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Proactive Disclosure
Appendix 2A (Sample)
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 form online and submit it to the CRTC, download the form.
Section A
Name of the Applicant
___________________________
2.1 Authorized Securities
Describe all categories of shares authorized to be issued.
| Security Type | Number of Votes Per Share |
Convertible
(y/n) |
Participating (6)
(y/n) |
Number of Shares Authorized | Number Issued and Outstanding |
|---|---|---|---|---|---|
2.2 Shareholding
Supply the details for each shareholder holding 10% or more of the voting shares(5), of the voting rights (if different from the voting shares), and of any other category of shares identified in the common shares(6) definition. For the remaining shareholders, (those holding less than 10%) supply the total shares under "Others Canadian" and "Others Non-Canadian".
| Security Type | Shareholder Name (1) | Complete Home Address or Legal Entity Jurisdiction |
Canadian(2)
(x) |
Number of Shares Held |
%
Votes |
|---|---|---|---|---|---|
2.3 Directors and Officers
Supply a list of the current/proposed directors and officers of the corporation (3) (4)
| Name of Directors/Officers (1) | Complete Home Address |
Canadian(2)
(x) |
Directors Date of Appointment | Officer Position |
|---|---|---|---|---|
Exemption:
The applicant hereby confirms that :
-
All ownership information for each of the entities that form part of the control chain has been supplied within the last 12 months from the date of this application, and accepted as satisfactory by the Commission; and
-
No changes have occurred since the last filing that would be subject to a notification requirement or prior approval by the Commission pursuant to the Regulations; and
-
No amalgamation has occurred.
date of filing of last complete update: __/__/__
YY/MM/DD
Section B
Name of the Shareholder Corporation
___________________________
2.1 Authorized Securities
Describe all categories of shares authorized to be issued.
| Security Type | Number of Votes Per Share |
Convertible
(y/n) |
Participating (6)
(y/n) |
Number of Shares Authorized | Number Issued and Outstanding |
|---|---|---|---|---|---|
2.2 Shareholding
Supply the details for each shareholder holding 10% or more of the voting shares(5), of the voting rights (if different from the voting shares), and of any other category of shares identified in the common shares(6) definition. For the remaining shareholders (those holding less than 10%), supply the total shares under "Others Canadian" and "Others Non-Canadian".
| Security Type | Shareholder Name (1) | Complete Home Address or Legal Entity Jurisdiction |
Canadian(2)
(x) |
Number of Shares Held |
%
Votes |
|---|---|---|---|---|---|
2.3 Directors and Officers
Supply a list of the present/proposed directors and officers of the corporation (3) (4)
| Name of Directors/Officers (1) | Complete Home Address |
Canadian(2)
(x) |
Directors Date of Appointment | Officer Position |
|---|---|---|---|---|
For an additional Appendix 2A, copy tables 2.1, 2.2 and 2.3 on a new page
Definitions
-
(1) Director/Shareholder: If any of these persons hold public office, by election or appointment, indicate the office held under the name of the person(s).
-
(2) Canadian: Specify if Canadian or Non-Canadian. If a person, CANADIAN means a Canadian citizen, ordinarily resident in Canada, and as defined in the Direction to the CRTC (Ineligibility of Non-Canadians) P.C. 1997-486 as amended by P.C. 1998-1268. If a corporation, CANADIAN means a "qualified corporation" as defined in the Direction to the CRTC (Ineligibility of Non-Canadians) P.C. 1997-486 as amended by P.C. 1998-1268.
-
(3) Directors: 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 Direction to the CRTC (Ineligibility of Non-Canadians) P.C. 1997-486 as amended by P.C. 1998-1268.
-
(4) Officers: Those persons designated as Chairman, President, Chief Executive Officer, Vice-President, General Manager, Secretary, Assistant-Secretary, Comptroller, Treasurer, Assistant-Treasurer or any others under similar titles.
-
(5) 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.
-
(6) 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.
-
(7) Applicant/Shareholder: If a person, refers to a person who has reached the age of majority.
