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Loan Application

Section A: Applicant Information

Business Name:    
Address:
Community:  Postal Code: 
Phone: Fax:
Email: Contact Name:
Title:

Business Activity: 

Years In Business:    

Section B: Business Ownership Information

List all owners of the business and indicate if they are Inuit beneficiaries under the Nunavut Land Claims Agreement (use back of form if additional space is needed)

Name of Owner

Beneficiary

Percentage Owned


Name of Owner

Date of Birth

SIN #

Section C: Form Of Business (check one)

Proprietorship (one owner, unincorporated)    
Partnership (two or more owners, unincorporated) Partnership    
Corporation (one or more owners, incorporated) Corporation Date:
Society (non-profit group, incorporated) Society Date:
Other (specify):

Section D: Project Information

Community Where Project Will Take Place: 
Project Start Date: Project End Date:
Briefly describe the project:

Section E: Proposed Use and Sources of Funds

Use of Funds

Item

Amount

$
$
$
$
$
$
$
$
$
Total Use of Funds: $

Source of Funds

Source

Amount

Client equity: $
Other funding:  
KBAP Contribution $
ED & T Contribution $
Loans – Identify Source:
$
$
Total Other Funding $
KCFI Loan $
Total Source of Funds: $

Type of Loan required:

Section F: Project Benefits

Economic Benefits

Inuit

Non-Inuit

Employment

F/T

P/T

Seasonal

F/T

P/T

Seasonal

Jobs Created
Jobs Maintained
Job Training Provided
Est. Annual Wages Paid $ $
Est. Gross Annual Sales $

Section G: Declaration of Applicant (must be completed to process application)

I do swear that I have personal knowledge of the matters discussed in this application, and I state that:

  1. All statements made, and materials provided by or on behalf of the applicant to KCFI and its agents for the purposes of this application, are true and correct;

  2. I make this application under my own free will;

  3. To the best of my knowledge, the proposed business or project complies with all territorial, federal, and municipal laws;

  4. To the best of my knowledge, the applicant or the corporation is not involved in any lawsuits or has any outstanding judgments against them;

  5. I agree to provide representatives of Kitikmeot  Community Futures Incorporated, with access to the site and premises of the project described in this application, to inspect books, accounts, records, and to make inquiries and credit checks, and to obtain any other information necessary to evaluate this application and/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 made under oath.
Applicant Signature
(please type full name)
Date

 
© Copyright 2008 Kitikmeot Community Futures Incorporated. All rights reserved.