Canadian Program Certification

Application form 206 - Live Action
 
This application form is to be used for Canadian program certification of Live Action and Continuous Action Animated productions, including domestic productions and international co-ventures/co-productions.

Visit our Web site under “Canadian Program Certification Application Forms” to select the appropriate form for other types of productions.

.
 

1.

Filing the application
 
File the application electronically via Access Key which is available on our Web site under "Forms and Access Key". Access Key allows secure transmissions to the Commission and also authenticates your identity. Note that completion of Section 14.0 DECLARATION OF THE APPLICANT OR ITS DESIGNATED REPRESENTATIVE is mandatory, even though a signature is no longer required when filing the application using Access Key.
 
When filing your application, please ensure that the file name of the documents attached to your application form includes a brief description of the document content. For example, "Doc1-Application"; "Doc2-Schedule 3, Mr. Smith's affidavit", and so forth.
 

2.

Instructions
 
The following application is in HTML format and may be downloaded to the word processing software of your choice. This enables you to complete the downloaded application by inserting your response in bold letters immediately following the question. You may add lines to the tables if necessary but do not alter or delete any text from the application.

Consult the Guide to the Canadian Program Certification Application Process which provides important information on completing and filing this application form.

Every line of this application must be completed and all applicable supporting documents and appendices identified in the checklist (Supporting Documents – Line 15.0) must be attached. If a line does not apply, insert N/A (Not Applicable) in the space provided. All supporting documents must be signed and dated.

The Commission reserves the right to refuse the application form if it has not been duly completed, was filled by hand or has been altered. The onus will be on applicants to submit a clear application that provides all of the relevant information and supporting documentation.

The individual line item numbers in this form correspond to those in the shaded boxes in Section 10, Completing the Application Form, in the Guide. Only those line items requiring additional explanation have entries in the Guide.  
   


   For Commission's use

   Production Title
  
   File Number                      PC DOC Number     


1.0  Conditions for certification
 

1.1
 

a)
 

Is the principle photography started and/or finished?
 


 


 


 

YES (  )
 

NO (  )
 


 

b)
 

Are all key creative personnel under signed contract?
 


 


 


 

YES (  )
 

NO (  )
 

 

c)
 

Are all committed budgets in place?
 


 


 


 

YES (  )
 

NO (  )
 

IMPORTANT: If you answered NO to any one of these questions, do not submit your application as it could be returned to you. You may proceed with the filing of your application only when your production meets all three of these conditions: the production is underway, all key creative personnel are under contract, and committed budgets are in place. As stated in Public Notice CRTC 2010-905, all three of these requirements must be met for the Commission to issue final certification.
 


2.0 Applicant information
 

2.1

Identification of the applicant
  Producer (  )          Broadcaster (  )          Distributor (  )
 
 

Given name:
Surname/Family name:
Or company name:
Address:
City (Province):
Postal Code:
Telephone:
Fax:
E-Mail:
 
  Note: An applicant may be the producer, the broadcast licensee or the distributor. Unless otherwise requested, the certification letter will be sent to the attention of the person identified on Line 14.0, DECLARATION OF THE APPLICANT OR ITS DESIGNATED REPRESENTATIVE, at the address specified above.
 

2.2

Contact person representing the applicant

 

Given name:
Surname/Family name:
Address:
City (Province):
Postal Code:
Telephone:
Fax:
E-Mail:
 


3.0  Corporate information

3.1

Production company

 

Company name:
Address:
City (Province):
Postal Code:
Telephone:
Fax:
E-Mail:
Place of incorporation:
Date of incorporation:
Web site:
 
3.2
 		 a)
 		 Is the production company a CRTC licensee? (A corporation, organization or person licensed by the CRTC to carry on a broadcasting distribution undertaking as set out in the Television Broadcasting Regulations, 1987.)
 

 
 
 		 YES (  )
 		 NO (  )
 

 		 b)
 		 Is the principal business of the production company the production of film, videotape or live programs?
 

 
 
 		 YES (  )
 		 NO (  )
 
    If NO, please explain.
 
3.3
 		 a)
 		 Is the production company owned and controlled by Canadians?

