17. The application for conversion of mining rights referred to in subdivision 5 of Division III of Chapter III of the Act shall be filed using the form supplied by the Minister and include the following information:
(1) the name, address and telephone number of the holder of rights to be converted;
(2) the number or the alphanumerical code identifying the rights to be converted;
(3) the geographical coordinates (latitude and longitude) in degrees, minutes, seconds and hundredth of a second of the apexes of the perimeter of lands that are subject to rights to be converted, defined according to the North American Datum 1983 (NAD83), and its system of geodesic coordinates in effect, in compliance with the National Topographic System of Canada (NTS);
(4) the name of the township, the parish or the seigniory or the NTS leaflet identification code where the lands that are subject to the rights to be converted are situated;
(5) the names of all the holders of immovable real rights affecting mining rights subject to the conversion and where the instruments evidencing immovable real rights are entered in the public register of real and immovable mining rights;
(6) a statement to the effect that the holders of immovable real rights, referred to in subparagraph 5, gave their consent to conversion and, where applicable, a statement specifying for each of them if the holder of immovable real rights required from the applicant, as a condition for accepting conversion, that the instruments evidencing immovable real rights concerning him be amended to take into account the conversion and entered at the time of conversion in the public register of real and immovable mining rights, with reference to the claims converted into map designated claims.