Appendix 5 – Commercial and Ethnic, Specialty and Other

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

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Doc5 - Appendix 5 – Ownership Information

Instructions

All columns must contain the complete information requested.

  1. As indicated in the Procedures for filing confidential information and requesting its disclosure in Commission proceedings, Broadcasting and Telecom Information Bulletin 2010-961, you may designate as confidential the civic number, street name and postal code of a residential address.
  2. If you wish to designate this information as CONFIDENTIAL:
    1. Name your confidential document as: NOT WEB – APP – Doc5 – CONFDOC - Appendix 2A – Ownership Information
    2. Name your abridged document, in which the information in the columns entitled “Civic Number and Street Name” and “Postal Code” is removed, as: APP – Doc5 – ABRIDGED VERSION – Appendix 2A – Ownership Information

Ownership Information

Complete the tables below for the licensee and for each shareholder holding a 10% or more voting interest in the licensee or its parent companies.

If the entity is a not-for-profit corporation, complete table 5.3 only.

Name of the Licensee:

__________________________________________

Definitions

5.1 Authorized Securities

Describe all categories of shares authorized to be issued.

Security Type
(Please identify
participating and
convertible shares)
Number of Votes Per Share Convertible
(y/n)
Participating (Footnote 6) (y/n) Number of Shares Authorized Number Issued and Outstanding
           
           
           
           
           
           

5.2 Shareholding

Supply the details for each shareholder holding 10% or more of the voting shares Footnote 5, of the voting rights (if different from the voting shares), and of any other category of shares identified in the common shares Footnote 6 definition. For the remaining shareholders, (those holding less than 10%) supply the total shares under "Others Canadian" and "Others Non-Canadian".

Security Type
(Please identify
participating and
convertible shares)
Name of the Holder(Footnote 1) Residential Address *
or  Corporation's Jurisdiction
Canadian Citizen(Footnote 2) (y/n) Number of Shares Held %
Votes
Civic Number and Street Name City and Province of residence or Corporation's Jurisdiction Postal Code
               
               
               
               
               
               

5.3 Directors and Officers

Supply a list of the current directors and officers of the corporation  

Name of the Directors(Footnote 1) (Footnote 3) / Officers(Footnote 4) Residential Address * Canadian Citizen(Footnote 2) (y/n) Directors' Date of Appoint-ment(Footnote 3) Officer
Position(Footnote 4)
Civic Number and Street Name City/Province Postal Code
             
             
             
             
             
Chief Executive Officer
(or the person in a position with similar functions)
Provide the name, complete residential address, citizenship and title of the position of this person
             

Residential address refers to a person's ordinary residence: the place in which the person's lifestyle is centered and to which the person regularly returns.  Note that a Post Office Box number is not accepted.

Complete the same tables for every shareholder identified in the above table 5.2 holding 10% or more of the voting interest

Name of the Shareholder Corporation:

__________________________________________

Definitions

5.1 Authorized Securities

Describe all categories of shares authorized to be issued.

Security Type
(Please identify
participating and
convertible shares)
Number of Votes Per Share Convertible
(y/n)
Participating (Footnote 6) (y/n) Number of Shares Authorized Number Issued and Outstanding
           
           
           
           
           
           

5.2 Shareholding

Supply the details for each shareholder holding 10% or more of the voting shares Footnote 5, of the voting rights (if different from the voting shares), and of any other category of shares identified in the common shares Footnote 6 definition. For the remaining shareholders, (those holding less than 10%) supply the total shares under "Others Canadian" and "Others Non-Canadian".

Security Type
(Please identify
participating and
convertible shares)
Name of the Holder(Footnote 1) Residential Address *
or Corporation's jurisdiction
Canadian Citizen(Footnote 2) (y/n) Number of Shares Held %
votes
Civic Number and Street Name City and Province of Residence or corporation's jurisdiction Postal Code
               
               
               
               
               
               

5.3 Directors and Officers

Supply a list of the present directors and officers of the corporation

Name of the Directors(Footnote 1) (Footnote 3)/Officers(Footnote 4) Residential Address * Canadian Citizen(Footnote 2) (y/n) Directors' Date of Appoint-ment(Footnote 3) Officer
Position(Footnote 4)
Civic Number and Street Name City/Province Postal Code
             
             
             
             
             
Chief Executive Officer
(or the person in a position with similar functions)
Provide the name, complete residential address, citizenship and title of the position of this person
             

Residential address refers to a person's ordinary residence: the place in which the person's lifestyle is centered and to which the person regularly returns.  Note that a Post Office Box number is not accepted.

Complete the same tables for any shareholders identified in the above table 5.2 holding 10% or more of the voting interest

Copy tables 5.1, 5.2 and 5.3 on a new page

Definitions

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