Application Form

Step 1 of 4 - Primary Applicant

25%

Primary Applicant

Legal Name(Required)

Matches Government ID

First Middle Last

Email(Required)

Would you like NEDC event emails?(Required)

Yes

Phone (primary)(Required)

Primary Is Cell

Cell

Phone (secondary)

Primary Is Cell

Cell

Home Address(Required)

Street Address Address Line 2 City Province Postal Code

Home is(Required)

Rented

Owned

On-reserve

Mailing Address is(Required)

Same as your home address

Different Address

Mailing Address

Street Address Address Line 2 City Province Postal Code

Ancestry(Required)

SIN Number

Birth Date(Required)

DD dash MM dash YYYY

Status Number

Nation Name

Marital Status(Required)

Single

Married / Common-law

Number of Dependents

Disability to Declare?

Yes

Credit History

Do you have credit problems?(Required)

Yes

In the past

Have you declared bankruptcy?(Required)

Yes

In the past

Funding Declaration

Do you, or your business, owe money to the Government of Canada?(Required)

Yes

Have you, or any business that you own or have previously owned, received financial assistance from NEDC?(Required)

Yes

Have you, or any business that you own or have previously owned, received financial assistance from the Government of Canada (including Aboriginal Affairs and Northern Development Canada)?(Required)

Yes

Declaration and Consent of Applicant

PERSONAL INFORMATION COLLECTION, USE & DISCLOSURE

NEDC is responsible for the administration of a wide variety of programs and services as further described in our website (www.nedc.info). In administering these programs, NEDC collects, uses and discloses personal information for the following purposes:

i.To perform its contractual obligations to the Government of Canada and Province of British Columbia for the term of the agreement(s) such as keeping records of program participant for meeting reporting requirements;
ii.Collecting and tracking aggregate information of program participants to evaluate the effectiveness of the program and to meet funding requirements;
iii.To meet, maintain, monitor, evaluate and regulate programs and client participation in programs including providing loans and other monies to clients;
iv.To meet terms, conditions and obligations of employment to our employees such as for benefit and payroll administration; and
v.To promote NEDC programs to its clients, members and the public.

I authorize duly appointed representatives of NEDC to obtain information from and share with persons or organizations, public or private, any information necessary, including credit information, about me from my credit bureau, employers, suppliers, band or any person in connection with to my dealings, to complete the assessment of the project.

I hereby consent to the collection, use and disclosure of my personal information by NEDC for the purposes of my application and participation in NEDC programs and any and all financial and government reporting requirements of NEDC in administering this application and my participation in such NEDC programs.

Signature(Required)

Date(Required)

Day

Month

Year

Do you have a co-applicant?(Required)

No, it is only me applying

Yes

Co-applicant Details

Co-applicant's Legal Name

Matches Government ID

First Middle Last

Phone (primary)

Primary Is Cell

Cell

Phone (secondary)

Primary Is Cell

Cell

Home Address

Street Address Address Line 2 City Province Postal Code

Home is

Rented

Owned

On-reserve

Mailing Address is

Same as your home address

Different Address

Mailing Address

Street Address Address Line 2 City Province Postal Code

Ancestry(Required)

SIN Number

Birth Date

DD dash MM dash YYYY

Status Number

Nation Name

Marital Status

Single

Married / Common-law

Number of Dependents

Disability to Declare?

Yes

Credit History

Do you have credit problems?

Yes

In the past

Have you declared bankruptcy?

Yes

In the past

Funding Declaration

Do you, or your business, owe money to the Government of Canada?

Yes

Have you, or any business that you own or have previously owned, received financial assistance from NEDC?

Yes

Have you, or any business that you own or have previously owned, received financial assistance from the Government of Canada (including Aboriginal Affairs and Northern Development Canada)?

Yes

Declaration and Consent of Co-Applicant

PERSONAL INFORMATION COLLECTION, USE & DISCLOSURE

i.To perform its contractual obligations to the Government of Canada and Province of British Columbia for the term of the agreement(s) such as keeping records of program participant for meeting reporting requirements;
ii.Collecting and tracking aggregate information of program participants to evaluate the effectiveness of the program and to meet funding requirements;
iii.To meet, maintain, monitor, evaluate and regulate programs and client participation in programs including providing loans and other monies to clients;
iv.To meet terms, conditions and obligations of employment to our employees such as for benefit and payroll administration; and
v.To promote NEDC programs to its clients, members and the public.

Signature

Date

Day

Month

Year

Business Information

Business Name

Type of Business

Full-time

Part-time

Seasonal

Structure of Business

Sole Proprietor

Partnership

Corporation

Community Owned

Unknown

Is the business registered?

Yes

I Don't Know

Business Number

Do you have a business license?

(from your City or First Nation)

Yes

Business Owner's Name

Gender

Female

Male

Non-binary

% of Ownership

Additional Business Owner's Name

Gender

Female

Male

Non-binary

% of Ownership

Office Address is

Same as home address

Different Address

Office is(Required)

Rented

Owned

On-reserve

Office Address(Required)

Street Address Address Line 2 City Province Postal Code

Business Mailing Address is

Same as home address

Same as office address

Different Address

Business Mailing Address

Street Address Address Line 2 City Province Postal Code

Business Phone

Business Email

Website

Project Information

Business Overview

What do you do? Who are your customers? Etc.

What Type of Project are your requesting funds for?

Start-up a Business

Expand a Business

Business Planning

Feasibility Study

Buy a Business

Other (please describe below)

Project Description

Describe what you need these funds for? What will you buy? Who will you hire? What are you spending money on

Financing Request - total project costs

Please be prepared to share a breakdown of these costs with your business development officer. More details will be needed later in the process.

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