EC 20383 (05/2013)
General Form – Electoral District Association
(used when a new representation order is made)
General instructions
Completing the Form – On Paper or Onscreen
•
•
•
•
The form can be filled out onscreen and saved with Adobe Professional. Print the form to collect the
necessary signatures.
If you cannot save, print all completed pages before closing the window. Information that is not
saved will be lost.
If there is insufficient space for your entries, photocopy the page or click "(+ additional page)" in the heading to
generate an extra page in a new window. Save or print the page before closing the window.
Important: Be sure the completed form is fully signed and dated.
Submitting the Form – By Mail, Fax or E-mail
•
•
The form can be submitted to the Registration Unit by mail, fax or e-mail. For e-mail, scan a signed
copy and send it as an attachment.
Since incomplete information may delay the processing of your submission, be sure to provide all
information requested. Failure to do so may result in your submission being rejected.
Reminders
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•
Where the chief executive officer is asked to sign, the signature required is that of the person
currently holding the position in the association. No one can sign on the chief executive
officer'sbehalf.
The same person cannot be both financial agent and chief executive officer of a registered electoral
district association as both are required to act, either jointly or alternately, by the Canada Elections
Act.
Related documentation
•
Registered Association Handbook Find it at www.elections.ca under Political Participants > Tools for
Electoral District Associations > Manuals.
Privacy statement
The personal information supplied on this form is collected under the authority of the Canada
Elections Act for the purpose of administering the registration of political entities. The information is
available for public inspection in accordance with the Act, and certain information is published on
the Elections Canada website at www.elections.ca. You have a right to access and/or to request
a correction of your personal information under the Privacy Act. For details on the collection
and use of this information, consult the entry for Personal Information Bank CEO PPU 036 at
www.infosource.gc.ca.
Please contact us if you have questions or require any help in completing the form.
Elections Canada
Registration Unit, Political Financing
30 Victoria Street
Gatineau Québec K1A 0M6
Tel.: 1-800-486-6563 (toll-free)
TTY: 1-800-361-8935 (toll-free)
Fax: 1-877-877-9517 (toll-free)
E-mail: [email protected]
Website: www.elections.ca
Page 1 of 9
EC 20383 (05/2013)
General Form – Electoral District Association
(used when a new representation order is made)
Section A
Identifying Information
Full name of the registered party
SectionBSubmissiontypeanddeclarationbythechiefexecutiveofficer
Type 1
This is a notice of continuation as a registered association (including the party leader’s consent). The
association is already registered under the 2003 Representation Order and will continue under the
2013 Representation Order.
Complete Section C (Parts 1 and 2) and Section L.
I certify that the information set out in this notice is complete and accurate.
Signature of the chief executive officer
Print name of the chief executive officer
Type 2
Year
Month
Day
This is a report of changes to the information recorded in the Registry of Electoral District Associations.
Complete applicable part(s) of Section C, then only sections with changes.
I certify that the information set out in this report is complete and accurate.
Signature of the chief executive officer
Print name of the chief executive officer
Type 3
Year
Month
Day
This is an application to register an electoral district association of a registered party (including the
party leader’s consent).
Indicate under which option (1, 2 or 3) the association is registering.
I hereby apply to register the electoral district association named below. I certify that the information set
out in this application is complete and accurate.
Print name of the chief executive officer
Signature of the chief executive officer
Year
Month
Day
Please choose one registration option
Option 1
Under the 2003 Representation
Order (308 districts)
Complete Section C (Part 1)
and all other sections
Section C
Option 2
Under the 2003 Representation
Order (308 districts) and
continuation under the 2013
Representation Order (338 districts)
Complete Section C (Parts 1and 2)
and all other sections
Option 3
Under the 2013 Representation Order
(338 districts)
Complete Section C (Part 2) and all other
sections
Electoral district association information
Part 1
Part 2
2003 Representation Order (308 districts)
2013 Representation Order (338 districts)
Full name of the association
Full name of the association
In English
In English
In French
In French
Full name of the federal electoral district
Full name of the federal electoral district
Page 2 of 9
EC 20383 (05/2013)
General Form – Electoral District Association
(used when a new representation order is made)
Full name of the electoral district association
SectionD
Full name of the registered party
Chiefexecutiveofficerinformation
Registration of first or new chief executive officer, appointment effective
Year
Month
Day
Change of contact information only
.
