Diamond Drilling Report

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Form 20

Protected A

Privacy Act Statement

The information you provide on this form is collected by Aboriginal Affairs and Northern Development Canada under the authority of the Northwest Territories and Nunavut Mining Regulations for the purpose of depositing a diamond drilling report. The information may be made available for public inspection, as prescribed by the Regulations, and will be handled in accordance with the provisions of the Privacy Act   . Individuals have the right to the protection of unauthorized disclosure of and access to their personal information that is under the control of a federal government institution. Instructions for obtaining your personal information are provided in Info Source   , a copy of which is available at major public and academic libraries or on line.

 
Name

Address



 
I carried out a diamond drill program in the area listed below:

Month __________________     Year __________________
 
State precise area, including claim(s) or permit(s) on which drilling was performed.

 

 

 

 

 
Drilling Details
Hole Number

Footage

Date Drilled
(YYYY-MM-DD)
 

 

 
 

 

 
 

 

 
 

 

 
 

 

 
 

 

 
 

 

 
 

 

 
 

 

 


Signature


Date (YYYY-MM-DD)
INTER 50-003E 2012-04-01