REVOCATION OF THE CANCELLATION OF A REGISTRATION
GENERAL INFORMATION
Client Number
Firm Name
Address
Jurist in Charge
Your File Number
Contact Person
Telephone
Fax
Email(s)
INFORMATION BEFORE CANCELLATION
It is necessary to obtain the information given to the Quebec Enterprise Registrar upon the cancellation
of the registration of a company or corporation to identify and formalize the modifications that have
been brought since the filing of that information. In the case of a federally incorporated legal person, it
is necessary to obtain a statement from the Strategis database for comparison purposes.
Incorporating Statute: Part IA of the Company Act
Part III of the Company Act
Documents:
Service:
Corporate Name:
French
Priority
Electronic
Search and Reservation:
Head Office:
To Do
Judicial district:
Signature for the application for cancellation:
Footnote:
Jurist
Modification
Canada Business Corporations Act
Part II CCA
English
Regular
French
English
Bilingual
Attached
By Marque d’Or
Firm
By the client
No specification
MODIFICATIONS FOLLOWING THE CANCELLATION
1st
2nd
Declaration
Declaration
Amending
Declaration
Name
Head Office
Mailing Address
Directors
Officers
Shareholders
Nature of the Activities
Other Names
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Establishments
DECLARATIONS - REGISTRATION, AMENDING, ANNUAL, INTER ALIA.
NAME
New
Designating Number
Registration Date
Old
Designating Number
Registration Date
(year/ month/ day)
(year/ month/ day)
HEAD OFFICE
Old
New
CONSTITUTION
Incorporating Statute
Date of Constitution (year/ month/ day)
MAILING ADDRESS
Old
New
Number of Directors
DIRECTORS, SHAREHOLDERS, OFFICERS
Minimum
Maximum
Name
Address
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Function
President
Vice President
Secretary
Treasurer
Other
If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
Incorporating Statute
Representative
Number of Shares
Class
Price Per Unit
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Name
Address
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Function
President
Vice President
Secretary
Treasurer
Other
If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
Incorporating Statute
Representative
Number of Shares
Class
Price Per Unit
Name
Address
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Function
President
Vice President
Secretary
Treasurer
Other
If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
Incorporating Statute
Representative
Number of Shares
Class
Price Per Unit
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Name
Address
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Function
President
Vice President
Secretary
Treasurer
Other
If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
Incorporating Statute
Representative
Number of Shares
Class
Number of Directors
Price Per Unit
Minimum
Maximum
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Name
Address
Function
President
Vice President
Secretary
Treasurer
Other
If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
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Incorporating Statute
Representative
Number of Shares
Class
Price Per Unit
Name
Address
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Function
President
Vice President
Secretary
Treasurer
Other
If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
Incorporating Statute
Representative
Number of Shares
Class
Price Per Unit
Name
Address
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Function
President
Vice President
Secretary
Treasurer
Other
If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
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Incorporating Statute
Representative
Number of Shares
Class
Price Per Unit
Name
Address
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Function
President
Vice President
Secretary
Treasurer
Other
If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
Incorporating Statute
Representative
Number of Shares
Class
Price Per Unit
Name
Address
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Function
President
Vice President
Secretary
Treasurer
Other
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If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
Incorporating Statute
Representative
Number of Shares
Class
Price Per Unit
Name
Address
Director
Resident Canadian?
Officer
Shareholder
More than 50%?
Rank
If requesting tax numbers
Telephone
S.S.N.
Function
President
Vice President
Secretary
Treasurer
Other
If the shareholder is a legal person, please indicate the incorporating statute and the name of the
representative
Incorporating Statute
Representative
Number of Shares
Class
Price Per Unit
Carswell Legal Solutions
75 Queen, Suite 4700
Montreal, QC
H3C 2N6
Toll Free : 1-800-668—668
Telephone : 514-393-9900
Fax : 514-393-4060
Order online at www.netco.net 24/7.
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