Send Information - Northland Resources Class Action Shareholder Portal

Contact information

Individual	Business or Government Entity
First Name	*
Last Name	*
Business Name	*
Contact Person	*
Address	*
City	*
Postal Code	*
Country	*
Province
State	*
Email Address	*
Phone Number

Total number of Northland Resources shares purchased between April 1, 2012 and the close of trading on January 23, 2013

Number of shares held at the close of trading on January 23, 2013

Purchase or Sale	Date of Purchase or Sale	Number of Shares Purchased or Sold	Price Per Share		Total Purchase / Sale Price	Proof of Purchase Enclosed?
Purchase or Sale	Date of Purchase or Sale	Number of Shares Purchased or Sold	Price Per Share		Total Purchase / Sale Price	Proof of Purchase Enclosed?
Add Transaction

By submitting this Form, I solemnly declare that the information provided in this Form is true and correct. *

I understand that I may receive email updates regarding the status of the proceedings.*