EX-5 7 micromem5.htm INSIDER REPORT FOR MANOJ PUNDIT Micromem Technologies Inc.: Form 55 - Prepared by TNT Filings
FORM 55-102F6
Notice - Collection and Use of Personal Information: The personal information required under this form is collected on behalf of and used by the securities regulatory authorities set out below for purposes of the administration and enforcement of certain provisions of the securities legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia and Newfoundland. Some of the required information will be made public pursuant to the securities legislation in each of the jurisdictions indicated above. Other required information will remain confidential and will not be disclosed to any person or company except to any of the securities regulatory authorities or their authorized representatives If you have any questions about the collection and use of this information, you may contact the securities regulatory authority in any jurisdiction(s) in which the required information is filed, at the address(es) or telephone number(s) set out on the back of this report.
 
INSIDER REPORT
 
(See instructions on the back of this report)
 
BOX 1. NAME OF THE REPORTING ISSUER (BLOCK LETTERS)       BOX 3. NAME, ADDRESS AND TELEPHONE NUMBER OF THE INSIDER (BLOCK LETTERS)   BOX 4. JURISDICTION(S) WHERE THE ISSUER IS A REPORTING ISSUER OR THE EQUIVALENT
MICROMEM TECHNOLOGIES INC. FAMILY NAME OR CORPORATE NAME
PUNDIT
GIVEN NAMES ALBERTA
MANOJ ONTARIO
              NO. STREET     APT   BRITISH COLUMBIA  
BOX 2. INSIDER DATA 146 GLENGARRY DRIVE                                                        1910

QUEBEC

CITY MANITOBA
RELATIONSHIP(S) TO REPORTING ISSUERS DATE OF LAST REPORT FILED DD MM YY TORONTO SASKATCHEWAN
    OR 5 3 2001   PROV   POSTAL CODE NEWFOUNDLAND  

5

        ONTARIO   M5M 1E2    
    DD MM YY   BUSINESS TELEPHONE NUMBER CHANGE IN NAME, NUMBER OR TELEPHONE NUMBER FROM LAST REPORT Yes No NOVA SCOTIA  
CHANGE IN RELATIONSHIP FROM LAST REPORT

YES

NO

IF INITIAL REPORT DATE YOU BECAME AN INSIDER         416-368-6200    
              BUSINESS FAX NUMBER    
              416-368-0300    

BOX 5. INSIDER HOLDINGS AND CHANGES (IF INITIAL REPORT, COMPLETE SECTIONS A D E AND F ONLY. SEE ALSO INSTRUCTIONS TO BOX 5)
    C      

A

B

TRANSACTIONS

D

E

F

           
  BALANCE OF CLASS OF SECURITIES ON LAST REPORT   PRESENT BALANCE OF CLASS OF SECURITIES HELD DIRECT /INDIRECT OWNDERSHIP / CONTROL OR DIRECTION IDENTIFY THE REGISTERED HOLDER WHERE OWNERSHIP IS INDIRECT OR WHERE CONTROL OR DIRECTION IS EXERCISED
DESIGNATION OF CLASS OF SECURITIES   DATE     NUMBER/VALUE ACQUIRED NUMBER/VALUE DISPOSED OF UNIT PRICE /EXERCISE PRICE

$ US

      NATURE  
         
  DD MM YY          
                     
COMMON SHARE OPTIONS

1,000,000

1

11

2002

97

 

500,000

7.06

X

500,000

1

 
COMMON SHARE OPTIONS

500,000

1

11

2002

97

 

500,000

3.19

X

0

1

 
COMMON SHARES

2,200

                278

2

Chitiz Pathak
COMMON SHARES

278

                2,200

1

 
                         
                         
                         
                         
                         
   
      BOX 6. REMARKS          
      options were cancelled          
ATTACHMENT YES NO          
               
This form is used as a uniform report for the insider reporting requirements under all provincial securities Acts. The terminology used is generic to accommodate the various Acts. The undersigned certifies that the information given in this report is true and complete in every respect. It is an offence to submit information that, in a material respect and at the time and in the light of the circumstances in which it is submitted, is misleading or untrue.          
         
