Printable PDF verion - Writers Guild of Canada

APPENDIX GINDEPENDENT PRODUCTION AGREEMENT 2012-2014 (Article A1110)STATEMENT OF DISTRIBUTORS’ GROSS REVENUESINGLE PRODUCTIONWGC PROJECT IDSection Filed By:Company ___________________________________ Producer Distributor Rights Holder Address _________________________________________________Contact _______________________________Phone_____________ Fax_________________Section Production Information:Final Title _________________________________ Previous Title ______________________________Production Company ____________________________________________ Year Produced _________Included in a Distribution Package (Article A1110 (v))? YES NO Budget ________________Official Treaty Co-Production? YES NO Head Distributor Delivered to Distributor on m m / d d / y y y ySection Report Summary:Cumulative, All Periods of Distribution to: mm / d d / y y y y Due Date m m / d d / y y y y(Article A1110 ii)Distributors’ Gross Revenue (From Section , Page 2) $______________ AIf reporting in a period where the Aggregate Distributor’s Gross Revenue exceedsthe project budget x 100%, (as confirmed by the WGC), complete lines B to JWGC confirmed pro-rata portion of Aggregate Distributor’s Gross $______________ BRoyalty Base (Line A – Line B) (If greater than $0.00 proceed to Line D) $______________ CRoyalty Payable (Line C X 3.2 %) $______________ DLess: Prior Royalty Payments (If applicable) $______________ ERoyalty Payable With This Report (Line D – Line E) $______________ FAdministration Fee (If applicable) (Line D X 2%) $___________GST $___________ $______________ GTotal Payable to WGC for Credited Writers (Line F +Line G ) $______________ HTotal Payable to AFBS (Line D X 10%) $______________ ISection Interest Payable:Date Filed m m / d d / y y y y Due Date m m / d d / y y y yNumber of months late ______ Interest Payable (Article A1103) $______________ JCertificationCertified correct: _________________________ Date: _________________________Signature_________________________Title: __________________________Authorized Official (Print or Type)Appendix G – Page 1 (Single)190