Mr.
Mrs.
Ms.
Miss
Surname
Given name
Correspondence
English
Address (residential)
City
Français
Mailing address (if different)
Prov./Terr.
Postal code
E-mail address (optional)
SectionE
Init.
City
Telephone
Prov./Terr.
Postal code
Fax
Addresswherecommunicationsmaybesenttotheassociation(headquarters)
This is where Elections Canada sends any correspondence addressed to the chief executive officer.
Same as address in Section D
Address
City
Prov./Terr.
Postal code
E-mail address (optional)
Telephone
Fax
City
Prov./Terr.
Postal code
E-mail address (optional)
Telephone
Fax
Association Web site (optional)
SectionF
Addresswherebooksandrecordsarekept
Same as address in Section E
Address
Page 3 of 9
EC 20383 (05/2013)
General Form – Electoral District Association
(used when a new representation order is made)
Full name of the electoral district association
Section G
Full name of the registered party
Financial agent information
Registration of first or new financial agent, appointment effective
Year
Financial agent position is currently vacant; remove this name
from the Registry
Name
Month
Day
Date terminated
Year
Change of contact information only
Month
Day
Thefinancialagentisanindividual
.
Mr.
Mrs.
Ms.
Miss
Surname
Given name
Init.
Correspondence
English
Address (residential)
City
Français
Mailing address (if different)
Prov./Terr.
Postal code
E-mail address (optional)
City
Prov./Terr.
Telephone
Postal code
Fax
Thefinancialagentisacorporation
The declaration must be completed and signed by a person authorized to sign on behalf of the corporation.
Name of corporation
Personauthorizedtosignonbehalfofthecorporation
.
Mr.
Mrs.
Ms.
Miss
Surname
Given name
Init.
Correspondence
English
Français
Address
City
Prov./Terr.
Postal code
E-mail address (optional)
Telephone
Fax
SectionH
Declarationbythefinancialagent
I consent to my appointment as financial agent for the electoral district association named above. I am aware of the duties and
responsibilities of this position under the Canada Elections Act and I am qualified to act as a financial agent under that Act.
Signature of the financial agent
Year
Month
Day
Page 4 of 9
EC 20383 (05/2013)
General Form – Electoral District Association
(used when a new representation order is made)
Full name of the electoral district association
Section I
Full name of the registered party
Auditor information
Registration of first or new auditor, appointment effective
Year
Auditor position is currently vacant; remove this name
from the Registry
Month
Name
Day
Date terminated
Year
Change of contact information only
Month
Day
The auditor is an individual
.
Mr.
Mrs.
Ms.
Miss
Surname
Given name
Init.
Professional designation Correspondence
English
Address (residential)
City
Français
Mailing address (if different)
Prov./Terr.
Postal code
E-mail address (optional)
City
Prov./Terr.
Telephone
Postal code
Fax
The auditor is a partnership
The declaration must be completed and signed by a person authorized to sign on behalf of the partnership.
Name of partnership
Personauthorizedtosignonbehalfofthepartnership
.
Mr.
Mrs.
Ms.
Miss
Surname
Given name
Init.
Professional designation Correspondence
English
Français
Address
City
Prov./Terr.
Postal code
E-mail address (optional)
Telephone
Fax
SectionJ
Declarationbytheauditor
I consent to my appointment as auditor for the electoral district association named above. I am aware of the duties and responsibilities
of this position under the Canada Elections Act and I am qualified to act as an auditor under that Act.
