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Appendix 5 – Commercial, including Specialty (e.g., Ethnic, Religious, Specialty Music)

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

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

Document must be saved as: Doc5 - Appendix 2A – Ownership Information

Complete the tables for the licensee and its shareholders corporation

If the entity is a not-for-profit corporation, complete Table A only.

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, 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)
     

5.2 Authorized Securities

In the table below, describe all categories of shares authorized to be issued.

Security Type: All the types of securities must be included, such as shares and options. Authorized shares must be reflected exactly as they are described in the articles or schedules of the corporation (whether voting or non-voting, even the types of shares that have not been issued).

Table B – Authorized Securities
Shares Number of Votes Per Share Convertible
(y/n)		 Participating (y/n) Number of Shares Authorized Number of Shares Issued and Outstanding
           
           
           
           
           

5.3 Shareholders

In the table below, provide the following details:

  1. A list specifying all shareholders that hold 10% or more of the voting sharesFootnote 3, of the voting rights (when different from the voting shares), and of any other common sharesFootnote 4 by type of shares.
  2. A breakdown between “Canadian” and “non-Canadian” of the remaining shares not yet accounted for (those owned by shareholders holding less than 10%), by type of shares. It is not required to specify the name of the shareholder(s).
  3. If non-voting participating shares are issued and outstanding, please indicate who the shareholders are.
  4. Jurisdiction for Legal Entity: Identify the jurisdiction where the shareholder’s legal entity is incorporated.
Table C – Shareholders
Security Type Shareholder Name City & Province of Ordinary Residence or Entity’s Jurisdiction
(P.O. box not accepted)		 CanadianFootnote 2 (y/n) Number of Shares Held % Votes
           
           
           
           
           

5.4 Parent corporations and other shareholders

* Copy and complete the above tables (A, B and C) for each corporation holding, directly or indirectly, 10% or more of the voting interest (shares and/or votes) of the licensee, or of any corporation forming part of its ownership chain.

Name of the shareholder corporation for which the following tables pertain: ______________________

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)
     
Table B – Authorized Securities
Security Type Number of Votes Per Share Convertible
(y/n)		 Participating) (y/n) Number of Shares Authorized Number of Shares Issued and Outstanding
           
           
           
           
           
           
Table C – Shareholders
Security Type Shareholder Name City & Province of Ordinary Residence or Entity’s Jurisdiction
(P.O. box not accepted)		 CanadianFootnote 2 (y/n) Number of Shares Held % Votes
           
           
           
           

Complete the above tables (A, B and C) for each shareholder identified in the above table C holding 10% or more of the voting interest (shares and/or votes) of the licensee, or of any corporation forming part of its ownership chain.

If required, copy tables A, B and C on a new page for additional shareholders.

Definitions

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