Program Development &
1201 Wilson Avenue
Downsview ON M3M 1J8
The IRP agreement requires carriers to maintain an Established Place of Business or reside in the jurisdiction where they base
plate. This form must be completed and back-up documentation provided prior to prorate registration in accordance with IRP
Plan, Sections 305 – Selection of Base Jurisdiction and the definition of Established Place of Business.
Name of Company or Registrant (print):
If yes, where?
2. What are your business hours?
If no, where?
You must include at least 3 of the following back-up documents:
I/we, the undersigned, do hereby certify, that the statements made herein are true and correct.
Signature of Registrant
5026E (2011/10) © Queen's Printer for Ontario, 2011 Once completed, this form has a 13 year retention schedule
Disponible en français