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Appendix 2A - Ownership information

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 shareholder corporations.

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

1. The licensee

Name of the licensee (or proposed licensee) for which the following tables pertain:____________________.

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

  1. Provide a list of the directors(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)

 Canadian(2) (y/n)
Directors
     
     
     
Chief Executive Officer (CEO)
     

Authorized Securities

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

Security Type: All the types of securities 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
Security Type Number of Votes Per Share Convertible (y/n) Participating (y/n) Number of Shares Authorized Number of Shares Issued and Outstanding
           
           
           
           
           

Shareholders

In the table below, provide the following details:

  1. A list specifying all shareholders that hold 10% or more of the voting shares(3), of the voting rights (when different from the voting shares), and of any other common shares(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)

 Canadian(2) (y/n) Number of Shares Held % Votes
           
           
           
           
           

2. Parent corporations and other shareholders

* Copy and complete the same tables for each corporation holding, directly and/or indirectly, 10% or more of the voting interest (shares and/or votes) of the applicant, 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)

 Canadian(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)

 Canadian(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.

Copy tables A, B and C on a new page if required, to add additional shareholders.

Definitions:

  1. Director: Means a person who is a member of the board of directors of a corporation or, where the corporation has no directors, a person performing functions that are similar to the functions performed by directors.

  2. Canadian: If an individual, CANADIAN means a Canadian citizen who is ordinarily resident in Canada, and a permanent resident who is ordinarily resident in Canada and has been ordinarily resident in Canada for not more than one year after the date on which that person first became eligible to apply for Canadian citizenship, as defined in the Direction to the CRTC (Ineligibility of Non-Canadians).

    If another type of person, please refer to the Direction to the CRTC (Ineligibility of Non-Canadians) for a definition.

  3. Voting shares: The shares to which are attached one or more votes, and includes securities that are convertible into such shares at all times at the option of the holder.
  4. Common shares: The shares that represent the residual equity in the earnings of the corporation, and includes securities that are convertible into such shares at all times at the option of the holder and the preferred shares to which are attached rights to participate in the earnings of the corporation with no upper limit.
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