         
               
CORRESPONDENCE ENGLISH FRENCH      
      BOX 7. SIGNATURE          
KEEP A COPY FOR YOUR FILE            
      NAME (BLOCK LETTERS) SIGNATURE   DD MM YY
      MANOJ PUNDIT SIGNATURE    "signed" DATE OF THIS REPORT 6 6 2003
BCSC 55-102F6 Rev. 2002 / 2 / 8 VERSION FRANCAISE DISPONIBLE SUR DEMANDE          
 
INSTRUCTIONS
Insider Reports in English and French are available from Manitoba, Ontario, and Quebec. If you are a corporate insider in the province of Quebec, you will receive correspondence in French. Individuals in the province of Quebec will receive, upon request, correspondence in English.     List of Codes  
BOX 5 C Nature of transaction      
General      
        Aquisition or disposition in the public market   10
Where an insider of a reporting issuer does not own or have control or direction over securities of the reporting issuer, or where an insider's ownership or direction or control over securities of the reporting issuer remains unchanged from the last report filed, a report is not required. Insider reports are not required to be filed in New Brunswick, the Northwest Territories, Nunavut, Prince Edward Island or the Yukon. Acquisition or disposition carried out privately   11
Acquisition or disposition under a prospectus   15
Acquisition or disposition under a prospectus exemption 16
Acquisition or disposition pusuant to a take-over bid, merger or acquisition 22
Acquisition or disposition under a purchase/ownership plan 30
        Stock dividend     35
If you have any questions about the form you should be using to file your report, see National Instrument 55-102 System for Electronic Disclosure by Insiders (SEDI). Conversion or exchange     36
Stock split or consolidation     37
        Redemption/retraction/cancellation/repurchase   38
BOX 1 Name of reporting issuer       Short sale     40
Provide the full legal name of the reporting issuer. Use a separate report for each reporting issuer. Compensation for property     45
Compensation for services     46
        Acquisition or disposition by gift     47
BOX 2 Insider data       Acquisition by inheritance or disposition by bequest 48
Indicate all of your relationship(s) to the reporting issuer using the following codes:   Issuer Derivatives      
Reporting issuer that has acquired securities issued by itself     1 Grant of options     50
Subsidiary of the reporting issuer     2 Exercise of options     51
        Expiration of options     52
Security holder who beneficially owns or who exercises control or direction over morethan 10% of the securities of the reporting issuer (Quebec Securities Act - 10% of a class of shares) to which are attached voting rights or an unlimited right to a share of the profits and to its assets in case of winding up  
Grant of warrants     53
    Exercise of warrants     54
  3 Expiration of warrants     55
        Grant of rights     56
Director of a reporting issuer     4 Exercise of rights     57
Senior officer of a reporting issuer     5 Expiration of rights     58
Director or senior officer of a security holder referred to in 3     6 Third Party Derivatives      
        Acquisition or disposition (writing) of third party derivative 70
Director or senior officer of an insider or subsidiary of the reporting issuer, other than in 4, 5 and 6
  7 Exercise of third party derivative     71
        Other settlement of third party derivative   72
Deemed insider - 6 months before becoming an insider     8 Expiration of third party derivative     73
If you have filed a report before, indicate whether your relationship to the reporting issuer has changed.   Miscellaneous      
  Change in nature of ownership     90
        Other     97
Specify the date of the last report you filed, and if it is an initial report, the date on which you became an insider.
  D Indicate the number of securities, or for debt securities, the aggregate nominal value, of the class held, directly and indirectly, after the transaction that is being reported.
BOX 3 Name, address and telephone number of the insider       E Indicate the nature of ownership, control or direction of the class of securities held using  
Provide your name, address and business telephone number.       the following codes:      
        Direct ownership     1
BOX 4 Jurisdiction              
Indicate each jurisdiction where the issuer is a reporting issuer or the equivalent.   Indirect ownership (identify the registered holder) 2
        Control or direction (identify the registered holder) 3
BOX 5 Insider holdings and changes       F For securities that are indirectly held, or over which control or direction is exercised, identify the registered holder.
Show direct and indirect holdings separately, both in the initial report and where a transaction is reported. Indicate only one transaction per line.          
        BOX 6 Remarks      
For an initial report complete only:       Add any explanation necessary to make the report clearly understandable.  
A designation of class of securities held       If space provided for any item is insufficient, additional sheets may be used.
D present balance of class of securities held       Additional sheets must refer to the appropriate Box and must be properly identified and signed.
E nature of ownership (see List of Codes)              
F identification of the registered holder where ownership is not direct       Office staff are not permitted to alter a report.  
           