 
 
 		 YES (  )
 		 NO (  )
 

 		 b)
 		 Explain how ownership and control are exercised. Example; is it an individual shareholder holding the majority of voting shares? A group of shareholders? A shareholder corporation? The Board of Director? Voting trust?
 
3.4 List the officers of the Production Company. Attach a separate sheet as Appendix 7 for the parent company.
 
Given name - Surname/Family name Position Held Citizenship or
Date of Permanent Residency Status
(YYYY/MM/DD)
  

 		    


3.5 Parent company

For filing purposes, please indicate the parent company holding the ultimate control of the Production Company. Where non-applicable indicate N/A.
 

 

Company name:
Address:
City (Province):
Postal Code:
Telephone:
Fax:
E-Mail:
Place of incorporation:
Date of incorporation:
Web site:
 


4.0 Production information
 

4.1

Final Title of Program:
 

Original Language:
 

 

For series, attach as Appendix 8, a list of episode titles.
 

4.2

Is there or will there be another language version of this production?  

YES (  )

NO (  )
 

If YES, indicate:

a) The other languages used:  

b) The titles of each language versions:

c) The dubbing/translation process used for each version. Select between lip synchronization, voice-over translation, sub-titles, or narration. If more than one dubbing/translation process were used in one version, list all of them:

d) The name of the company and country where each dubbing/translation was done:

e) The start and end dates of each dubbing translation:

    From (YYYY/MM/DD):         To (YYYY/MM/DD):

f) List the given names – surname/family names and citizenship of the people employed as narrators, leads or voice-over in Section 8.11, if applicable. Also, indicate which version they participated in.

 

4.3

Indicate the running length of program excluding commercial time (HH:MM:SS):
(If a series, indicate N/A and proceed to Line 4.4.)

Note: productions of less than five minutes in duration usually do not need to apply for certification. See Guide, Sections 4 and Section 10, Line item 4.3.
 

4.4

Is the production a "series"?
 

 

 

YES (  )

NO (  )
 

 

If YES, indicate the:
 

 

a)

Cycle/Season:
 

 

b)

No. of episodes:
 

 

c)

Episode Numbers: From:                    To:
 

 

d)

Running length of each episode excluding commercial time (HH:MM:SS):
 
  Note: For series, a certification number ("C" or "SR") is required for each cycle/season.

4.5

Start and end dates of principal photography (yy/mm/dd):
 

 

 

From (YYYY/MM/DD):

To (YYYY/MM/DD):

 

 

 Note: If a series, indicate the start of principle photography of the 1st episode to the end of the principle photography of the last episode. The principal photography for all the episodes must be completed within a 12-month period.

 

4.6

Where was this production filmed? Identify which provinces in Canada. If filmed abroad, identify country(ies) involved.
 

 

Studio
 

 

In Canada: 
 

(       % of shooting time)

 

Outside Canada:
 

(       % of shooting time)

 

On Location
 

 

In Canada:
 

(       % of shooting time)

 

Outside Canada:
 

(       % of shooting time)

4.7

Name(s) of broadcaster(s):

Canadian:

Non-Canadian:
 

 
 
Broadcast date(s):

Broadcast date(s): 

4.8
 

This application requires a:
 

 

(  ) "C" number for a Canadian domestic production.
 


 

(  )  "SR" number for an international co-venture/co-production*.
 

 

* If the application is for a co-venture/co-production, complete and attach Appendix 1 (available on the Commission's web site). Also attach a signed copy of the co-venture/co-production agreement as Appendix 6.
 
4.9
 		 Provide the International Standard Audiovisual Number(s) (ISAN) for this production, if applicable.  (See Guide, Section 10, Line item 4.9)

 ISAN:
 


5.0  Rights holders

5.1
 		 Who owns the resulting production upon completion?
 

Given name:
Surname/Family name:
Or caompany name:
Address:
City (Province):
Postal Code:
Telephone:
Fax:
E-Mail:
 
Canadian:
(  ) Canadian citizen          (  ) Permanent resident          (  ) Canadian controlled corporation
 
or Non-Canadian:
(   ) Non-Canadian citizen              (   ) Non-Canadian controlled corporation

 
5.2
 		 Who holds the following rights? (Please indicate name of individual, broadcaster or company and citizenship/nationality.)
 

 		 a)
 		 Canadian Broadcasting Rights:
 

