Apply for assistanceWe value and support a cooperative spirit Loan Application form Step 1 of 7 14% Section A: Applicant InformationBusiness Name*Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Community*Postal CodePhone*FaxEmail* Contact Name* First Last Title*Business Activity*Years in Business* Section B: Business Ownership InformationList 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* First Last Beneficiary* Yes No Percentage Owned*Percentage Owned*Name of Owner* First Last Beneficiary* Yes No Name of Owner* First Last Beneficiary* Yes No Percentage Owned*Name of Owner* First Last Date of Birth* MM slash DD slash YYYY SIN #*Name of Owner* First Last Date of Birth* MM slash DD slash YYYY SIN #*Name of Owner* First Last Date of Birth* MM slash DD slash YYYY SIN #* Section C: Form Of Business (check one)Proprietorship Proprietorship (one owner, unincorporated)Partnership Partnership (two or more owners, unincorporated)Corporation Corporation (one or more owners, incorporated)Date MM slash DD slash YYYY Society Society (non-profit group, incorporated)Date MM slash DD slash YYYY Other(please specify) Section D: Project InformationCommunity where project will take place*Project start date* MM slash DD slash YYYY Project end Date MM slash DD slash YYYY Briefly describe the project* Section E Proposed Use and Sources of FundsUse of Funds*ItemAmount (CAD $) Total use of Funds*KBAP ContributionED & T ContributionLoansSourceAmount (CAD $) Identify SourceClient EquityTotal other FundingKCFI LoanTotal Source of Funds*Type of Loan required Term Loan Line of Credit Guarantee Section F: Project BenefitsJobs Created - InuitFull-timePart-timeSeasonalJobs Maintained - InuitFull-timePart-timeSeasonalJobs Created - Non-InuitFull-timePart-timeSeasonalJobs Maintained - Non-InuitFull-timePart-timeSeasonalJob Training ProvidedInuitNon-InuitEstimated Annual Wages PaidInuitNon-InuitEstimated Gross Annual SalesInuitNon-Inuit 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: 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; I make this application under my own free will; To the best of my knowledge, the proposed business or project complies with all territorial, federal, and municipal laws; To the best of my knowledge, the applicant or the corporation is not involved in any lawsuits or has any outstanding judgments against them; 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; 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 Name*(please type full name)Date* MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged. Click here to download the Word Document version
