0001104659-21-091760.txt : 20210713 0001104659-21-091760.hdr.sgml : 20210713 20210713172435 ACCESSION NUMBER: 0001104659-21-091760 CONFORMED SUBMISSION TYPE: F-X PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20210713 DATE AS OF CHANGE: 20210713 EFFECTIVENESS DATE: 20210713 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: Greenbrook TMS Inc. CENTRAL INDEX KEY: 0001735948 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 000000000 STATE OF INCORPORATION: A6 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: F-X SEC ACT: 1933 Act SEC FILE NUMBER: 333-257872 FILM NUMBER: 211088708 BUSINESS ADDRESS: STREET 1: 890 YONGE STREET, 7TH FLOOR CITY: TORONTO STATE: A6 ZIP: M4W 3P4 BUSINESS PHONE: 416-322-9700 MAIL ADDRESS: STREET 1: 890 YONGE STREET, 7TH FLOOR CITY: TORONTO STATE: A6 ZIP: M4W 3P4 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: Greenbrook TMS Inc. CENTRAL INDEX KEY: 0001735948 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 000000000 STATE OF INCORPORATION: A6 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: F-X BUSINESS ADDRESS: STREET 1: 890 YONGE STREET, 7TH FLOOR CITY: TORONTO STATE: A6 ZIP: M4W 3P4 BUSINESS PHONE: 416-322-9700 MAIL ADDRESS: STREET 1: 890 YONGE STREET, 7TH FLOOR CITY: TORONTO STATE: A6 ZIP: M4W 3P4 F-X 1 tm2120938d2_fx.htm F-X

U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM F-X

Appointment of Agent For Service
of Process And Undertaking

A.	Name of issuer or person filing (the "Filer"): GREENBROOK TMS INC.

(1)

This is [check one]:

	x	an original filing for the Filer

	¨	an amended filing for the Filer

(2)

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

Identify the filing in conjunction with which this form is being filed:

	Name of Registrants:	Greenbrook TMS Inc.
	Form Type:	Registration Statement on Form F-10
	File Number (if known):	333-257872
	Filed by:	Greenbrook TMS Inc.
	Date Filed (if filed concurrently, so indicate):	July 13, 2021 (filed concurrently)

Filer is incorporated or organized under the laws of Ontario, Canada and has its principal place of business at

890 Yonge Street
7th Floor
Toronto, Ontario, Canada
M4W 314
(telephone: (416) 915-9100).

The Filer designates and appoints TMS NeuroHealth Centers Inc. (the "Agent"), located at

8401 Greensboro Drive, Suite 425
Tysons Corner, Virginia 22102
(telephone: (416) 322-9700)

as the agent of the Filer 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 any offering made or purported to be made in connection with the securities registered or qualified by the Filer on Form F-10 on the date hereof (the "Form F-10") or any purchases or sales of any security in connection therewith. 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 the 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.

The Filer 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.

The 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.

The Filer 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 Form F-10; the securities to which the Form F-10 relates; 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, thereto duly authorized, in Toronto, Canada, on July 13, 2021.

Filer:

GREENBROOK TMS INC.

By:	/s/ Bill Leonard
	Name:	Bill Leonard
	Title:	Chief Executive Officer

This statement has been signed by the following person in the capacity and on the date indicated:

TMS NEUROHEALTH CENTERS INC.

By:	/s/ Bill Leonard
	Name:	Bill Leonard
	Title:	President