INSTRUCTIONS

ALBERTA - ANNUAL RETURN

Business Corporation Act

All items must be answered by all corporations.

Item 1. This nine digit number is located on the Certificate of Incorporation, Registration, Amalgamation, or

Continuance in the top right hand corner.

Item 2. The full legal name of the corporation as indicated on the certificate of Incorporation Registration,

Amalgamation, or Continuance.

Item 3. If there are any changes or new appointments to be made in the following items, the notices must be submitted

with the Annual Return if they have not been previously filed.

Registered Office Address / Address for Service by Mail – Notice of Change of Address.

Attorney (Extra-Provincial Corporation) – Notice of Attorney

Change of Attorney’s Address – Notice of Change of Address of Registered Attorney

Item 4. The year covered by the report.

Item 5. Date or registration indicates the date on which the corporation was incorporated, continued, amalgamated or

extra-provincially registered.

Item 6. If there has been a change of directors and you have not already filed a Notice of Directors, please file with

your annual return.

Item 7. Provide the following information:

• Name and address of each shareholder, and the percentage of issued voting shares each holds.
• If there is more than five shareholders, list the five who hold the highest percentage of issued voting shares.
• If a shareholder is a corporation, give the corporation access number.
• If the corporation is a distributing corporation and cannot give information on shareholders, indicate the name and complete mailing address of the Transfer Agent.
• The percentages must add up to 100% unless you have listed only the five major shareholders.

The following information must be included:

• name of the person authorizing (director/authorizing officer)
• identification
• date
• business and residence telephone number

When the information is submitted to your service provider, identification of the authorized person/officer/director/declarant will be required.

Note: This form is not a tax return. Filing of this information does not alter your taxation obligations.

Please print two copies of the Annual Return form and submit.

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Annual Return

Business Corporation Act

1. Corporate Access Number
2. Name of Corporation
3. Address City/Town Province Postal Code
4. This Report is for Year Ending 20____	5. Date of Incorporation, Continuance, Amalgamation or Registration

6. Has there been a change of directors? Yes No

If Yes, has a Notice of Directors been filled? Yes No If No, submit update with Annual Return.

7. SHAREHOLDERS

Name and Full Address % of voting shares issued

(Including Postal Code)

If a Director,

Corporate Access Number________________________ Check this box

Name and Full Address % of voting shares issued

(Including Postal Code)

If a Director,

Corporate Access Number________________________ Check this box

Name and Full Address % of voting shares issued

(Including Postal Code)

If a Director,

Corporate Access Number________________________ Check this box

Name and Full Address % of voting shares issued

(Including Postal Code)

If a Director,

Corporate Access Number________________________ Check this box

__________________________________ _________________________ ______________________

Name of Person Authorizing (please print) Telephone Number (Business) Telephone (Residence)

__________________________________ _________________________ ______________________

Identification (e.g. Operators Drivers License) Title (please print) Date

This information is being collected for the purpose of corporate registry records in accordance with the Business Corporations Act. Questions about the collection of the information can be directed to the Freedom of Information and Protection of Privacy Coordinator for Alberta Registries, Research and Program Support, 3^rd Floor Commerce Place 10155-102 Street, Edmonton, Alberta T5J 4L4 (780) 422-2362

REG 3062 FORM 22

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