Notice of Shareholders or Change of Shareholders

Notice of Shareholders

Corporate Access Number

Name of Corporation

Address

Name

Full Address (including postal code)

Corporate Access # (corporations only)

% of voting shares

Name

Full Address (including postal code)

Corporate Access # (corporations only)

% of voting shares

Name

Full Address (including postal code)

Corporate Access # (corporations only)

% of voting shares

Name

Full Address (including postal code)

Corporate Access # (corporations only)

% of voting shares

Name

Full Address (including postal code)

Corporate Access # (corporations only)

% of voting shares

Last Name

First Name

Middle Name (optional)

Relationship to Corporation

Email Address

Phone Number (optional)

Date of Submission

Signature

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[field id="Name of Corporation"]

[field id="Address"]

[field id="Name 1"]

[field id="Full Address (including postal code) 1"]

[field id="Corporate Access # (corporations only) 1"]

[field id="% of voting shares 1"]

[field id="Name 2"]

[field id="Full Address (including postal code) 2"]

[field id="Corporate Access # (corporations only) 2"]

[field id="% of voting shares 2"]

[field id="Name 3"]

[field id="Full Address (including postal code) 3"]

[field id="Corporate Access # (corporations only) 3"]

[field id="% of voting shares 3"]

[field id="Name 4"]

[field id="Full Address (including postal code) 4"]

[field id="Corporate Access # (corporations only) 4"]

[field id="% of voting shares 4"]

[field id="Name 5"]

[field id="Full Address (including postal code) 5"]

[field id="Corporate Access # (corporations only) 5"]

[field id="% of voting shares 5"]

[field id="Last Name"]

[field id="First Name"]

[field id="Middle Name (optional)"]

[field id="Relationship to Corporation"]

[field id="Email Address"]

[field id="Phone Number (optional)"]

[field id="Date of Submission"]