EX-99.36 37 exhibit99-36.htm EXHIBIT 99.36

ZEN GRAPHENE SOLUTIONS LTD.

(the "Issuer")

Request for Financial Statements

Fiscal Year: 2019

In accordance with National Instrument 51-102 - Continuous Disclosure Obligations, registered and beneficial shareholder may elect annually to receive interim (quarterly) financial statements and corresponding management discussion and analysis ("MD&A") and/or annual financial statements and MD&A.

If you wish to receive these documents by mail or email, please return this completed form to:

CAPITAL TRANSFER AGENCY ULC

390 BAY ST., SUITE 920

TORONTO, ON M5H 2Y2

Rather than receiving financial statements by mail, you may choose to view these documents on the

SEDAR website at www.sedar.com.

I HEREBY CERTIFY that I am a registered and/or beneficial holder of the Corporation, and as such, request that my name be placed on the Corporation's Mailing List in respect to its annual and/or interim financial statements and the corresponding MD&A for the current financial year.

SHAREHOLDER REGISTRATION (PLEASE PRINT CLEAR IN BLOCK LETTERS)
STREET ADDRESS
CITY | PROV/STATE | POSTAL/ZIP CODE
COUNTRY (IF NOT CANADA OR USA) | EMAIL
IF THIS IS AN ADDRESS CHANGE, PLEASE CHECK THE BOX AND PROVIDE YOUR FORMER ADDRESS BELOW
☐
PLEASE SEND ME THE FOLLOWING:
☐ | Annual Financial Statements with MD&A
☐ | Interim Financial Statements with MD&A

SIGNED: |  |  | DATE: |
| (Signature of Shareholder) |  |  |