(RDCMS# 414513 - Date revised: 2013)
Application for Determination or Declaration under the
I. Applicant
Name:
_____________________
Address:
___________________
Email Address:
______________
Telephone Number:
__(____)______________________________________________
Fax Number:
__(____)___________________________________________________________
II. Applicant’s Authorized
Name of Representative:
________
Address:
___________________
Email Address:
______________
Telephone Number:
__(____)______________________________________________________
Fax Number:
__(____)___________________________________________________________
III. Other Parties Affected
Provide the name and address of any artist, artists’ association,
association affected by this application
______________________________________________________________________________
___________________________
___________________________
Application for Determination or Declaration under the
Status of the Artist Act
__________________________________________________________________
________________________________________________________________
___________________________________________________________
__(____)______________________________________________
__(____)___________________________________________________________
II. Applicant’s Authorized Representative (If applicable)
_________________________________________________________
________________________________________________________________
___________________________________________________________
__(____)______________________________________________________
__(____)___________________________________________________________
Provide the name and address of any artist, artists’ association, producer or producers’
association affected by this application(Use additional sheets if necessary):
______________________________________________________________________________
____________________________________________________________________
________________________________________________________________________
Application for Determination or Declaration under the
___________________________________________________
___________________________________________________
___________________________________________________
__(____)______________________________________________________
__(____)___________________________________________________________
________________________________________________
___________________________________________________
___________________________________________________
__(____)______________________________________________________
__(____)___________________________________________________________
producer or producers’
______________________________________________________________________________
___________________________________________________
___________________________________________________
CANADA INDUSTRIAL RELATIONS BOARD
Application for Determination or Declaration under the Status of the Artist Act
2
IV. Details of Application
Under what provision of the Status of the Artist Act is this application being made?
subsection 30(2)
subsection 33(5)
section 34
section 41
section 47
section 48
other (please specify)
___________________________________________________
What question(s) do you wish the Board determine?
______________________________________________________________________________
______________________________________________________________________________
What declaration or determination are you seeking?
______________________________________________________________________________
______________________________________________________________________________
Provide a description of the facts which give rise to the application. (Use additional sheets if
necessary)
______________________________________________________________________________
______________________________________________________________________________
Please attach copies of any relevant documents
V. Board 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:
__________________
The personal information provided on this form is collected solely for the purpose of administering the Status of the Artist Act
and may be accessed by contacting the Board. The information may appear in the Board's written reasons for decision which may
be posted on the Board’s Website.
Send a copy to all affected parties.