Fillable Section I Company and Issue Description (The New York Stock Exchange)

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Section I Company and Issue Description (The New York Stock Exchange)

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1
Form last updated July 21, 2017
ADDITIONAL LISTING APPLICATION
Section I Company and Issue Description
Company Name
Address
City, State, Zip Code
Company Contact - Name and Title
Telephone # E-mail
Listed Security Trading Symbol
Total shares issued and outstanding as of
Shares held in treasury as of
Section II Transaction Details
The Company hereby makes application to the NYSE American for the additional listing of the following shares:
Total Shares
1
For a forward stock split or stock dividend, make application for the difference between the shares issued and outstanding (i)
prior to the split/dividend and (ii) after the split/dividend. (Note: any shares listed in Line 2 of the Reconciliation Sheet will
automatically be affected by the factor of the split/dividend.) For listing of any ad hoc shares in connection with a dividend
payment on a preferred stock (or notes), those shares should be listed in the Shares column. For any substitution listing (e.g.,
reverse split, reincorporation or reorganization) the shares should be listed as “N/A”.
2
For example, acquisition, private placement, stock option plan, stock split, inducement grant, etc.
Shares
1
Purpose
2
Date of Board
Authorization
Date of Shareholder
Authorization (if
applicable)
Anticipated Date
of Issuance
2
Section III Insider Participation and Future Potential Issuances
Yes No Does any Director, Officer or principal shareholder of the Company have a direct or indirect interest
in the transactions?
Yes No Does the transaction potentially require the Company to issue any shares in the future above the
amount currently applied for? (For example for an earn-out, price protection, or reset provision.)
* If yes provide complete details in the space below of such insider interest along with Audit Committee minutes (if
applicable) and/or of such future potential issuance(s). Attach a rider if additional space is needed.
Section IV Information for a Technical Original Listing
3
Check all applicable categories Effective Date
Reverse Stock Split Ratio of -for-
Change in state of incorporation from to
Other (please describe briefly):
Does the transaction require the turn-in of listed securities or stock certificates? Yes No
Complete the Reconciliation Sheet for any Technical Original Listing (See Appendix A).
3
Technical Original Listing is a change in the company's status technical in nature and the shareholders of the original company
receive or retain a share-for-share interest in the new company without any change in their equity position or rights.
3
Section V Information for a Forward Stock Split or Stock Dividend
Forward Stock Split Ratio: -for-
Or
Stock Dividend per Share: %
Record Date: Payment Date:
Complete the Reconciliation Sheet for any forward or reverse stock split or stock dividend (See Appendix
A).
Section VI Attachments and Signature
The following Company documents are incorporated by reference into this Additional Listing Application. If any
such documents are filed via EDGAR, then indicate under what cover they are filed, the filing date and the exhibit
number:
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
The Company hereby applies for the listing of the above mentioned additional shares and the undersigned hereby
certifies that the statements made herein, and the papers and exhibits submitted in support hereof are, to the best
of such person’s knowledge and belief, true and correct.
Name:
Title:
Date submitted:
Signature: /s/
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Section I Company and Issue Description (The New York Stock Exchange)

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Completed 26 March 2021

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