Appointment of Agent for Service of Process and Undertaking (f-x)
December 15 2017 - 3:03PM
Edgar (US Regulatory)
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C.
20549
FORM F-X
APPOINTMENT OF AGENT FOR SERVICE OF
PROCESS AND
UNDERTAKING
A.
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Name of issuer or person filing (Filer):
Trillium
Therapeutics Inc.
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B.
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(1)
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This is (check one):
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[X]
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An original filing for the Filer.
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[_]
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An amended filing for the Filer.
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(2)
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Check the following box if you are filing the
Form F-X in paper in accordance with Regulation S- T Rule 101(b)(9) [_]
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C.
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Identify the filing in conjunction with which this Form
is being filed:
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Name of registrant:
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Trillium Therapeutics Inc.
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Form type:
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Form F-10
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File number (if known):
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333-222085
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Filed by:
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Trillium Therapeutics Inc.
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Date filed (if filed concurrently, so indicate):
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December 15, 2017 (filed concurrently)
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D.
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The Filer is incorporated or organized under the laws of
Ontario, Canada
and has its principal place of business at
2488
Dunwin Drive, Mississauga, Ontario L5L 1J9; telephone (416)
595-0627
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E.
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The Filer designates and appoints
Puglisi &
Associates
(Agent), located at
850 Library Avenue, Suite 204,
Newark, Delaware 19711; telephone (302) 738-6680
as the agent of the
Filer upon whom may be served any process, pleadings, subpoenas, or other
papers in:
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(a)
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any investigation or administrative proceeding conducted
by the Commission; and
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(b)
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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 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 the service of an
administrative subpoena shall be effected by service upon such agent for
service of process, and that 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.
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F.
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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 the Form F-10 relates has
ceased reporting under the Exchange Act.
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The Filer further undertakes to advise the Commission
promptly of any change to the Agents 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.
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G.
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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.
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2
SIGNATURES
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, thereunto duly
authorized, in Mississauga, Ontario, this 15th day of December, 2017.
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TRILLIUM THERAPEUTICS INC.
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By:
/s/ Niclas
Stiernholm
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Name: Niclas
Stiernholm
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Title:
President and Chief Executive Officer
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This statement has been signed by
the following person in the capacity indicated on December 15, 2017.
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PUGLISI & ASSOCIATES
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as Agent for Service of Process for Trillium
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Therapeutics Inc.
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By:
/s/ Donald
J. Puglisi
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Name: Donald
J. Puglisi
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Title:
Managing Director
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