AFFIDAVIT RE: SHARES

COUNTRY OF _______________

TO WIT:
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IN THE MATTER OF ________ SHARES
(THE “SHARES”) IN THE CAPITAL OF
BLUE PLANET ENVIRONMENTAL
INC. (THE “CORPORATION”)


I, ___________________, of the ________ of _______________, in the
____________ of ________________, MAKE OATH AND SAY THAT:

1. I am the ___________ of _________________ (the “Shareholder”) and as such
have knowledge of the matters hereinafter deposed.

2. The Shareholder is the registered owner of the Shares and such Shares were
issued/purchased by the Shareholder on or about ____________, 20___.

3. The Shareholder has not sold, transferred, assigned, pledged, hypothecated or
otherwise encumbered the Shares, nor has the Shareholder in any way divested itself or been
divested of the ownership thereof.

4. The Shareholder does not have a share certificate that evidences the Shares and
one cannot be produced.

5. the undersigned on behalf of himself/herself and the Shareholder hereby
indemnifies and saves the Corporation harmless from any and all costs, damages and liabilities
which the Corporation may incur as a result of the non delivery to the Corporation of a certificate
that evidences the Shares and the issuance of a replacement share certificate, and the Shareholder
hereby undertakes that should a certificate representing all or a portion of the Shares come into
its possession, the Shareholder will deliver it promptly to the Corporation for cancellation.

6. Attached as Schedule “A” is a true and correct copy of a notarized brokerage
statement confirming/evidencing the Shareholder’s ownership of the Shares.


SWORN BEFORE me at the

of

, in the

of

,
___________ of ______________, this

day of

, 201

.



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A Commissioner, etc. )



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