Digital Media Survey – Registration Form – Form 157

Purpose of this form

In Broadcasting Regulatory Policy CRTC 2022-47 Annual Digital Media Survey (the Regulatory Policy), the Commission determined that a new digital media survey will be issued to Canadian and non-Canadian digital media broadcasting undertakings (DMBU) This registration form is to be completed by any person required by the Policy^Footnote1 to complete the survey in order to facilitate the issuance and completion of the survey forms in the Commission’s Data Collection System (DCS). The registration form must be completed for each DMBU operated in whole or in part in Canada.

Filing

You can file the registration form electronically via My CRTC Account by attaching the form to the Broadcasting Cover page. My CRTC Account allows you to securely submit documents to the Commission with a user ID and password. Therefore, a signature is not required when using My CRTC Account.  Registrants who file in this manner are not required to submit a hard copy of the form.

If you are not able to submit your registration form electronically with My CRTC Account, contact the Commission at 1-877-249-CRTC (2782) or if you have any questions related to this form, contact the Commission at 873-353-6252.

The following form is in HTML format and may be downloaded to the word processing software of your choice. This enables you to complete the downloaded form by inserting your response in bold letters immediately following the question. Do not alter or delete any text from the registration form.

The registration form must be divided into sections as set out in the form and include the numbered questions followed by the corresponding response. Responses must be provided, at a minimum, in a size 10 font.

1. General information

All information with an * is required.

1.1 Identification of the digital media broadcasting undertaking

* Name of the digital media broadcasting undertaking:

1.2 Identification of the registrant

* Corporation ( ) Other ( ) Specify:

* Legal name of the entity operating the service(s):

* Name of the contact person representing the service:

* Title of the contact person representing the service:

* Address:

* City/Town:

* Province/Territory/State:

* Country:

* Postal code (A1A 1A1) or Zip code:

* Telephone (999-999-9999):      Ext:

Fax (999-999-9999):

* Email (yourname@yourdomain.com):

* Website (www.mycompany.com):

1.3 Sent by

* Name:

* Telephone (999-999-9999): Ext:

* Email (yourname@yourdomain.com):

1.4 Designated representative

Is there a designed representative? Yes ( ) No ( )

I, _________________________, the registrant, hereby designate____________________ as my designated representative to complete, sign and file a registration form with the Canadian Radio-television and Telecommunications Commission and to sign and file a response with respect thereto (if necessary) and I do hereby ratify, confirm and adopt as my own act, such registration form and all responses made thereto.

* Date:

* At: Example: city, province / state

Signature (a signature is not required when submitting electronically):

* Address of designated representative:

* Title:

* Telephone (999-999-9999):  Ext:

Fax (999-999-9999):

* Email (yourname@yourdomain.com):

1.5 Declaration of the registrant or its designated representative

I, *___________________________________ , solemnly declare that:

1. I am the designated representative of the registrant named in this registration form and as such have knowledge of all matters declared therein.
2. The statements made in this registration form or in any document filed pursuant to any request for further information by the Commission are (will be) to the best of my knowledge believed to be true in all respects.
3. The opinions and estimates given in this registration form or in any document filed pursuant to any request for further information by the Commission are (will be) based on facts as known to me.
4. I have examined the provisions of the broadcasting policy relevant to this registration form.

And I have signed

Signature (a signature is not required when submitting electronically):

* Date (yyyy-mm-dd):

Witnessed by

Signature (a signature is not required when submitting electronically):

* Name:

* Date (yyyy-mm-dd):

* At: Example: city, province / state

2. Information on the digital media broadcasting undertaking

• *Name of the DMBU:
• *Related licensed broadcasting undertakings
  • Stand-alone (  ) or
  • Affiliated Canadian broadcasting undertakings (  )
    • If so, identify (provide all call signs or service names):
• *Unique content (original programming) provided through DMBU? (yes or no)
• *Type of Service:
  • Audiovisual
    • AVOD (Advertisement-based video on demand)  (  )
    • SVOD (Subscription-based video on demand)  (  )
    • TVOD (Transactional-based video on demand)  (  )
    • HVOD (Hybrid video on demand)  (  )
  • Audio
    • Advertisement-based audio  (  )
    • Subscription-based audio (  )
    • Transactional-based audio (  )
    • Hybrid audio (  )
    • Over-the-air radio station broadcast live-streamed over the internet  (  )
    • Podcast service – free access (  )
    • Podcast service – subscription-based ( )
  • Other
    • BDU (e.g. revenues from DMBUs)  (  )
    • Live or on-demand broadcast of video game playthrough or competition (e.g.  esports or speedruns)  (  )
    • Other – please specify:
• Language of content, if applicable [must total to 100%].
  • % English
  • % French
  • % Indigenous
  • % Other – please specify:
• *Website(s) address(es):
• *Launch date (in Canada) (year/month/day):
• *Country of incorporation:
• *Location of headquarters:

Date modified:

2022-02-23