Appendix 3A - 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, you must save your document as: NOT WEB – APP - Doc6 – CONFDOC - Appendix 3A – Ownership Information
  3. In that case, you will be required to also submit an ABRIDGED version of this information. You must make a copy of the confidential document, remove the information in the columns entitled “Civic Number and Street Name” and “Portal Code” and save it as: APP - Doc6 – ABRIDGED VERSION – Appendix 3A – Ownership Information

Ownership Information

1. The applicant

*Name of the corporation 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 yet accounted for, by type of shares.
    Table 1b) - Capital Structure and Shareholders
    Security Type 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, 20% 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 yet accounted for by type of shares.
    Table 2b) - Capital Structure and Shareholders
    Security Type 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
                 
                   
                   
                   
                   

3. Control statement and agreements

Attach as Appendix 3B:

A statement regarding who controls/will control the licensee and by what means. If the control is to be held by a shareholder corporation, also advise who controls/will control it and by what means.

4. Corporate documents

As Appendix 3C, append a copy of all constituting documents (for example, certificate and articles of incorporation, amendment or amalgamation, by-laws, partnership agreement, etc.) for the applicant and for each corporation or other legal entity listed in table 2b) of Appendix 3A,  that are not already on file with the Commission.

5. Business arrangements and related documents

If the applicant has entered into a business arrangement with another party (for example, Programming, Supply Agreement, Trademark Licence Agreement, Joint Venture or Shareholder Agreement, etc.), copies of such agreements applicable to the service must be filed with the Commission. Provide a copy, draft or otherwise as Appendix 3D.

The applicant is reminded that, if its application is approved, such approval will be in accordance with the ownership and control set out in the application. If approved, the applicant is expected to file, when available, any additional agreements, such as those identified above, entered into before or after the launch of the service for which it is applying.

Definitions:

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).

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).

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.

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.

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.

Date modified: