Statutory Declaration of Beneficial Ownership (Ontario Corporation)

STATUTORY DECLARATION OF INDIVIDUALS WITH SIGNIFICANT CONTROL

(Beneficial ownership of an Ontario corporation)

I, ______, of ______, in the Province of Ontario, DO SOLEMNLY DECLARE THAT:

1. I am the ______ of ______, Ontario corporation number ______ (the “Corporation”), and I have knowledge of the matters I declare below.

2. The Corporation keeps a register of individuals with significant control, as section 140.2 of the Business Corporations Act (Ontario) requires, at ______.

3. During its current financial year the Corporation has taken reasonable steps to identify every individual with significant control over it and to keep the register accurate, complete and up to date.

4. In this declaration, an individual with significant control is a person who is the registered holder or beneficial owner of, or has direct or indirect control or direction over, shares carrying 25 per cent or more of the votes or making up 25 per cent or more of all outstanding shares by fair market value, or who has influence that, if exercised, would result in control in fact of the Corporation.

5. The individuals with significant control over the Corporation are:

   Name: ______
   Date of birth: ______
   Latest known address: ______
   Jurisdiction of residence for tax purposes: ______
   Nature and extent of control: ______
   Became an individual with significant control on: ______

6. To the best of my knowledge, no other individual has significant control over the Corporation, and no one holds shares of the Corporation for another person except as described above.

7. I make this declaration at the request of ______, to confirm who owns or controls the Corporation.

8. AND I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.

Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.