EX-99.3 4 mmtikuper.htm INSIDER REPORTING - CYNTHIA KUPER Micromem Technologies Inc.: Insider Report Cynthia Kuper - Prepared by TNT Filings Inc.

 

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)

 

  

NOTE: July3/03–Consolidated version of form, as recently amended–For your convenience–Effective in Alta., B.C., Man., Newf./Lab., Ont.,and Que.and in other juris.,at a later date.

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
KUPER
GIVEN NAMES
CYNTHIA

ALBERTA
              NO. STREET     APT     ONTARIO

BOX 2.

 INSIDER DATA 1952 MONTGOMERY AVE

BRITISH COLUMBIA
CITY

QUEBEC

RELATIONSHIP(S) TO REPORTING ISSUERS

 DATE OF LAST REPORT FILED DD MM YY VILLANOVA

MANITOBA

 

   OR 15 02 06   PROV   POSTAL CODE   SASKATCHEWAN

5

 

       PA   19085

NEWFOUNDLAND

  
    DD MM YY   BUSINESS TELEPHONE NUMBER CHANGE IN NAME, NUMBER OR TELEPHONE NUMBER FROM LAST REPORT Yes No    

CHANGE IN RELATIONSHIP FROM LAST REPORT

YES

NO

IF INITIAL REPORT DATE YOU BECAME AN INSIDER         416 - 364 - 6513  EXT

NOVA SCOTIA

  
              BUSINESS FAX NUMBER    
              416 - 360 - 4034    


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 SHARES OPTIONS

 400,000 09 08 06 50 200,000   0.80  x  600,000 1  
                         
                         
                         
                         
                         
                         
      BOX 6. REMARKS          
                 
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
      /S/ CYNTHIA KUPER DATE OF THIS REPORT 15 08 06
BCSC 55-102F6 Rev. 2002 / 2 / 8 VERSION FRANCAISE DISPONIBLE SUR DEMANDE