 
 
 		 Canadian (  )
 		 Non-Canadian (  )
 
Non-Canadian Broadcasting Rights:
 

 
 
 		 Canadian (  )
 		 Non-Canadian (  ) 
 

 		 b)
 		 Canadian Distribution Rights:
 

 
 
 		 Canadian (  )
 		 Non-Canadian (  )
Non-Canadian Distribution Rights:
 

 
 
 		 Canadian (  )
 		 Non-Canadian (  )


6.0 Synopsis and Program Category

See Guide, Section 10, Line items 6.1 and 6.2 for more information on synopsis and program categories. Also see Public Notice 2010-808 for complete category definitions. Official category designation will be confirmed based on the synopsis provided below. A DVD recording of your program may be requested.
 

6.1

Synopsis

In order to support the category you will select in 6.2, describe in sufficient detail below; what the viewer will see, how the program is presented, the theme, subject matter and setting of the program/series:


Synopsis

 


6.2

Program category
  SELECT ONLY ONE of the following categories according to the definition that best describes your production.
 
Information / Education
 
1) News (newscasts, newsbreaks, headlines)
 		 (  )
2a) Analysis & Interpretation (includes consumer affairs, talk or panel shows, short docs, etc.)
 		 (  )
2b) Long-form documentary (provides an in-depth critical analysis of a specific subject or point of view with a minimum duration of 22 minutes)
 		 (  )
3) Reporting & Actualities (political conventions, conferences, non-entertainment fund-raising, etc.)
 		 (  )
4) Religion (more than 50% of religion and religious teachings, as well as discussions of the human spiritual condition.)
 		 (  )
5a) Formal Education (can be related to established curricula) & Pre-school (Ages 2-5)
 		 (  )
5b) Informal Education/Recreation & Leisure (includes lifestyle, outdoor, recreational sports, how-to-talk shows, etc.)
 		 (  )
6a) Professional Sports (includes analysis and review.)
 		 (  )
6b) Amateur Sports (includes analysis and review.)
 		 (  )
  Music and Entertainent
 
7a) Drama - on-going drama series
 		 (  )
7b) Drama - on-going comedy series (sitcoms)
 		 (  )
7c) Drama - specials, mini-series, TV movies
 		 (  )
7d) Drama - theatrical feature films aired on television
 		 (  )
7e) Drama - animation
 		 (  )
7f) Drama - programs of comedy sketches (stand-up)
 		 (  )
7g) Drama - other (readings, improvisations, continuous action animation, experimental shorts, etc.)
 		 (  )
8a) Music & Dance (more than 50% of live or pre-recorded performances)
 		 (  )
8b) Music Video Clips
 		 (  )
8c) Music Video Programs (more than 50% music video clips)
 		 (  )
9) Variety (mix of acts - comedy, music, magic, dance, etc.)
 		 (  )
10) Game Shows (skill and chance)
 		 (  )
11a) General Entertainment and Human Interest (celebrity profiles that may use promotional footage, talk or interview shows, awards, galas, tributes, entertainment-oriented magazines, fund-raising which include entertainers (i.e. telethons); community events and fashion shows.)
 		 (  )
  11b) Reality Television (unscripted dramatic or humorous situations of ordinary people, docudramas, docusoaps, contains minimal amounts of in-depth critical analysis.)


(  )
  Other categories: It is NOT POSSIBLE to select the following categories for certification purposes. Please refer to Public Notice CRTC 2010-808 for more details.

 		  

 

12)&13)

Interstitials & Public Service Announcements (programming of less than 5 minutes).
Productions of less than five minutes in duration that meet the criteria for Canadian certification applicable to longer programs will be considered as Canadian programs without individual certification. Applications for certification of such productions are no longer required, unless specifically requested by the Commission.
 

 

14)

Infomercials, Promotional and Corporate Videos. These are not eligible for certification as Canadian programs.
 

 

15)

Filler programming. If your program is less than 30 minutes and is to be used as a filler program (Category 15) by the broadcaster, select one of the categories listed above which best defines your program, i.e. categories 2a) to 11b).
 
6.3 a) Is the production screenplay based on a publication?
 

