Fund will be used for:
Loan Security Offered
List below the collateral you propose to offer towards the loan. If applicable, indicate the fair market value of the assets. Example of security include business assets, personal assets, property and loan guarantees.
* For Machinery, Equipment and Vehicles indicate make, model, year, series number.
* For Property indicate legal description, street address and PID
Debts Held by the Business/Company
List below any debts held by business/company. This should include any other loans held in the company name, leasing agreements, lines of credit. Community Futures 16/37 may request copies of debt agreements.
If financial assistance is provided by Community Futures 16/37 will you allow us to make a public announcement regarding your project? (You would be contacted before any announcement was made)
Is the business/company or any of the principals involved in ANY legal action or litigation? (If yes, provide details).
Personal Statement of Affairs
Do you rent or own your home?
Are you related to any employee or director of Community Future 16/37?
Are you a committee member, director or employee of Community Futures 16/37?
If yes above, may we refer this application to another Community Futures office?
Please provide three references. At least two references should be from customers or previous employers and should be comments on your business capability.
Statement of Yearly Income & Expenditure
Collection of Information – Voluntary
The following collection of information is voluntary and solely for the purpose of determining eligibility for various program(s) and gathering statistical information for the Government of Canada
Personal Equity Statement
The figures below should represent all personal assets and liabilities for both you and your spouse.
Have you ever had an asset repossessed?
Have you ever declared bankruptcy?
Do you owe any taxes prior to the current year?
Environmental Risk Assessment
How do you occupy the property described above?
Have environmental assessments of the property been carried out in the last 5 years?
Historical uses of property
Current or planned uses of property
Is there a neighbouring land use from which a potential pollutant(s) could enter your property?
Do you use, store, handle or transport hazardous materials or goods (defined under the workplace hazardous materials information system in Canada)?
Do you dispose of, or recycle, any such hazardous materials?
Do you produce infectious waste (such as medical pathological waste)?
Do you use equipment that may contain P.C.B.s on site at your place business other than in transformers or equipment owned by the electrical utility?
Does the premise or property contain asbestos?
Are you aware of any concerns with respect to Radon Gas in the vicinity of your property?
Are there any, or have there ever been, underground or above ground storage tanks on the property?
Do you use, or store, any bulk gases (such as propane, butane, carbon dioxide, nitrogen ammonia)?
Have any of your workers filed complaints, or claims, for any environmental health reasons?
Do you cary environmental insurance, and if so, does your insurance require annual environmental reviews or assessments to determine environmental liabilities?
Are there discharges to the environment, and if so, are necessary permit or licenses issued to your business (Federal, Provincial or Municipal)?
Does the property have ay pits, ponds, lagoons or other dumping areas on site?
Does the property have any landfills, junkyards, incinerators or other waste disposal facilities or buried wastes?
Are there or have there been, any spills, polluting incidents, environmental orders or civil actions or other environmental concerns on the property, or violations of permits, regulations or laws?
Before signing, please read this page
- The statements made in this application are for the express purpose of obtaining financing from the Community Futures 16/37 and are true, full and correct as of the date below.
- I understand that any additional information required to support this application must be supplied to the Community Futures 16/37 before adequate consideration can be given to this application.
- Community Futures 16/37 requires that reference and credit check to be performed as a normal requirements of public funds. I consent to Community Futures 16/37 making any inquiries of such persons, firms or corporations, as it deems necessary in order to reach a decision on this application.
- I acknowledge that Community Futures 16/37 is not providing me with professional financial or legal advice, but rather offers itself as a source of information. I release Community Futures 16/37, its representatives and employees from responsibility should I choose to rely on the information provided to me by Community Futures 16/37.
- I have included with this application form:
- A completed and signed Personal Equity Statement for each principal/owner of the business and each loan applicant.
- Business Plan (Ask your Business Analyst)
- Projected Cash Flow Sheet for the next three years, including detail of assumptions
- Financial Statements for the last three years (for existing business).
- Environmental Risk Assessment
- Photocopy of your driver’s license or BCEID
I hereby authorize Community Futures Strathcona to obtain information it deems necessary about me from time to time, including but not restricted to, reports from credit bureaus or any other source agency Community Futures Strathcona deems appropriate. I declare the information given on this statement is true and accurate. I have no liabilities or financial obligations other than those stated.