Appendix G Declaration of Receipts and Distribution Royalty Payments
Appendix G - Declaration of Receipts and Distribution Royalty Payments
(See Article A1110)
DECLARATION OF RECEIPTS AND DISTRIBUTION ROYALTY PAYMENTS
The Independent Production Agreement requires the payment of a Distribution Royalty based upon Distributors’ Gross Revenue to all credited Writers as provided in Article C11 of the IPA. Such Royalty payments are made at least annually and as per the required reporting period and must be accompanied by a statement of all Distributors’ Gross Revenue in accordance with the following Distribution Royalty Payment Form. Insurance and Retirement contributions and Writer deductions must be remitted in relation to Distribution Royalty payments. In the case of a limited company, certification must be by an officer or director of the company.
The Distribution Royalty Payment Form contains separate first pages for single productions and series. All subsequent pages are to be included for all projects.
In accordance with the terms of the Distributor’s Assumption Agreement:
a) a Distributor shall be under no obligation to pay Distribution Royalties pursuant to the IPA and this Distributor’s Assumption Agreement until such time as the aggregate Distributors’ Gross Revenue exceeds one hundred percent (100%) of the Budget, and
b) if more than one party (i.e. the Producer and one or more Distributors, or more than one Distributor) reports Distributors’ Gross Revenue for a project, for the reporting period that coincides with the point where Distributors’ Gross Revenue exceeds one hundred percent (100%) of the total Budget the Guild shall notify the Producer and all Distributors who have signed a Distributor’s Assumption Agreement of the pro-rata portion of Distributors’ Gross Revenue to be reported by the Producer and/or each Distributor for inclusion on the Distribution Royalty Payment form.
DISTRIBUTION ROYALTY PAYMENT FORM
(see following)
INDEPENDENT PRODUCTION AGREEMENT 2012-2014 (Article A1110)
STATEMENT OF DISTRIBUTORS’ GROSS REVENUE
| SINGLE PRODUCTION | WGC PROJECT ID | 
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 Section Œ     Filed By:
            Section Œ     Filed By:         
	 Company        ___________________________________  Producer q Distributor q Rights Holder q
Company        ___________________________________  Producer q Distributor q Rights Holder q
Address _________________________________________________
Contact _______________________________Phone_____________ Fax_________________
	
	


 Section      Production Information:
            Section      Production Information:
Final Title _________________________________ Previous Title ______________________________
Production Company ____________________________________________ Year Produced _________
Included in a Distribution Package (Article A1110 (v))? YES q NO q Budget ________________
Official Treaty Co-Production? YES q NO q
	

 Head Distributor                                                                      Delivered to Distributor on       m m / d d / y y y y
Head Distributor                                                                      Delivered to Distributor on       m m / d d / y y y y      
	
	


 Section      Report Summary:
            Section      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
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)
                                                                                                                                              (Article A1110 ii)
Distributors’ Gross Revenue (From Section , Page 2) $______________ A
If reporting in a period where the Aggregate Distributor’s Gross Revenue exceeds
the project budget x 100%, (as confirmed by the WGC), complete lines B to J
WGC confirmed pro-rata portion of Aggregate Distributor’s Gross $______________ B
Royalty Base (Line A – Line B) (If greater than $0.00 proceed to Line D) $______________ C
Royalty Payable (Line C X 3.2 %) $______________ D
Less: Prior Royalty Payments (If applicable) $______________ E
Royalty Payable With This Report (Line D – Line E) $______________ F
Administration Fee (If applicable) (Line D X 2%) $___________
GST $___________ $______________ G
Total Payable to WGC for Credited Writers (Line F +Line G ) $______________ H
Total Payable to AFBS (Line D X 10%) $______________ I
	 
          
	


 Section        Interest Payable:
Section        Interest Payable:
Date Filed m m / d d / y y y y Due Date m m / d d / y y y y
Number of months late ______ Interest Payable (Article A1103) $______________ J
	
	


 Certification
            Certification
Certified correct: _________________________ Date: _________________________ Signature
_________________________ Title: __________________________
	 Authorized Official  (Print or Type)
                                    Authorized Official  (Print or Type)
Appendix G – Page 1 (Single)
APPENDIX G
INDEPENDENT PRODUCTION AGREEMENT 2012-2014 (Article A1110)
STATEMENT OF DISTRIBUTORS’ GROSS REVENUE
| SERIES PRODUCTION | WGC PROJECT ID | 
 | 
	


 Section Œ       Filed By:
            Section Œ       Filed By:        
	 Company        _____________________________________          Producer q Distributor q Rights Holder q
Company        _____________________________________          Producer q Distributor q Rights Holder q
Address ____________________________________________________________________________
Contact ___________________________________ Phone_____________ Fax______________
	
	


 Section        Production Information:
            Section        Production Information:
Final Title ________________________________ Previous Title ___________________________________
Production Company ___________________________________________ Year Produced _________
Included in Distribution Package (Article A1110) ? YES q NO q Official Treaty Co-Production? YES q NO q
	