 
 
 		 YES (  )
 		 NO (  ) 
 
b) If YES, please identify name of work (book, publication, etc.) on which the production screenplay is based:
 
c) Name of Author:
 

 
 
 		 Canadian (  )
 		 Non-Canadian (  ) 
 
d) Has the work been published in Canada?
 

 
 
 		 YES (  )
 

 NO (  ) 
 
6.4 Is the program a mixture of animation and live action?
 
YES (  ) NO (  ) 
 
If YES, indicate the percentage of animation and live action. (See Guide, Section 8(i), to ensure completion of the appropriate form.)
 
Animation:          %         

Live Action:          %         
 
6.5 Is this production a music video program? (see "Music video program" in Section 9, Definitions and Requirements, of the Guide). Complete and attach a separate Appendix 2 for each video clip.
 
YES (  ) NO (  ) 


 
6.6 Does the program contain music video clips?
 
YES (  ) NO (  ) 
 
a) If YES, what percentage of the program's running time* is devoted to music video clips?          %
*If a series, what percentage of the running time of each episode is devoted to music video clips?
 
b) If the percentage in a) is greater than 50%, what percentage of the total number of video clips** are Canadian?          %
**If a series, what percentage of the total number of video clips in each episode is Canadian?
 
Complete and attach a separate Appendix 2 for each video clip.
 


7.0  Producer Personnel and Control

List below all Canadian and non-Canadian persons occupying the following functions and/or that receive such a credit. With regards to series, if more than one person fulfills the specific position throughout the series, then list each of their names and citizenship, per episode, on a separate sheet, and attach as Appendix 9. See also Section 10, Line item 7.1 in the Guide.
 
For Drama productions (categories 7a) to 7g) inclusively), a Declaration of Citizenship is to be submitted as Appendix 4 for each person filling a producer-related function. The same will apply to each person indicated in Section 8.0.
 
    Given name - Surname/Family name Citizenship

 		 Date of
Permanent Residency Status
(YYYY/MM/DD)		 Remuneration
 (Can$)
 
7.1 Producer(s):
 		        
7.2 Co-producer(s):
 		        
7.3 Executive Producer(s):
 		        
7.4 Line Producer(s):
 		        
7.5 Associate Producer(s):
 		        
7.6 Supervising Producer(s):
 		        
7.7 Production Manager(s):
 		        
7.8 All other Person(s) fulfilling other producer-related functions:        


7.9  Request for non-Canadian courtesy credits (See "Foreign credits" in Section 9, of the Guide.)


Complete and attach a separate Affidavit, as Appendix 3, for each non-Canadian courtesy credit requested.
Given name - Surname/Family name Company Citizenship 

Remuneration
(Can$)

 		 Screen Credit
Requested
 

 		        


7.10 Control of the production (See "Producer control" in Section 9, Definitions and Requirements, of the Guide.)

Who has the final approval over hiring key creative personnel?
 
a) Name of Individual or Company:
 
b) Canadian/Non-Canadian at production start:
 
Canadian (  )
 		 Non-Canadian (  )
 
7.11 Who has final approval over the budget?
 
a) Name of Individual or Company:
 
b) Canadian/Non-Canadian at production start:
 
Canadian (  )
 		 Non-Canadian (  )

 
7.12 Who controls the distribution of the production?
 
a) Name of Individual or Company:
 
b) Canadian/Non-Canadian at production start:
 
Canadian (  )
 		 Non-Canadian (  )
 


8.0  Key and Non Key Creative Production Personnel


List below all Canadian and non-Canadian persons occupying the following functions and/or that receive such a credit. With regards to series, if more than one person fulfills the specific position throughout the series, list each of their names and citizenship, per episode, on a separate sheet, and attach as Appendix 9. See also Section 10, Line item 8.0 in the Guide. Enter gross remuneration paid to all other Canadian and/or Foreign staff on Line 8.10.
 
For Drama productions (categories 7a) to 7g) inclusively), a Declaration of Citizenship is to be submitted as Appendix 4 for each person filling a key creative position: Director, Screenwriter, Production Designer, DOP/Chief Camera Operator, Music Composer, Picture Editor, First and Second Lead/Voice Performer. See “Key creative positions” in Section 9, Definitions and Requirements, of the Guide.
 
