REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN[Section 475.4 of the Canada Elections Act]

EC 20081 (2016/04) Ce formulaire est disponible en français

REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Declaration PART 1

SECTION A – GENERAL INFORMATIONPolitical affiliation

ED code Electoral district Fiscal year-end yyyy/mm/dd

SECTION B – REGISTERED ASSOCIATION'S INFORMATIONAssociation's full name

Street no.

Street Apt.

Primary phone number

Alternate phone number

E-mail address

SECTION C – FINANCIAL AGENT'S INFORMATIONSurname Given name Middle

initial

Street no.

Street Apt.

Primary phone number

Alternate phone number

E-mail address

SECTION D – REQUIRED DOCUMENTS

The following documents MUST accompany this return:

Part 1 Part 2a Part 2b Part 2c Part 2d Part 2e

Part 4Part 3a Part 3b Part 3c Part 3d Part 3e Part 3f

Auditor's Report and Invoice (if required)

Loan agreements, including all terms and conditions and repayment schedules for new loans made during the fiscal period

City Prov./ Terr.

Postal code

City Prov./ Terr.

Postal code

SECTION E – DECLARATION

I hereby declare that to the best of my knowledge:

• The information contained in this return is complete and accurate, including the attached statement of assets and liabilities and the statement of revenues and expenses.

• All contributions related to the conduct or management of the registered association have been properly recorded.

• No money, goods or services have been provided by way of loan, advance, deposit, contribution or gift during the fiscal period, except as appears in this return.

• No other person or entity has, on behalf of the registered association, made any payment or given, promised or offered any reward, office, employment or valuable consideration or incurred any liability on account of or in respect of the conduct or management of the registered association, except as specified in this return.

Financial agent's signature date yyyy/mm/dd

Financial agent's signature

SECTION F – PRIVACY NOTICE

Personal information in this Registered Association Financial Transactions Return (Return) is collected for the administration of the political financing requirements set out in the Canada Elections Act (Act). This information may be shared with the Commissioner of Canada Elections to ensure that the Act is complied with and enforced as well as the Canada Revenue Agency in relation to the Income Tax Act. Failure to provide the Chief Electoral Officer (CEO) with the Return is considered to be an offence under the Act. Upon request by any person, the CEO is required under the Act to make the Return available for inspection by such person. You have the following rights with respect to your personal information under the Privacy Act: a) to access the information; b) to correct it, if necessary; and c) to have it protected. You have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information. Your personal information is retained under the personal information bank (PIB) Elections PPU 010. A description of the PIB can be found at www.infosource.gc.ca.

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REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of Contributions Received PART 2a

No. Surname Given name Middle initial

Street no. Street Apt. City Prov./

Terr.Postal code

Date received

yyyy/mm/dd

1 Monetary

$

2 Non-monetary

$

3 Total per

contributor $

Totals carried forward from previous page $

Subtotal $(A)

Total amount of monetary and non-monetary contributions of $200 or less, other than those reported in Amount C $(B)

Number of contributors of $200 or less

Total amount of anonymous contributions of $20 or less $(C)

Approximate number of anonymous contributors

Total amount of all contributions $(A+B+C)

Number of contributors

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REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of New Loans During the Fiscal Period PART 2b

Lender details

Type of lender: A - Individual B - Financial institution C - Registered party D - Registered association

Surname Given name Middle initial Street no. Street Apt. City Prov./

Terr.Postal code

Type of lender (A/B/C/D)

Loan details

Type of loan: A - Term B - On demand C - Line of credit D - Overdraft

Loan no.Date

received yyyy/mm/dd

Type of loan (A/B/C/D)

Fixed interest rate

%

Variable interest rate (prime + or -)

%

Amount borrowed or maximum amount overdrawn

$

Page of

Guarantor details

Date received

yyyy/mm/ddSurname Given name Middle

initial Street no. Street Apt. City Prov./ Terr.

Postal code

Type of guarantor (A/B/C)

Amount guaranteed

$

Total amount guaranteed $

Number of guarantors

Type of guarantor: A - Individual B - Registered party C - Registered association

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REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of New Loans During the Fiscal Period PART 2b Cont.

Loan payments

Payment date yyyy/mm/dd

Amount paid $

Contributed or transferred loan payment

$

Name of individual or political entity that made the loan payment on behalf of the

registered association

Principal payment(s)

$

Interest payment(s)

$

Balance

$

Total $

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REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of Contributions Returned to Contributors or Remitted to the Chief Electoral Officer PART 2c

No. Date

received yyyy/mm/dd

Surname Given name Middle initial

Street no. Street Apt. City Prov./

Terr.Postal code

Type of contributor

(A or B)

Monetary

$

Non-

monetary

$

Date returned to contributor yyyy/mm/dd

Date remitted to

CEO yyyy/mm/dd

Totals carried forward from previous page $

Total $

Type of contributor: A - Individual B - Other

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PART 2dREGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of Transfers Received

No.Date

received yyyy/mm/dd

ED code of transferor

Name of political entity making transfer

Registered party

Monetary

$

Registered party Non-monetary

$

Registered association Monetary

$

Registered association

Non-monetary $

Candidate Monetary

$

Candidate

Non-monetary

$

Leadership contestant Monetary

$

Nomination contestant Monetary

$

Totals carried forward from previous page $

Total $

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PART 2eREGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Summary of Contributions, Loans and Transfers

