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Ulkatcho First Nation
Member Information Update & New Gold Share Distribution Survey
Survey must be completed by August 29, 2025, at 12:00 pm PST
Section A - Member Information
*
1.
Full Legal Name:
(Required.)
*
2.
Date of Birth:
(Required.)
3.
Status Number:
*
4.
Address:
(Required.)
Mailing Address:
City:
Province/State:
Postal Code/Zip Code:
5.
Phone Number(s):
6.
Email Address:
Section B - Distribution Election
7.
Please indicate how you wish to receive your entitlement:
Cash payment - A cheque to be picked up or mailed
Shares - I elect to receive my entitlement in shares (where available)
Note: if you do not indicate a preference, the default will be a cash payment.
Section D - Children/Minor Beneficiaries
8.
Please list all children
under the age of 19
for whom you are the parent or legal guardian.
Child 1 full name:
Child 1 date of birth:
Child 1 status number
Child 1 relationship to you:
Child 2 full name:
Child 2 date of birth:
Child 2 status number:
Child 2 relationship to you:
Child 3 full name:
Child 3 date of birth:
Child 3 status number:
Child 3 relationship to you:
9.
Please add any additional children entries here. Be sure to include their full name, date of birth, status number and their relationship to you:
Note: Minor beneficiaries' entitlements will be placed in a Minors' Trust with Scotiatrust as Trustee and Jarislowsky Fraser as Investment Manager. Funds will be held until age 19 subject to financial literacy requirements.
Section E - Declaration & Consent
I certify that the information provided above is true and complete to the best of my knowledge. I consent to the use of this information by the Nation to update the membership list.
10.
Do you wish to be put on a UFN member E-mail distribution list for future community updates?
Yes
No
11.
Signature (*Please type your name in if this is done electronically)
12.
Date:
13.
Signature of Parent/Guardian (if applicable):
Send me a copy of my responses via email
