Ministry of
Culture
Application for Determination
under the Foreign Cultural Objects
Immunity From Seizure Act
Submit completed application to:
Please read the Guidelines before completing this
Application.
Ministry of Culture
Office of the Assistant Deputy Minister
Culture Policy, Programs and Services Division
400 University Avenue, 5th Floor
Toronto ON M7A 2R9
Complete the Checklist at the end of this
Application. Be sure to attach all necessary
documents.
If you have any questions, please contact the
Ministry staff person assigned to your request. This
person will have been identified in the Ministry’s
response to your letter of intent.
Ministry of Culture will make every effort to process your
Application within 45 days from the day that the Application
is deemed complete, i.e., effective from the day that the
Ministry is satisfied that all necessary documents are in
order.
1. Applicant Institution Information
Name of organization
Address
Street number and name
Suite/Unit City
Province
Postal code
ON
Name of Director or CEO
Name of Contact Person
Telephone
Fax
(
(
)
E-mail
Website
)
Description of applicant institution (art gallery, museum, cultural agency, etc.)
Date of formation
Date of incorporation
Will applicant be the exhibiting
institution for the foreign cultural
objects?
Is there a partner exhibiting institution?
(If objects are to be shown in more than one venue,
information is needed about those other venues.)
Yes
No
Yes
Corporation number
No
Name Partner(s)
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2. Foreign Cultural Objects Information (“Objects” are foreign works of art or objects of cultural significance.)
General description of objects
Lender(s) of objects
Confirmed
provenance
check of objects?
Yes
No
State why objects are of cultural significance
State why objects are of interest and benefit to the people of Ontario
Dates that objects will be in Ontario (shipping in/out)
From
To
3. Exhibition Information
Title and description of exhibition
Exhibition dates
From
0368 (10/2006)
To
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Statement by Applicant
On behalf of and with the authority of the applicant, I certify that the information given in support of this
application is true, correct and complete in every respect.
Name (enter or print)
Title (must be Director or CEO)
Signature
Date
Attachment Checklist for Supplementary Applicant Information
Note: If the most recent of the applicant’s following documents are already on file with the
Ministry, they need not be provided with this Application. Please state the appropriate Ministry file
number where these documents can be found.
File Number
Most recent annual report
Most recent financial statements (if other than those in annual report)
Attachment Checklist for Supplementary Cultural Objects Information
Complete and signed copies of all loan agreements between applicant and the foreign owner(s) or foreign custodian(s), describing
the objects.
If the objects are being brought in by a foreign custodian, complete and signed copies of all agreements between the foreign
custodian(s) and the foreign owner(s), authorizing the foreign custodian to bring the works into Ontario.
A signed Statutory Declaration (Appendix A)
A notarised complete list of all objects being brought into Ontario, including the invoice or other identifying number (i.e. object
number), as well as the title and description of each work. Include an electronic version (Word format) of this list of objects.
0368 (10/2006)
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