Printable PDF verion - Writers Guild of Canada

APPENDIX GINDEPENDENT PRODUCTION AGREEMENT 2012-2014 (Article A1110)STATEMENT OF DISTRIBUTORS’ GROSS REVENUESERIES 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 Distribution Package (Article A1110) ? YES NO Official Treaty Co-Production? YES NO Head Distributor Delivered to Distributor on m m / d d / y y y yBudget ____________________ Ep. Budget __________________Section Report Summary:Cumulative, All Periods of Distribution to: m m / d d / y y y y Due Date m m / d d / y y y y(Article A1110 ii)Distributors’ Gross Revenue (Section , Page 2) Total $____________ Per Episode $____________ 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 KPer episode WGC confirmed pro-rata portion of Aggregate Distributor’s Gross $____________ BPer Episode Royalty Base (Line A – Line B) (If greater than $0.00 proceed to Line D) $____________ CPer Episode Royalty Payable(Line C X 3.2%)$____________ DTotal Royalty Payable (Episodes to which WGC Royalties apply ____ X Line D) $____________ EPrior Royalty Payments (If Applicable) $____________ FRoyalty Payable With This Report (Line E – Line F) $____________ GAdministration Fee (If applicable) (Line G X 2%)$____________GST $____________ $___________ HTotal Payable to WGC for Credited Writers (Line G +Line H) $___________ ITotal Payable to AFBS (Line G X 10%) $___________ JSection 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) $____________ KCertificationCertified correct: ______________________ Date: __________________Signature_______________________Title: __________________Authorized Official (Print or Type)Appendix G – Page 1 (Series)191