Microsoft Word rdcmsprod-#414513-v1-Form 04 Application for Determination or Declaration under the Status of the Artist Act
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| (RDCMS# 414513 - Date revised: 2013)
Application for Determination or Declaration under the I. Applicant
Name:
_____________________
Address: ___________________
Email Address: ______________
Telephone Number: __(____)______________________________________________
Fax Number: __(____)___________________________________________________________
II. Applicant’s Authorized
Name of Representative: ________
Address: ___________________
Email Address: ______________
Telephone Number: __(____)______________________________________________________
Fax Number: __(____)___________________________________________________________
III. Other Parties Affected
Provide the name and address of any artist, artists’ association, association affected by this application ______________________________________________________________________________
___________________________ ___________________________
Status of the Artist Act __________________________________________________________________ ________________________________________________________________ ___________________________________________________________ __(____)______________________________________________ __(____)___________________________________________________________ II. Applicant’s Authorized Representative (If applicable) _________________________________________________________ ________________________________________________________________ ___________________________________________________________ __(____)______________________________________________________ __(____)___________________________________________________________ Provide the name and address of any artist, artists’ association, producer or producers’ association affected by this application(Use additional sheets if necessary): ______________________________________________________________________________ ____________________________________________________________________ ________________________________________________________________________
Application for Determination or Declaration under the ___________________________________________________
___________________________________________________ ___________________________________________________
__(____)______________________________________________________ __(____)___________________________________________________________
________________________________________________ ___________________________________________________
___________________________________________________ __(____)______________________________________________________
__(____)___________________________________________________________ producer or producers’ ______________________________________________________________________________
___________________________________________________ ___________________________________________________
CANADA INDUSTRIAL RELATIONS BOARD Application for Determination or Declaration under the Status of the Artist Act
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IV. Details of Application
Under what provision of the Status of the Artist Act is this application being made? subsection 30(2) subsection 33(5) section 34 section 41 section 47 section 48 other (please specify) ___________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What declaration or determination are you seeking? ______________________________________________________________________________
Provide a description of the facts which give rise to the application. (Use additional sheets if necessary) ______________________________________________________________________________
Please attach copies of any relevant documents V. Board Proceedings
Do you believe an oral proceeding will be required? Yes No
In what language would you prefer to have the proceedings conducted? English French
Bilingual
Signature of Applicant or Authorized Representative _________________________
Date:
__________________
The personal information provided on this form is collected solely for the purpose of administering the Status of the Artist Act and may be accessed by contacting the Board. The information may appear in the Board's written reasons for decision which may be posted on the Board’s Website. Send a copy to all affected parties. Yüklə 22,19 Kb. Dostları ilə paylaş:
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