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

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

All information with an * is required.

Ownership Information

1. The licensee

*Name of the licensee for which the following tables pertain: _____________________.

  1. *Provide a list of the directors and officers, including the Chief Executive Officer (CEO). If such a position does not exist, identify the person who performs functions that are similar to those of a CEO. If the person is also a director, repeat the information in both sections.
    Table 1a) - Directors and Officers
    Name
    Residential address
    Canadian (x) Directors: Date of appointment and term Officer Position
    Civic address of individuals (P.O. box not accepted) City & Province Postal Code
                 
                 
    Chief Executive Officer (CEO)
                 
  2. *In the table below, provide a list of the shareholders holding 10% or more of the voting shares, of the voting rights (when different from the voting shares), and of other common shares, by type of shares.
  3. *Also include in the table below, a breakdown between “Canadian” and “non-Canadian” of the remaining shares not accounted for, by type of shares.
    Table 1b) - Capital Structure and Shareholders
    Security Type
    (Please identify
    participating and
    convertible shares)
    Name
    Residential Address  / Entity’s jurisdiction
    Canadian (y/n) Number held % votes
    Civic address (P.O. box not accepted) City & Province/OR Entity's jurisdiction Postal Code
                 
                   
                   
                   
                   

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 corporation for which the following tables pertain:_____________________.

  1. *In the table below, provide a list of the directors and officers, including the Chief Executive Officer (CEO). If such a position does not exist, identify the person who performs functions that are similar to those of a CEO. If the person is also a director, repeat the information in both sections.
    Table 2a) - Directors and Officers
    Name
    Residential address
    Canadian (x) Directors: Date of appointment and term Officer Position
    Civic address of individuals (P.O. box not accepted) City & Province Postal Code
                 
                 
    Chief Executive Officer (CEO)
                 
  2. *In the table below, provide a list of the shareholders holding 10% or more of the voting shares, of the voting rights (when different from the voting shares), and of other common shares, by type of shares.
  3. *Also include in the table below, a breakdown between "Canadian" and "non-Canadian" of the remaining shares not accounted for by type of shares.
    Table 2b) - Capital Structure and Shareholders
    Security Type
    (Please identify
    participating and
    convertible shares)
    Name
    Residential Address  / Entity’s jurisdiction
    Canadian (y/n) Number held % votes
    Civic address (P.O. box not accepted) City & Province/OR Entity's jurisdiction Postal Code
                 
                   
                   
                   
                   

Definitions:

  1. Canadian: Specify if Canadian or Non-Canadian. If a person, refer to the definition of CANADIAN in the Direction to the CRTC (Ineligibility of Non-Canadians). If a corporation, CANADIAN means a "qualified corporation" as defined in the Direction to the CRTC (Ineligibility of Non-Canadians).
  2. 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, as defined in the the Direction to the CRTC (Ineligibility of Non-Canadians).
  3. Officers: Those persons designated as Chairman, President, Chief Executive Officer, Vice-President, General Manager, Secretary, Assistant-Secretary, Controller, Treasurer, Assistant-Treasurer or any others under similar titles.
  4. 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.
  5. 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.

CRTC Appendix 2A (2019-05-27) - Ownership information

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