No. Type of inflow

1

Monetary

$

2

Non-monetary

$

3

Total (1+2)

$

4

Number of contributors or

lenders

CONTRIBUTIONS

1. Individuals

LOANS - Not including overdraft(s)

2. Individuals

3. Financial institutions

4. Registered party

5. Registered associations

6. Subtotal loans (items 2 to 5)

TRANSFERS

7. Registered party

8. Registered associations

9. Candidates

10. Leadership contestants

11. Nomination contestants

12. Subtotal transfers (items 7 to 11)

TOTAL

13. Total (1 + 6 + 12)

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PART 3aREGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of Transfers Sent

No. Date sent yyyy/mm/dd

ED code of transferee

Name of political entity receiving transfer

Registered party

Monetary

$

Registered party Non-monetary

$

Registered association Monetary

$

Registered association

Non-monetary $

Candidate Monetary

$

Candidate

Non-monetary

$

Leadership contestant

Non-monetary $

Nomination contestant

Non-monetary $

Totals carried forward from previous page $

Total $

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REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of Unpaid Claims and Loans PART 3b

No.Date

received yyyy/mm/dd

Payment due date

yyyy/mm/ddSupplier or lender Unpaid claim

invoice number

In legal proceedings (yes or no)

Unpaid claim

$

Unpaid loan

$

Totals carried forward from previous page $

Total $

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REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Previously Reported Unpaid Claims and Loans That Have Been Paid in Full Since Last Fiscal Period PART 3c

Type: A- Claim B- Loan

No.Date

received yyyy/mm/dd

Payment due date

yyyy/mm/ddSupplier or lender Unpaid claim invoice

number

Amount outstanding as of last fiscal period

$Type

(A or B)

Total $

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Status of unpaid claim or loan: A - Disputed B - In legal proceedings C - Payment(s) made according to agreed upon repayment schedule

Number of months after the day on which it was due: A- 18 to 35 months B- 36 months or more

No.Date

received yyyy/mm/dd

Payment due date

yyyy/mm/ddSupplier or lender

Unpaid claim invoice number

Explanation of why amount is unpaid; if disputed, state steps taken to resolve the dispute

Status of unpaid claim or loan

(A/B/C/D/E)

Number of months past due

(A or B)

Unpaid claim

$

Unpaid loan

$

Totals carried forward from previous page $

Total $

REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of Unpaid Claims and Loans 18 and 36 Months Past Due PART 3d

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D - Written off E - Other

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PART 3eREGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of Expenses Incurred for Voter Contact Calling Services

For Calls Made During An Election Period

Page of

No. Supplier

Amount paid

$

Contributed or

transferred service

$

Unpaid claim

$

Total

$

Totals carried forward from previous page $

Total $

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REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURN Statement of Candidate Loans Assumed by the Registered Association PART 3f

No.Write off

date yyyy/mm/dd

Lender's name Candidate's name ED code Election date yyyy/mm/dd

Date assumed yyyy/mm/dd

Amount assumed $

Total $

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REGISTERED ASSOCIATION FINANCIAL TRANSACTIONS RETURNPART 4

REVENUES

[1a] Contributions

[1b] Transfers

[1c] Interest income

[1d] Fundraising activities

[1e] Other (attach supporting schedule)

[1f] TOTAL REVENUES

EXPENSES AND CASH OUTFLOWS

[2a] Advertising – radio

[2c] Advertising – other (signs, brochures, ads, etc.)

[2d] Voter contact calling services

[2f] Amortization

[2g] Transfers

[2b] Advertising – TV

[2e] Bank charges and interest

[2h] Fundraising activities

Current Fiscal

Previous Fiscal

[2k] Polling and research

[2l] Professional services

[2n] Travel and hospitality

[2o] Other (attach supporting schedule)

[2j] Office expenses (insurance, supplies, subscriptions and dues, maintenance, etc.)

[2m] Salaries and benefits

[2p] TOTAL EXPENSES

[3a] NET INCOME (LOSS)

Previous Fiscal

Current Fiscal

[2i] Office expenses (rent and utilities)

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CURRENT ASSETS[4a] Cash and equivalents

[4b] Accounts receivable

[4c] Inventory

[4d] Prepaid expenses

[4e] Other (attach supporting schedule)

[4f] TOTAL CURRENT ASSETS

LONG-TERM ASSETS[5a] Capital assets (attach supporting schedule)

[5b] Other (attach supporting schedule)

[5c] TOTAL LONG-TERM ASSETS

[6a] TOTAL ASSETS (4f + 5c)

CURRENT LIABILITIES[7a] Accounts payable and accrued liabilities

[7c] Other (attach supporting schedule)

[7d] TOTAL CURRENT LIABILITIES

LONG-TERM LIABILITIES[8a] Loans

[8b] Other (attach supporting schedule)

[8c] TOTAL LONG-TERM LIABILITIES

NET ASSETS[9a] Opening balance

[9b] Add net income (subtract loss)

[9c] Ending balance = Accumulated surplus (deficit)

[10a] TOTAL LIABILITIES AND NET ASSETS (7d + 8c + 9c)

STATEMENT OF REVENUES AND EXPENSES STATEMENT OF ASSETS AND LIABILITIES

[7b] Loans

Current Fiscal

Previous Fiscal

Current Fiscal

Previous Fiscal

Current Fiscal

Previous Fiscal

Current Fiscal

Previous Fiscal

Current Fiscal

Previous Fiscal

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