Australia
  Australia
 
           
Mike Fitzpatrick
  Company Director    120 Collins Street
 Melbourne
 Victoria 3000
 Australia
  Australia
 
           
Yves Fortier
  Company Director    1188 Sherbrooke Street
 West, Montreal, Quebec
 H3A 3G2, Canada
  Canada
 
           
Ann Godbehere
  Company Director    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  Canada and
United Kingdom
 
           
Richard Goodmanson
  Company Director    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United States of America
 
           
Andrew Gould
  Chairman and Chief Executive Officer of Schlumberger Ltd.    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United Kingdom

8


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    Present Principal        
Name   Occupation   Business Address   Citizenship
Lord Kerr
  Company Director    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United Kingdom
 
           
Paul Tellier
  Company Director    1188 Sherbrooke Street
 West, Montreal, Quebec
 H3A 3G2, Canada
  Canada
 
           
Executive Officers
           
 
           
Hugo Bagué
  Group Executive, People and Organisation    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  Belgium
 
           
Preston Chiaro
  Group Executive, Technology
& Innovation
   4700 Daybreak Parkway
 South Jordan, Utah
 84095
 United States
  United States of America
 
           
Bret Clayton
  Group Executive, Business Support and Operations    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United States of America
 
           
Jacynthe Coté
  Chief Executive of Rio Tinto Alcan    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  Canada
 
           
Andrew Harding
  Chief Executive of Rio Tinto Copper    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  Australia
 
           
Harry Kenyon-Slaney
  Chief Executive of Rio Tinto Diamonds & Minerals    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United Kingdom
 
           
Doug Ritchie
  Chief Executive of Rio Tinto Energy    3 West Tower
 410 Ann Street
 Brisbane, QLD 4000
 Australia
  Australia
 
           
Debra Valentine
  Group Executive, Legal and External Affairs    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United States of America
 
           
Sam Walsh
  Chief Executive of the Iron Ore Group    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United Kingdom
 
           
Directors
           
 
           
Dan Larsen
  Director    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United States of America
 
           
Ulf Quellmann
  Director    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  Germany

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    Present Principal        
Name   Occupation   Business Address   Citizenship
Ben Mathews
  Director    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United Kingdom
 
           
Executive Officers
           
 
           
Matthew Whyte
  Secretary    2 Eastbourne Terrace
 London W2 6LG
 United Kingdom
  United Kingdom

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EXHIBIT INDEX
     
Exhibit    
Number   Description
 
A
  Joint Filing Agreement between Rio Tinto plc and Rio Tinto International Holdings Limited
 
   
B
  Private Placement Agreement between Ivanhoe Mines Ltd. and Rio Tinto International Holdings Limited*
 
   
C
  Shareholders’ Agreement between Robert M Friedland and Rio Tinto International Holdings Limited*
 
   
D
  Registration Rights Agreement by and between Ivanhoe Mines Ltd. and Rio Tinto International Holdings Limited*
 
   
E
  Amending Agreement between Rio Tinto International Holdings Limited and Ivanhoe Mines Ltd.**
 
   
F
  Heads of Agreement between Rio Tinto International Holdings Limited and Ivanhoe Mines Ltd.**
 
   
G
  Amending and Additional Rights Agreement between Rio Tinto International Holdings Limited and Ivanhoe Mines Ltd.***
 
   
H
  Credit Agreement between Rio Tinto International Holdings Limited and Ivanhoe Mines Ltd.***
 
   
I
  Heads Of Agreement between Ivanhoe Mines Ltd. and Rio Tinto International Holdings Limited dated December 8, 2010****
 
*   Filed as an exhibit to the original Schedule 13D on November 3, 2006.
 
**   Filed as an exhibit to the amended Schedule 13D on September 12, 2007.
 
***   Filed as an exhibit to the amended Schedule 13D on October 26, 2007.
 
****   Filed as an exhibit to the amended and restated Schedule 13D on December 14, 2011.

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EX-99.A 2 u10566exv99wa.htm EX-99.A exv99wa
EXHIBIT A
JOINT FILING AGREEMENT
The undersigned hereby agree that the Statement on Schedule 13D, dated November 3, 2006, with respect to the common shares, without par value, of Ivanhoe Mines Ltd. is, and any amendments thereto executed by each of us shall be, filed on behalf of each of us pursuant to and in accordance with the provisions of Rule 13d-1(k)(1) under the Securities and Exchange Act of 1934, as amended, and that this Agreement shall be included as an Exhibit to the Schedule 13D and each such amendment. Each of the undersigned agrees to be responsible for the timely filing of the Schedule 13D and any amendments thereto, and for the completeness and accuracy of the information concerning itself contained therein. This Agreement may be executed in any number of counterparts, all of which taken together shall constitute one and the same instrument.
IN WITNESS WHEREOF, the undersigned have executed this Agreement as of the 3rd day of November, 2006.
         
  Rio Tinto plc
 
 
  By:   /s/ Anette V Lawless    
    Signature   
 
    Anette V Lawless / Director   
    Name/Title   
 
  Rio Tinto International Holdings Limited
 
 
  By:   /s/ Anette V Lawless    
    Signature   
 
    Anette V Lawless / Director   
    Name/Title   
 

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