Annex A

In the Matter of the
Canada Cooperatives Act
and
Articles of Incorporatiion
Filed Pursuant to Section 10
in the Name

_________________________________________

Declaration

We, the undersigned, do solemnly declare that:

1. We are the incorporators of __________________________, (the "Cooperative") and we have personal knowledge of the matters herein deposed to.

2. The information contained in forms 3003 and 3006 filed with the articles of incorporation meets the requirements of the Act.
   
   

3. Choose one of the following statements: 

   After incorporation, the Cooperative will be organized and operated and will carry on business on a cooperative basis.

   (For non-profit housing cooperatives)
   After incorporation, the Cooperative will be organized and operated and will carry on business on a cooperative basis and the Cooperative will comply with Part 20 of the Canada Cooperatives Act.

   (For worker cooperatives)
   After incorporation, the Cooperative will be organized and operated and will carry on business on a cooperative basis and the Cooperative will comply with Part 21 of the Canada Cooperatives Act.

And we make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.

(This declaration must be signed by all the incorporators of the Cooperative.)

Declared before me at the City of _____________________.
in the Province of _______________,
this _____ day of _______________, 19_____
A Commissioner, etc.

(Signature) __________________________

Name of director __________________________
(Please print)

Declared before me at the City of _____________________.
in the Province of _______________,
this _____ day of _______________, 19_____
A Commissioner, etc.

(Signature) __________________________

Name of director __________________________
(Please print)

Declared before me at the City of _____________________.
in the Province of _______________,
this _____ day of _______________, 19_____
A Commissioner, etc.

(Signature) __________________________

Name of director __________________________
(Please print)

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