As a result of amendments to sections 149.1(4.1), 149.1(22) and 188.2(2) of the Income Tax Act, if an “ineligible individual” is a member of the board of directors, a trustee, officer or equivalent official, or any individual who otherwise controls or manages the operation of the charity, then the charity may have its
charitable status refused or revoked or may have its authority to issue charitable receipts suspended.

Therefore please complete the following document.

  1. Have you ever been found guilty of a criminal offence in Canada relating to financial dishonesty, including tax evasion, theft, fraud or any other criminal
    offence that may be relevant to the operation of this charity, for which you have not been granted a pardon?
  2. Have you ever been found guilty of a criminal offence outside of Canada relating to financial dishonesty, including tax evasion, theft, fraud or any other criminal offence that may be relevant to the operation of this charity, that if committed in Canada would be a criminal offence, and for which you have not been granted a pardon?
  3. Within the past 5 years, have you been found guilty of a non-criminal offence within Canada relating to financial dishonesty, such as offences under
    fundraising legislation, consumer protection legislation or securities legislation, or any other offence that may be relevant to the operation of this charity
  4. Within the past 5 years, have you been found guilty of a non-criminal offence outside of Canada relating to financial dishonesty, such as offences under
    fundraising legislation, consumer protection legislation or securities legislation, or any other offence that may be relevant to the operation of this charity?
  5. Have you been a member of a board of directors, a trustee, officer, or an individual who otherwise controlled or managed the operation of a charity in the
    past five years?
    If so, has this charity had its charitable registration revoked in the past five years?
    If so, was the charitable status revoked as a result of conduct that constituted a serious breach of the requirements for registration, including improper receipting arrangements, abusive tax shelters, or providing undue private benefit to directors?
  6. Have you, at any time, been a promoter of (sold or promoted the sale on your own or someone else’s behalf) or otherwise been involved with a gifting
    arrangement or other tax shelter in which a charity participated and the registration the charity has been revoked within the past five years for reasons that were related to participation in the tax shelter?

I affirm that I am eligible to stand as a Director and further that I consent to nomination as a Director of
the Galiano Club.

Dated this _____ day of ______________ 20 ___ At _______________________. BC

Name: ____________________________ Signed: _____________________________