    Given name - Surname/Family name Citizenship

 		 Date of
Permanent Residency Status
(YYYY/MM/DD)
 		 Remuneration
(Can$)
 
8.1 Director:
 		        
8.2 Screenwriter/
Scriptwriter:
 		        
8.3 Production Designer:        
8.4 DOP/Chief Camera Operator:
 		        
8.5 Music Composer of original music composed especially for this production:
 		        
8.6 Picture Editor:        
8.7 Researcher:
 		        
8.8 Chief Technician:
 		        
8.9 Chief Sound:
 		        
8.10 All other production staff:
 		  
  a) Canadian:
 		        
  b) Foreign:
 		        


8.11


Lead performers

 		 List the top 5 credited on-screen/off-screen performers in order of importance. Indicate role (actor, singer, host, narrator, etc.). See "Lead performers" in Section 9, Definitions and Requirements, of the Guide.

Also list, on the appropriate line, the given names – surname/family names and citizenship of the people employed as narrators, leads or voice-over in dubbed versions.  Specify which version they participated in.
 
*Where 2 or more of the leads are non-Canadian, provide the on-screen time of each performer.
 
    Given name - Surname/Family name Role
 		 Citizenship
 		 Date of
Permanent
Residency Status
(YYYY/MM/DD)
 		 Remuneration
(Can$) 
 		 Screen Time*
 (MIN.)
8.12 1st Lead/Voice:
 		            
8.13 2nd Lead/Voice:
 		            
8.14 3rd Lead/Voice:
 		            
8.15 4th Lead/Voice:
 		            
8.16 5th Lead/Voice:
 		            

8.17 All other on-screen performers

Indicate the number of individuals in each of the following categories.

 
Musicians Chorus Dancers Extras

 

      
 

Percentage of canadian performers:      %
 
Percentage of non-canadian performers:      %
     

8.18

Guest
    a) YES (  ) NO (  )
 
    If YES, complete (b) and (c) below.
 
    b) Type of Guest participation:
 
      Interview (  )          Panel (  )          Contestant (  )          Other (  ) specify:
 
    c) Number of guests per episode:
 
      i) Canadians: Cost (Can$):
 
      ii) Non-Canadians: Cost (Can$):
 

8.19

Audience participation in the program
    YES (  ) NO (  )
 
  If Yes, provide details in the synopsis.
 


9.0  Financing Information

Enter each individual source of financing. The total on Line 9.1 must be sufficient to cover the total cost of the production on Line 10.1 below. For co-ventures/co-productions, please enter both Canadian and foreign financing covering the total cost of the production indicated on Line 10.1. The coverage of any short-fall must be fully explained.
 
Source of financing Type Canadian Non-
Canadian
 		 Amount (Can$)
 		 % of
Total
 

 		          

 

9.1 Total financing available
 		 $

100%
 


10.0  Production Costs

NOTE:
 
Lines 10.1 and Lines 10.2 to 10.5

The total of lines 10.2 to 10.5 should not add up to the amount indicated on Line 10.1 as they only reflect specific parts of the total cost of production. More precisely, Line 10.1 also includes key creative personnel and other cost expenditures which are not detailed in this Section. In fact, Lines 10.2 to 10.5 correspond to their respective columns found in Appendix 5b – Breakdown of Costs (BOC) form for live action productions.

 
Breakdown of Costs Form (BOC)

Completion of the live action productions Breakdown of Costs (BOC) form, available on the Commission's web site, is mandatory when non-Canadian expenditures are incurred for either services or post-production and laboratory work. Attach as Appendix 5b.
 
For co-ventures/co-productions, completion of the BOC is mandatory and must include both the foreign and the Canadian portions of the budget which, when added together, must amount to the total cost of production indicated on Line 10.1.
 
Services Costs

Includes costs for development, story, stock footage & music rights, non-key creative personnel, all producer positions (other than producer and co-producer), production staff, all production labour, all rentals, transportation, shipping, customs & communications, animals, video studio facilities, video remote technical facilities, second unit crew, completion guarantee, unit publicity & amortization (in the case of a series).
 
