Notification to acquire control of an existing Canadian business

INVESTOR

1. Name of investor (if more than one, please itemize)
   
   
   
2. Mailing address
   
   
   
3. Telephone
   
   Facsimile
   
   Internet address (URL - if available) 
   
   
   
4. Name and address of the person or entity that controls the investor
   (if more than one, please itemize) 
   
   
   INVESTMENT
   
   
5. Country of origin of investment
   
   
   
6. Does not apply - go to question 7
   
   
7. Date of implementation of investment 
   
   
   CANADIAN BUSINESS BEING ACQUIRED
   If more than one entity is acquired, provide the information in 8, 9 and 10
   for each entity being acquired - please itemize 
   
   
8. Name(s) of the Canadian business(es) being acquired
   
   
   
9. Business address(es) of the Canadian business(es)
   
   
   
10. Brief description of the business activities of the Canadian business(es)
    (e.g. film production, magazine publishing, etc.)
    
    
    
11. Where the Canadian business is, immediately prior to the implementation of the investment, controlled outside Canada, indicate the country of control (ultimate control) 
    
    
    
12. Number of persons employed in connection with the Canadian business 
    
    
    VALUE OF ASSETS
    
    
13. 1. Give the value of all assets of the entity carrying on the Canadian business and of all other entities in Canada, control of which is being acquired in this transaction, or, if purchasing assets, give the total value of all assets of the Canadian business being acquired: 
       

       AND

    2. If the acquisition of the Canadian business is the result of the acquisition of control of a corporation incorporated outside Canada, give the total value of the assets of all entities both in Canada and outside Canada, the control of which is being acquired in this transaction 
       
       
       THE VALUE OF ASSETS IS THE VALUE SHOWN IN THE APPLICABLE FINANCIAL STATEMENTS, EXPRESSED IN CANADIAN DOLLARS
       
       
14. Does not apply  - go to question 15
    
    

    CANADIAN CULTURAL HERITAGE OR NATIONAL IDENTITY

15. 1. Indicate which of the following business activities the investment falls within:
       

       Publication, distribution or sale of books, magazines, periodicals or newspapers in print or machine readable form

       Production, distribution, sale or exhibition of film or video products

       Production, distribution, sale or exhibition of audio or video music recordings

       Publication, distribution or sale of music in print or machine readable form

       PLEASE PROVIDE THE FOLLOWING INFORMATION.   WHERE APPLICABLE, YOU MAY USE ANNUAL REPORTS, OTHER BUSINESS MATERIAL, OR A SEPARATE ATTACHMENT TO ANSWER ITEMS b) to d):

    2. a description of the business activities of the investor 
       
       
       
    3. a description of any business activity carried on by the person or entity that controls the investor, if any, that is similar to those indicated in a) 
       
       
       
    4. a description of any products manufactured or sold, or to be manufactured or sold, and of any services rendered, or to be rendered, by the Canadian business 
       
       
       
    5. Provide the following information on the Canadian Business:
       1. Name of the vendor:
          
       2. Name of the person or entity that controls the vendor:
          
    
    

    IF YOU ARE UNABLE TO ANSWER ANY OF THE QUESTIONS RELEVANT TO YOUR INVESTMENT, INDICATE THE REASONS 

    Date 
    

    Signature of Investor 
    

    Name and Title 
    

Please send this form to:

Deputy Director of Investments
Cultural Sector Investment Review
Department of Canadian Heritage
25 Eddy Street, 7th floor, Suite 216 (25-7-M)
Gatineau, Quebec
K1A 0M5
Telephone: 819-994-5637
Facsimile: 819-994-5408

7540-CH-041-0018E