Nunavut Business Credit Corporation
APPLICATION for
NBCC Assistance
Company Information
Business NameAddress / Business Registration Number
Community / Years in Business
Postal Code / GST #
Contact #1
Name / Business Phone
Title / Business Fax
SIN / Cell Phone
e-Mail / Birth Date
Contact #2
Name / Business Phone
Title / Business Fax
SIN / Cell Phone
e-Mail / Birth Date
Business Information
Business Type
Incorporated / Partnership / Sole Proprietor / OtherPrincipal Owners / Shareholder Information
Name / Community / Percentage Ownership / Beneficiary%
%
%
Industry Sector Information
Please check all that are appropriate.
Travel & Tourism / Financial ServicesHospitality / Professional Services
Arts & Crafts / Real Estate
Manufacturing / Construction
Food Processing / Transportation
Communications / Other Services
Trade or Retail
Type of Assistance Required
Please check all that are appropriate.
Term Loan / Loan GuaranteeFor purchase of equipment
For construction of building / Bid or Performance Bond
Leasehold improvement
Change of ownership / Line of Credit
Working Capital
Loan consolidation
Brief Project Description
Project Benefits
First Year / Following YearsFull time / Part time / Inuit / non-Inuit / Full time / Part time / Inuit / non-Inuit
Jobs Created
Jobs Maintained
Management / Staff / Management / Staff
Wages Paid
Gross Sales / NU Purchases / Gross Sales / NU Purchases
Financial Information
Previous Loans Outstanding
Lender / Purpose / Year / Account/Loan Number / Amount$
Estimated Costs and Financing
Programme Costs
/Source of Financing
/ $
/ Loan: NBCC
Loan:
Loan:
Contribution: BDF
Contribution:
Grant:
Other:
Equity: Cash
Equity: / $
Total Project Cost / $ / Total Project Financing / $
Declaration of Applicant
I do swear that I have personal knowledge of the matters discussed in this application, and state that:
1) I will contact the representatives of the Nunavut Business Credit Corporation (NBCC) and supply all requested information and appendices;
2) I make this application under my own volition;
3) To the best of my knowledge, all statements made and material provided by or on behalf of the undersigned are true;
4) To the best of my knowledge, the proposed business plan or project complies with all municipal, territorial and federal laws;
5) I agree to grant the representatives of the NBCC access to the site and premises of the project described in the application, to inspect books, accounts, records, to make inquires and credit checks and to obtain any other information necessary to evaluate this application or the resultant project; and
6) I make this declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if make under oath.
When applying for an NBCC loan or a renewal, the applicant understands and agrees that:
1) Any expenses incurred to the point of funding shall be borne by the applicant upon approval of the project, but if the project is not approved, the applicant will not be responsible for the cost relating to the set up or execution of our investigation;
2) If financing is provided for the purpose of the business project as described herein, the applicant shall follow the business plan as presented in the application and use the funds received from the NBCC for the purposes intended;
3) The NBCC will not be held liable for any loss incurred by the applicant as a result of consultation with or advice given by the NBCC;
4) The NBCC will be notified immediately of any application pending and under consideration by another lender, or if negotiations are entered into, or an offer of financing is received, during the period of consideration of this application.
5) The applicant provides permission for release of information to NBCC from any and all Creditors and Lenders.
6) If financing is provided, the applicant provides permission for release of their name (if an individual) or the company name (if a company) to the public.
Authorized Signature/Seal of Applicant / Date / CommunityPage 4 of 4