The determination as to whether a Services cost item is Canadian or non-Canadian is based on the citizenship (or date of landing for landed immigrants who are not yet Canadian citizens) of the person on whose account the cost was incurred or of the person providing the service. For example, if costs are incurred on account of a Canadian or landed immigrant traveling on production-related business to a location, whether inside or outside Canada, all of the costs incurred on account of this person's travel, including food and lodging while traveling and on-location, would be considered Canadian expenditures since they were incurred on account of a Canadian citizen or landed immigrant. If however, these same costs were incurred in respect of a non-Canadian, even if they were incurred in Canada, they would be considered non-Canadian expenditures.
In the case of services provided by an incorporated company, the company must be incorporated and have a Canadian business in Canada address as well as be owned and controlled by Canadian in order for the cost to be considered Canadian.

 
Post-production and Laboratory Costs
 
Includes costs for videotape stock & production laboratory (other than purchases), voice edit labour & other editorial labour, editorial equipment rentals, post-production picture labour & post-production sound labour, special effects/foley, computer graphics, music labour & other music expenses, titles/optical, versioning & amortization (in the case of a series).
 
Note that the following costs are excluded from both services and post‑production/laboratory costs: The producer, co-producer, director, screenwriter, production designer, DOP/chief cameraman, picture editor, 1st lead performer, 2nd lead performer, music composer, purchased goods and all non-related production expenses, such as accounting, legal fees, bank charges, insurance, auditing, corporate overhead, interim financing, interest and contingency.
 

 

 

Amount (Can$)
 

10.1

Total cost of the production, including deferrals. For a co-venture/co-production this would include both the Canadian and foreign elements.
 

 

10.2

Total amount spent on Canadian services.
 

 

10.3

Total amount spent on non-Canadian services. Complete Appendix 5b if foreign services costs are incurred.
 

 

10.4

Total amount spent on Canadian post-production and laboratory work.
 

 

10.5

Total amount spent on non-Canadian post-production and laboratory work. Complete Appendix 5b if foreign post-production and laboratory costs are incurred.
 

 

10.6

For a series: Average cost per episode.
 

 

10.7

For a co-venture/co-production with a foreign country: Canadian portion of production cost/budget.
 

 

10.8

For a co-venture/co-production with a foreign country: Foreign portion of production cost/budget.
 

 

 


11.0  Post Production and Laboratory

11.1

Identification of individuals(s) or company(s) doing the post-production
 

Given name:
Surname/Family name:
Or company name:
Address:
City (Province):
Postal Code:
Telephone:
Fax:
E-Mail:
 
11.2 Use of post-production facilities outside Canada?
 
    YES (  ) NO (  )
 
   If YES, specify the country(ies) and the percentage of the work that was done in each:

 
 Country(ies) Percentage%
 
   
   
   

11.3
Does the program use existing or pre-recorded music/sounds? (See Guide, Section 10, Line item 11.3.)
 
    YES (  ) NO (  )
 
  If YES:
 
  a) From Canadian source: 
 
    i) Duration (HH:MM:SS):
(Total duration of minutes for the entire production or series.)
 
    ii) Cost (Can$):
 
  b) From non-Canadian source
 
    i) Duration (HH:MM:SS):
(Total duration of minutes for the entire production or series.)
 
    ii) Cost (Can$):
 
    iii) Nationality:
 
11.4 Does the program use existing (non-original) footage such as archival, library, stock, B-roll? (See Guide, Section 10, Line item 11.4.)
 
    YES (  ) NO (  )
 
  If YES:
 
  a) Canadian-produced:
    i) Duration (HH:MM:SS):
(Total duration of minutes for the entire production or series.)
 
    ii) Cost (Can$):
 
    iiI) List names and nationality of company sources. If more than one, indicate cost per source:
 
  b) Non-Canadian produced:
 
    i) Duration (HH:MM:SS):
(Total duration of minutes for the entire production or series.)
 
    ii) Cost Can$):
 
    iii) Nationality:
 
    iv)      List names and nationality of Company sources. If more than one, indicate cost per source:
 
11.5 Does the program contain excerpts from an original foreign production? (See Guide, Section 10, Line item 11.5.)
 
    YES (  ) NO (  )
 
  If YES, was the original production Canadian or non-Canadian?

Canadian (   )                       Non-Canadian (   )

 
  Provide the title of the original production:

  Indicate:
 
  a) Country(ies):
 
  b) Cost (Can$):
 
  c) Total duration (HH:MM:SS):
(Total duration of minutes for the entire production or series.)
 