Signature of the auditor
Year
Month
Day
Page 5 of 9
EC 20383 (05/2013)
General Form – Electoral District Association
(used when a new representation order is made)
Full name of the electoral district association
SectionK
Full name of the registered party
Officersoftheassociation
RemoveofficersfromtheRegistry+ (additional page)
Name
Date terminated
Name
Date terminated
Name
Date terminated
Year
Year
Year
Month
Day
Month
Day
Month
Day
AddorupdateofficersintheRegistry+ (additional page)
New association officer, appointment effective
Change of contact information only
Year
Surname
Day
Given name
Address (residential)
City
Month
Init.
Mailing address (if different)
Prov./Terr.
Postal code
City
Prov./Terr.
New association officer, appointment effective
Surname
Month
Day
Given name
Address (residential)
Init.
Position title
Mailing address (if different)
Prov./Terr.
Postal code
City
Prov./Terr.
New association officer, appointment effective
Surname
Postal code
Change of contact information only
Year
Month
Given name
Address (residential)
City
Postal code
Change of contact information only
Year
City
Position title
Day
Init.
Position title
Mailing address (if different)
Prov./Terr.
Postal code
City
Prov./Terr.
Postal code
Page 6 of 9
EC 20383 (05/2013)
General Form – Electoral District Association
(used when a new representation order is made)
Full name of the electoral district association
Section L
Full name of the registered party
Declaration and consent of the leader of the registered party
This is a declaration relating to:
The 2003 Representation Order
Complete Part 1
The 2003 Representation Order and a notice of continuation
Complete Parts 1 and 2
as a registered association under the 2013 Representation Order
Complete Part 1
The 2013 Representation Order
Part 1
I,
Name of the leader of the registered party
certify that
Name of the electoral district association
is an electoral district association of the party
Full name of the registered party
for the federal electoral district of
Name of the federal electoral district
Part 2
In addition, as a result of the representation order under section 25 of the
Electoral Boundaries Readjustment Act, this association has the consent of the
registered party to continue as the electoral district association for
Name of the new federal electoral district
under the name of
New name of the electoral district association
Signature of the leader
Year
Month
Day
Page 7 of 9
EC 20383 (05/2013)
General Form – Electoral District Association
(used when a new representation order is made)
Full name of the electoral district association
SectionK
Full name of the registered party
Officersoftheassociation
RemoveofficersfromtheRegistry+ (additional page)
Name
Date terminated
Year
Name
Month
Day
Month
Day
Month
Day
Month
Day
Month
Day
Month
Day
Month
Day
Month
Day
Month
Day
Date terminated
Year
Name
Day
Date terminated
Year
Name
Month
Date terminated
Year
Name
Day
Date terminated
Year
Name
Month
Date terminated
Year
Name
Day
Date terminated
Year
Name
Month
Date terminated
Year
Name
Day
Date terminated
Year
Name
Month
Date terminated
Year
Name
Day
Date terminated
Year
Name
Month
Date terminated
Year
Name
Day
Date terminated
Year
Name
Month
Date terminated
Year
Name
Day
Date terminated
Year
Name
Month
Date terminated
Year
Page 8 of 9
EC 20383 (05/2013)
General Form – Electoral District Association
(used when a new representation order is made)
Full name of the electoral district association
SectionK
Full name of the registered party
Officersoftheassociation
AddorupdateofficersintheRegistry
Change of contact information only
New association officer, appointment effective
Year
Surname
Day
Given name
Address (residential)
City
Month
Init.
Mailing address (if different)
Prov./Terr.
Postal code
City
Prov./Terr.
Year
Surname
Month
Day
Given name
Address (residential)
Init.
Postal code
City
Prov./Terr.
Year
Surname
Postal code
Change of contact information only
New association officer, appointment effective
Month
Day
Given name
Address (residential)
Init.
Position title
Mailing address (if different)
Prov./Terr.
Postal code
City
Prov./Terr.
Year
Surname
Postal code
Change of contact information only
New association officer, appointment effective
Month
Given name
Address (residential)
City
Position title
Mailing address (if different)
Prov./Terr.
City
Postal code
Change of contact information only
New association officer, appointment effective
City
Position title
Day
Init.
Position title
Mailing address (if different)
Prov./Terr.
Postal code
City
Prov./Terr.
Postal code
Page 9 of 9