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Appendix 5 - Indigenous (Native)

Sample form only: do not complete

This form is for reference purposes only. It is not to be completed in this format.

To complete this and submit it to the CRTC, download the form.

Instructions

You must complete the tables below and save your document as:
Doc5 - Appendix 5 – Ownership Information

The information provided for each of the columns in the tables below must be complete.

Name of the Licensee:  ___________________________

5.1 Directors and Chief Executive Officer (CEO) (or similar)

  1. Provide a list of the directorsFootnote 1 or, where the corporation has no directors, a list of persons performing functions that are similar to the functions performed by directors, such as members of the management committee of a partnership.
  2. Provide information on the CEO. If such a position does not exist, identify the person who performs functions that are similar to those of a CEO and identify the title of that position. If the CEO is also a director, repeat the information in both sections.
Table A – Directors and CEO (or similar)
Name City & Province of Ordinary Residence
(P.O. box not accepted)		 CanadianFootnote 2
(y/n)
Directors
     
     
     
Chief Executive Officer (CEO)
     

Definitions

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