11.6 Were the program concept/story rights acquired for this production?
 
    YES (  ) NO (  )
 
  If YES, indicate:
 
  a) The title of the original concept/story:
 
  b) The originating country(ies) of the concept/story:
 
  c) The acquisition cost (Can$):
 
  d) Is this amount part of your production cost?
 
    YES (  ) NO (  ) Please explain:
 
  e) The concept/story acquisition rights were paid to the following source :
 
    Canadian (  ) Non-Canadian (  )
 


12.0  Screen Credits

Does your production have opening and/or closing credits?

YES (  )                                                             NO (  )


If YES, it is mandatory to attach as Appendix 10 the screen credits of all cast, crew and corporate screen credits (both main and end titles), including all banners, logos, etc. Where non-Canadians are involved in the production, indicate the citizenship of those individuals or country of incorporation for company(ies) on each card. If the production is a series and the screen credits are not the same for all episodes, attach a list of the credits for each episode.

If NO, explain  why your program has no screen credits and describe what will be on-screen at the end of the program:

 


13.0  Advertising declaration

Do you declare that this production is neither an infomercial, nor a public service announcement, and that, within the program itself, there is no form of endorsement, advertisement, solicitation, or use of addresses or toll-free telephone numbers intended to sell or promote goods or services, other than in the commercial breaks?

YES (  )                                                             NO (  )  

If NO, please explain why in details:
 
Note that the term "advertising material" is defined in the Television Broadcasting Regulations, 1987. It also includes segments which use addresses or telephone numbers, product reviews or sponsorships (beyond corporate name/logo) or other messages intended to sell or promote goods or services. Infomercials are not to be counted as Canadian programming. Refer to CRTC Circular No. 350 and Public Notice CRTC 1994-139 for the definition and broadcast guidelines for "Infomercials". All these documents are available on the Commission Web site.
 


14.0  Declaration of Applicant or its designated representative

Completion of this Section is mandatory.


I, ___________________________________ SOLEMNLY DECLARE THAT:
 
a)
 		 I am the producer or the designated representative of the production company named in this application and as such have knowledge of all matters declared therein.
 
b)
 		 I certify that the information given herein is true and accurate to the best of my knowledge and belief, and I understand that the Commission retains the right to require additional information to be filed in order to verify or substantiate any of the information filed in the application.
 
c)
 		 I further understand that, subject to the provisions of the "Access to Information Act," the financial information filed in the application is filed on a confidential basis but that it may be aggregated with other data and made available to the public in aggregate form for statistical analysis and research.
 
d)
 		 I also understand that should the final production be different from what is set out in the application, the certification may be revoked.
 
AND I HAVE SIGNED

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

Given name - Surname/Family name (Printed):

Please select:   Mr (   )         Mrs. (   )           Ms. (   )           Other (   ), specify:

Title: 

Date:
 


15.0 Supporting Documents

Note

      
 

   a)

 Appendices 1 to 5 are available on the Commission's web site.  
     b) Appendices 6 to 10 are to be prepared by the applicant, as required.  
     c) Indicate YES or NO beside each Apendix attached. Place N/A to denote those appendices that are not applicable.

  
     APPENDED
(YES or NO)
Appendix 1 Co-venture/co-production with a foreign country (Line 4.8)  
Appendix 2 Music Video Clips (Lines 6.5 and 6.6)  
Appendix 3 Affidavit - Exemption for Non-Canadian Courtesy Credit (Line 7.9)  
Appendix 4 Declaration of Citizenship (Lines 7.0 and 8.0)  
Appendix 5b BOC form - Live Action (Lines 10.0, 10.3 and 10.5)  
Appendix 6 Signed copy of the co-venture/co-production agreement (Line 4.8)  
Appendix 7 Officers of the Parent Company (Line 3.4)  
Appendix 8 Series: Individual episode titles (Line 4.1)  
Appendix 9 Series: Producer (Line 7.0) and Key Creative (Line 8.0)  
Appendix 10 Screen credits (Line 12.0)  


This document is available in alternative format upon request.
CRTC - 206 (2012-01-09) - Canadian Program Certification - Live Action
version française disponible

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