If you acquired or disposed of securities while an insider, complete sections A to F :   BOX 7 Signature and filing      
A Indicate a designation of the securities traded that is sufficient to identify the class, including yield, Sign and date the report.      
series, maturity.              
B Indicate the number of securities, or for debt securities, the aggregate nominal value, of the class   File one copy of each of the report in each jurisdiction in which the issuer is reporting within the time limits prescribed by the applicable laws of that jurisdiction.
      Manually sign the report.      
C Indicate for each transaction:              
the date of the transaction (not the settlement date)       Legibly print or type the name of each individual signing the report.  
the nature of the transaction (see List of Codes)       If the report is filed on behalf of a company, partnership, trust or other entity, legibly print or type the name of that entity after the signature.  
the number of securities acquired or disposed of, or for debt securities, the aggregate nominal value    
        If the report is signed on behalf of an individual by an agent, there shall be filed with each jurisdiction in which the report is filed a duly completed power of attorney.  
the unit price paid or received on the day of the transaction, excluding the commission    
if the report is in American dollars, check the space under "$ US"      
        If the report is filled by facsimile in accordance with National instrument 55-102 System for Electronic Disclosure by Insiders (SEDI), the report should be sent to the applicable securities regulatory authority at the fax number set out below.
       
       
Alberta Securities Commission Securities Commission of Newfoundland Commission des valeurs mobilieres du Quebec **  
4th Floor, 300 - 4th Avenue S.W. P.O. Box 8700, 2nd Floor West Block Stock Exchange Tower  
Calgary, AB, T2P 3C4 Confederation Building     P.O. Box 246, 22nd Floor  
Attention: Information Officer * St. John's, NFLD, A1B 4J6   800 Victoria Square  
Telephone: (403) 297-6454 Attention: Director of Securities *   Montreal, PQ, H4Z 1G3  
Facsimile: (403) 297-6156 Telephone: (709) 729-4189   Attention: Responsible de l'accs l'information  
  Facsimile: (709) 729-6187   Telephone: (514) 940-2150 or  
British Columbia Securities Commission           (800) 361-5072 (in Qu bec)  
PO Box 10142, Pacific Centre Nova Scotia Securities Commission Facsimile: (514) 873-3120  
701 West Georgia Street 2nd Floor, Joseph Howe Building        
Vancouver, BC, V7Y 1L2 1690 Hollis Street, P.O. Box 458   Saskatchewan Securities Commission  
Attention: Supervisor, Insider Reporting * Halifax, NS, B3J 3J9     800 - 1920 Broad Street  
Telephone: (604) 899-6500 or Attention: FOI Officer *     Regina, SK, S4P 3V7  
(800) 373-6393 (in BC) Telephone: (902) 424-7768   Attention: Director *  
Facsimile: (604) 899-6550 Facsimile: (902) 424-4625   Telephone: (306) 787-5645  
          Facsimile: (306) 787-5899  
The Manitoba Securities Commission Ontario Securities Commission        
1130 - 405 Broadway Suite 1903, Box 55, 20 Queen Street West * For questions about the collection and use of  
Winnipeg, MB, R3C 3L6 Toronto, ON, M5H 3S8       personal information  
Attention: Continuous Disclosure * Attention: FOI Coordinator *        
Telephone: (204) 945-2548 Telephone: (416) 593-8314   ** in Quebec questions about the collection and use of
Facsmile (204) 945-4508 Facsimile: (416) 593-3666     personal information may also be addressed to the  
            Commission d'accs l'information du Quebec  
            (1-888-528-7741)  
               
BCSC 55-102F6 (Reverse) Rev. 2002 / 2 / 8