Application for Determination or Declaration

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I. Applicant

Name:

Address:

Telephone Number:

Facsimile Number:

II. Other Parties Affected

Provide the name and address of any artist, artists association, producer or producers association affected by this application (use additional sheets if necessary):

III. Details of Application

Under what provision of the Status of the Artist Act is this application being made?

______ section 30(2) ______ section 33(5) ______ section 34

______ section 41 ______ section 47 ______ section 48

______ other (please specify):

What question(s) do you wish the Tribunal determine? (use additional sheets if necessary):

What declaration or determination are you seeking? (use additional sheets if necessary):

Provide a description of the facts which give rise to the application (use additional sheets if necessary):

Please attach copies of any relevant documents

IV. Tribunal 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: ________________________

Name and address of Applicant's Authorized Representative, if any:

Form 4 (02/2006)

Send Completed Form To:
Canadian Artists and Producers Professional
Relations Tribunal
240 Sparks Street, 1st Floor West
Ottawa, Ontario  K1A 1A1