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 ("Filer"):
ACASTI PHARMA INC.
B.
This is (check one):
QAn original filing for the Filer.
¨An amended filing for the Filer.
C.
Identify the filing in conjunction with which this form is being filed:
Name of registrant: | Acasti Pharma Inc. |
Form type: | Form CB |
File number (if known): | 005-83129 |
Filed by: | Acasti Pharma Inc. |
Date filed (if filed concurrently, so indicate): | concurrently with Form CB |
D.
The Filer is incorporated or organized under the laws of
QUEBEC
and has its principal place of business at
225 Promenade du
Centropolis, Suite 200
Laval, Quebec
Canada H7T 3B3
Telephone: (450) 687-2262
E.
The Filer designates and appoints C T Corporation System (the "Agent"), located at:
111 Eighth Avenue
New York, NY 10011
Telephone: (212) 894-8940
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 Exchange Offer by the Filer on Form CB on September 2, 2008 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.
F.
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 following the effective date of the latest amendment to the Form CB. The Filer further undertakes to advise the Commission promptly of any change to the Agents name or address during such period by amendment of this Form, referencing the file number of the relevant form in conjunction with which the amendment is being filed.
G.
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 CB, the securities to which the Form CB relates; and the transactions in such securities.
2
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 the City of Laval, Province of Quebec, this 2nd day of September, 2008.
ACASTI PHARMA INC. | ||
Filer: ACASTI PHARMA INC. |
By: |
/s/ Henri Harland |
Name: Henri Harland | ||
Title: CEO |
This statement has been signed by the following person in the capacity indicated on September 2, 2008.
C T Corporation System | |
as Agent for Service of Process for | |
ACASTI PHARMA INC. | |
By: | /s/ Mark S. Eppley |
Name: Mark S. Eppley | |
Title: Assistant Vice-President and Secretary |