RE-200-T (2017-04) Page 1 Courtesy Translation The Registraire des entreprises does not produce an English version of its forms. However, it provides translations of the content of the forms for information purposes. Declaration of Registration or Initial Declaration for a Legal Person Do not use this area. Date d immatriculation NEQ A M J 1 1 If you were previously registered, enter the NEQ that was assigned to you. Québec enterprise number NEQ 1 1 Check the appropriate box. Registration Initial Act respecting the legal publicity of enterprises (CQLR, chapter P-44.1) 1 Identification 1.1 of legal person 1.2 Other names used in Québec, if applicable Versions(s) of the name in a language other than French, if applicable If you do not have enough space, please enclose Appendix 1, indicating your NEQ, if applicable. 1.3 of legal person 1.4 Elected domicile, if applicable 2 Legal form Legal form codes SA Business corporation or company PMSBL Non-profit legal person COP Cooperative SYC Syndicate of co-ownership MUT Mutual insurance company AU Other Code If AU, specify the legal form Constituting act (title and exact reference) Place of constitution (province, state or territory) Date of constitution ( Y M D ) Anticipated date of cessation, if applicable ( Y M D ) Services Québec
RE-200-T (2017-04) Page 2 3 Identification of directors Position codes for directors PR President SE Secretary AU Other VP Vice-President TR Treasurer AD Director If you do not have enough space, please enclose Appendix 2, indicating your NEQ, if applicable. 4 Unanimous shareholder agreement, if applicable Is there a unanimous shareholder agreement that restricts or withdraws the powers of the directors? Yes No All powers have been withdrawn from the board of directors by a unanimous shareholder agreement. Identification of shareholders or third parties having assumed the powers of the board of directors (only if all powers have been withdrawn from the board of directors) If you do not have enough space, please enclose Appendix 3, indicating your NEQ, if applicable.
RE-200-T (2017-04) 5 Identification of officers who are not members of the board of directors, if applicable Page 3 President Secretary Chief officer (specify the position) President Secretary Chief officer (specify the position) President Secretary Chief officer (specify the position) 6 Identification of main shareholders, if applicable, or name (in the case of an enterprise) of the first shareholder Does the first shareholder hold more than 50% of the votes? Yes No, or name (in the case of an enterprise) of the second shareholder Does the first shareholder hold more than 50% of the votes? Yes No, or name (in the case of an enterprise) of the third shareholder Does the first shareholder hold more than 50% of the votes? Yes No 7 Activities, number of employees and establishments in Québec 7.1 Main activities (in order of importance) 7.2 Number of employees in Québec 0 None A 1 to 5 B 6 to 10 C 11 to 25 D 26 to 49 E 50 to 99 F 100 to 249 G 250 to 499 H 500 to 749 I 750 to 999 J 1,000 to 2,499 K 2,500 to 4,999 L 5,000 or more 7.3 Identification of establishments in Québec Principal establishment in Québec Main activities of this establishment Specific activities to be declared: Tobacco retail sales outlet EAC (6 0 4 1) Sale of artificial tanning services EAC (9 7 1 5)
RE-200-T (2017-04) Page 4 7 Activities, number of employees and establishments in Québec (continued) 7.3 Identification of establishments in Québec (continued) Other establishments Main activities of this establishment Specific activities to be declared: Tobacco retail sales outlet EAC (6 0 4 1) Sale of artificial tanning services EAC (9 7 1 5) If you do not have enough space, please enclose Appendix 4, indicating your NEQ, if applicable. 8 Conversion, if applicable 8.1 Amalgamation or division Ordinary amalgamation Applicable statute following the amalgamation or division (title and exact reference) Simplified amalgamation Division Place (province, state or territory) Date of amalgamation or division ( Y M D ) 8.2 Identification of legal persons involved in the amalgamation or formed as a result of the division Québec enterprise number (NEQ) (1 1) Québec enterprise number (NEQ) (1 1) 8.3 Continuance or other conversion Continuance Applicable statute following the most recent continuance or other conversion (title and exact reference) Other conversion Place (province, state or territory) Date of continuance or other conversion ( Y M D ) If you do not have enough space, please enclose Appendix 5, indicating your NEQ, if applicable.
RE-200-T (2017-04) Page 5 9 Administrator of the property of others, if applicable Capacity codes for the administrator of the property of others FI Trustee LI Liquidator SQ Receiver SY Trustee in bankruptcy AU Other Mandate of administrator of the property of others Capacity code If AU, specify the capacity 10 Mandatary (power of attorney), if applicable 11 Certification I, (first and last names of signee, and, if applicable, name of enterprise), residing at (address), hereby certify that I am the person required to sign the declaration, and that the information provided herein is accurate and complete; the representative of the person required to sign the declaration, and that the latter person has declared the information provided herein to be accurate and complete. Signature Date Sign form RE-200 and return it along with your payment, if applicable. Do not fax. Contact person and priority service Contact person Enter the information of the person to contact about the declaration. of contact person Telephone number Extension Email address Important: The information provided will be used solely for the purposes of the declaration; it will not be entered in the enterprise register. Priority service If you are requesting priority service, please check the box below, and write traitement prioritaire on the envelope. Priority service* * Additional fees are required. For information about fees related to a request for priority service, consult form RE-101, Tarifs et modalités de paiement, on the Registraire des entreprises website.
Appendix 1 Complete Appendix 1 if you do not have enough space in section 1.2. RE-200-T (2017-04) Appendix 1 1.2 Other names used in Québec, if applicable (continued)
Appendix 2 Complete Appendix 2 if you do not have enough space in Part 3. RE-200-T (2017-04) Appendix 2 3 Identification of directors (continued) Position codes for directors PR President SE Secretary AU Other VP Vice-President TR Treasurer AD Director
Appendix 3 Complete Appendix 3 if you do not have enough space in Part 4. RE-200-T (2017-04) Appendix 3 4 Unanimous shareholder agreement, if applicable Identification of shareholders or third parties having assumed the powers of the board of directors (only if all powers have been withdrawn from the board of directors)
Appendix 4 Complete Appendix 4 if you do not have enough space in section 7.3. RE-200-T (2017-04) Appendix 4 7.3 Identification of establishments in Québec (continued) Other establishments Main activities of this establishment Specific activities to be declared: Tobacco retail sales outlet EAC (6 0 4 1) Sale of artificial tanning services EAC (9 7 1 5) Main activities of this establishment Specific activities to be declared: Tobacco retail sales outlet EAC (6 0 4 1) Sale of artificial tanning services EAC (9 7 1 5) Main activities of this establishment Specific activities to be declared: Tobacco retail sales outlet EAC (6 0 4 1) Sale of artificial tanning services EAC (9 7 1 5)
Appendix 5 Complete Appendix 5 if you do not have enough space in section 8.2. RE-200-T (2017-04) Appendix 5 8.2 Identification of legal persons involved in the amalgamation or formed as a result of the division (continued) Québec enterprise number (NEQ) (1 1) Québec enterprise number (NEQ) (1 1) Québec enterprise number (NEQ) (1 1) Québec enterprise number (NEQ) (1 1) Québec enterprise number (NEQ) (1 1) Québec enterprise number (NEQ) (1 1) s