Appendix 2A – Ownership Information – Commercial

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.

Instruction

The document must be saved under the name: Appendix 2A – Ownership Information – Commerciale.

Please complete the tables for the licensee and each of the shareholder corporations.

If the entity is a not‑for‑profit corporation, please complete questions 1 to 3 only.

  1. 1. Proposed Licensee Name

    Option #1 - The proposed licensee is a non-profit corporation that has already been incorporated.

    Legal name on the Certificate of Incorporation: ___________________________

    Option #2 - The proposed licensee is a non-profit corporation that has not yet been incorporated.

    The application is submitted by _______ (Name of the individual submitting the application) on behalf of a non-profit corporation to be incorporated.

  2. 2. Declaration of control

    Please indicate who will control the proposed licensee:

    Control exercised by the licensee’s Board of Directors (B.O.D.)

    Control exercised by an individual

    If control is exercised by an individual, please identify the individual and confirm whether they are Canadian and ordinarily resident in Canada: ___________________________

    Other

    If other, please explain how control is exercised: _______________________________

  3. 3. Members of the Board of Directors (B.O.D.) and Chief Executive Officer (CEO)

    1. Please provide the list of members of the B.O.D. or, if not applicable, the individuals performing functions similar to those of such a position.
    2. Please provide the information regarding the person who holds the position of CEO. If such a position does not exist, indicate the name of the person who performs comparable functions and specify their title in parentheses.

Notes

Table A – Members of the B.O.D. and CEO

Full name

City and province of ordinary residence

CanadianFootnote 1
(Yes/No)

Position held (e.g.: President, Secretary)

Members of the B.O.D.

 

 

 

 

 

 

 

 

 

 

 

 

CEO

 

 

 

 

  1. 4. Shareholding of the licensee

    If the licensee is a for‑profit corporation, please complete Section 4.

Authorized Securities

In the table below, describe all categories of shares authorized to be issued, as well as the identity of the holders of those shares.

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note

Table C – Shareholders

Security Type

Shareholder Name

City & Province of Ordinary Residence or Entity’s Jurisdiction

Canadian
(Y/N)

Number of Shares Held

% Votes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notes

  1. 5. Parent corporations and other shareholders

    If the proposed licensee is owned by corporations, please complete Section 5.

Please copy and complete the following tables for each corporation that holds, directly or indirectly, 10% or more of the voting shares.

Name of the shareholder corporation to which the following tables apply: _____________________________________________________

Table A – Members of the B.O.D. and CEO

Full name

City and province of ordinary residence

Canadian
(Yes/No)

Position held (e.g.: President, Secretary)

Members of the B.O.D.

 

 

 

 

 

 

 

 

 

 

 

 

CEO

 

 

 

 

Notes

Authorized Securities

In the table below, describe all categories of shares authorized to be issued, as well as the identity of the holders of those shares.

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note

Table C – Shareholders

Security Type

Shareholder Name

City & Province of Ordinary Residence or Entity’s Jurisdiction

Canadian
(Y/N)

Number of Shares Held

% Votes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notes

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