Investment Canada Act - Notification to Establish a New Canadian Business

1.

Name of Investor:

2.

Mailing Address:

3.

Telephone:

Facsimile:

Internet:

4.

Is the investor a WTO investor or a NAFTA investor? (ultimate control):

 Yes

 No

5.

Name and address of the person or entity that controls the investor:

6.

Country of origin of investment:

7.

Does not apply – go to 8.

8.

Date of implementation of investment:

9.

Name, or proposed name, of Canadian business being established:

10.

Business address of the Canadian business being established (if not determined, city and province in Canada)

11.

Brief description of the business activities of the Canadian business being established (e.g., manufacturing clothing, wholesaling food, etc.)

12.

Does not apply – go to 17.

17.

(a)

Projected number of persons to be employed in connection with the new Canadian business at the end of the second full year of operation:

 1 to 10

 10 to 49

 50 to 199

If 200 or more, please specify _____________

(b)

Projected total amount of Canadian dollars to be invested in the new Canadian business during the first full two years of operation:

 under $500,000

 $0.5M to $2M 

 $2M to $5M

If over $5M, please specify _____________

(c)

Projected level of annual sales or revenues of the new Canadian business during the second full year of operation:

 under $500,000

 $0.5M to $2M

 $2M to $5M

If over $5M, please specify _____________

18.

Indicate if the investment falls within any of the following business activities:

(a)

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

readable form (other than the sole activity of their printing or typesetting)

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

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

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

IF YOU HAVE CHECKED OFF ANY OF THE ABOVE ACTIVITIES, PROVIDE THE FOLLOWING INFORMATION WHERE APPLICABLE.  YOU MAY USE APPLICABLE ANNUAL REPORTS, OTHER BUSINESS MATERIAL, OR A SEPARATE ATTACHMENT TO ANSWER ITEMS (b) TO (d):

(b)

a description of the business activities of the investor

(c)

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)

(d)

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

(e)

in the case of an acquisition of control of a Canadian business, provide the following information:

(i)

Name of vendor:

(ii)

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

____________________________________________

[Name of Investor]

[Title of Investor]

Please send this form to:

Industry Canada, Director of Investments
235 Queen Street, Rm. 301B, East Tower
P.O. Box 2800, Station "D"
Ottawa, Ontario  K1P 6A5
Fax: (613) 996-2515