 Head Distributor                                                                           Delivered to Distributor on     m m / d d / y y y y
Head Distributor                                                                           Delivered to Distributor on     m m / d d / y y y y
	 Budget ____________________   Ep. Budget __________________
Budget ____________________   Ep. Budget __________________
	


 Section        Report Summary:
            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)
(Article A1110 ii)
Distributors’ Gross Revenue (Section , Page 2) Total $____________ Per Episode $____________ A
If reporting in a period where the aggregate Distributor’s Gross Revenue exceeds
the project budget x 100%, (as confirmed by the WGC) complete lines B to K
Per episode WGC confirmed pro-rata portion of Aggregate Distributor’s Gross $____________ B
Per Episode Royalty Base (Line A – Line B) (If greater than $0.00 proceed to Line D) $____________ C
| Per Episode Royalty Payable(Line C X 3.2%) $____________ D | 
Total Royalty Payable (Episodes to which WGC Royalties apply ____ X Line D) $____________ E
Prior Royalty Payments (If Applicable) $____________ F
Royalty Payable With This Report (Line E – Line F) $____________ G
Administration Fee (If applicable) (Line G X 2%) $____________
GST $____________ $___________ H
Total Payable to WGC for Credited Writers (Line G +Line H) $___________ I
Total Payable to AFBS (Line G X 10%) $___________ J
	
	


 Section      Interest Payable:
            Section      Interest Payable:
	
 Date Filed       m m / d d / y y y y        Due Date            m m / d d / y y y y
Date Filed       m m / d d / y y y y        Due Date            m m / d d / y y y y 
Number of months late ______ Interest Payable (Article A1103) $____________ K
	
	


 Certification
            Certification
Certified correct: ______________________ Date: __________________
Signature
	 _______________________                          Title:  __________________                          Authorized Official  (Print or Type)
                                    _______________________                          Title:  __________________                          Authorized Official  (Print or Type)
Appendix G – Page 1 (Series)
APPENDIX G
INDEPENDENT PRODUCTION AGREEMENT 2012-2014 (Article A1110)
STATEMENT OF DISTRIBUTORS’ GROSS REVENUE
| ALL PRODUCTIONS | 
	


 Section       Distributors’ Gross Revenue
            Section       Distributors’ Gross Revenue  
Pre-Sales: (Article C1103(c))
Specify Source_______________________________________________ $__________
Specify Source_______________________________________________ $__________
Specify Source_______________________________________________ $__________ $__________ j
Distribution Revenue:
Received by the Producer: (Specify Name)__________________________________________
From Regular Distribution (From List of Distribution Territories, Section ‘)$__________
From Package Exploitation (Article A1110 (v)) (Section ’) $__________
From Treaty Co – Production (Section “) $__________
From Collective Societies and Similar Agencies $__________ $__________ k
Received by the Head Distributor: (Specify Name)____________________________________
From Regular Distribution (From List of Distribution Territories, Section ‘)$__________
From Package Exploitation (Article A1110 (v)) (Section ’) $__________
From Treaty Co – Production (Section “) $__________ $__________ l
Received by Sub Distributors:(Specify Name)_____________________________________
(Specify Name)_____________________________________
(Specify Name) ____________________________________
From Regular Distribution(From List of Distribution Territories, Section ‘)$__________
From Package Exploitation (Article A1110 (v)) (Section ’) $__________
From Treaty Co – Production (Section “) $__________ $_________ m
Other Revenue:
Compact Devices (Article C1103(d)):
Typical Sell-Through $______________ X 20% $__________
Less than Typical Sell-Through $______________ X 10% $__________ $__________ n
Other Revenue Streams:
Specify_____________________________________________________ $__________
Specify_____________________________________________________ $__________
Specify_____________________________________________________ $__________ $__________ o
Total Distributors’ Gross Revenue (To Line A, Section , Page 1) $__________
	 Appendix G Page 2
Appendix G Page 2
APPENDIX G
INDEPENDENT PRODUCTION AGREEMENT 2012-2014 (Article A1110)
STATEMENT OF DISTRIBUTORS’ GROSS REVENUE
| ALL PRODUCTIONS | 
	


 Section ‘       Distribution Territories
            Section ‘       Distribution Territories
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 | Distribution | License Period | |
| Territory and MediaLicensed | RevenueCollected | In Perpetuity | Period Ending | 
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| If insufficient space, please attach a list. | |||
	
	Appendix G Page 3
	 
APPENDIX G
INDEPENDENT PRODUCTION AGREEMENT 2012-2014 (Article A1110)
STATEMENT OF DISTRIBUTORS’ GROSS REVENUE
| ALL PRODUCTIONS | 
	



 Section ’   Package Distribution
Section ’   Package Distribution
| Title | Production Company | Allocation of Revenue | |
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| Total Package Value | 
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| Total This Project (To Section , Page 2) | 
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| If insufficient space, please attach a list. | |||
	
	


 Section “     Official Treaty Co-Productions
Section “     Official Treaty Co-Productions
Canadian Co-Producer_______________________________________________
| Exclusive Territories | Revenue | 
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Other Co-Producers_________________________________________________
| Territories | Revenue | 
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| Total Co-Production Revenue – Transfer to Section , Page 2 |  | |||
	
Appendix G Page 4