Business Plan Or Project Summary

BDPF ELIGIBILITY INFORMATION

WHO IS ELIGIBLE TO RECEIVE FUNDING UNDER THIS PROGRAM? An applicant business receiving funding must be one of the following: 1. An Individual or Sole Proprietorship; 2. A Partnership; 3. A Corporation registered under the NWT Business Corporations Act; or 4. A Co-Operative registered under the NWT Business Co-Operative Association Act. An applicant business must carry on business in the Northwest Territories (NWT) and meet one or more of the following criteria: a. Is a NWT Business Enterprise with less than <$500,000 in Annual Revenue; b. Is a Artist or Craftsperson who generates income through the sale of products that is produced or intended to be produced; or c. Is a NWT based Harvester who produces income through lawful Renewable Resource Activities. An Applicant business is INELIGIBLE if any of the following are true: 1. The business received funding through the BDIC Venture Investment Program; 2. The business has debts with the GNWT or any of its agencies which are not in good standing; 3. The business has GNWT Vendor Account Hold(s); 4. If a BDIC Board member, BDIC officer or BDIC staff member has an interest in the business; or 5. The business has already received the maximum amount of BDPF Funding. WHAT ARE THE APPROVED PURPOSES FOR FUNDING? Level I communities are Fort Smith, Hay River, Inuvik, Yellowknife & N’dilo, all other NWT communities are Level II Funding under this program is to be used for the following purposes: 1 Start-up Expenses Covering: a Assets; b Marketing; c Feasibility Assessments; d Business Plans; e Research Projects; 2 Expansion Expenses covering anything in part “1” if the applicant carries on business in a Level II community. 3 Expansion Expenses covering anything in part “1” for an applicant in a level 1 community, but only if the expansion is expected to create new employment opportunities. 4 For acquisition of Raw Materials for NWT based Artist or Craftsperson. 5 For Short-term business projects that result in the creation of employment opportunities. 6 Aftercare; a Purchase Accounting Software; b Fees associated with training in an accredited business or Accounting Program; c Fees/Travel Costs associated with business, education seminars promoted by the BDIC; d Succession Planning; and Funding cannot be used to cover GST or other taxes on project expenditures WHAT IS THE MAXIMUM AMOUNT OF FUNDING AVAILABLE? There is no limit to the number of applications that can be made by an applicant under this program provided the total amount disbursed from all contributions to the applicant does not exceed the established maximum. The established maximum amount of contribution to an applicant is set by the level of community and the time period in which previous contributions will count toward the established maximum, and are set out below: Maximum regular BDPF Funding Maximum Aftercare Funding Community Maxumum Time Period Community Maximum Time Period Level I $10,000 Previous 5 Years Level I $2,500 Lifetime Level II $20,000 Previous 5 Years Level II $5,000 Lifetime Funds received through the Aftercare Funding are in adition to the “maximum regular BDPF funding”. How is an Application Assessed? The BDIC will consider the following: 1 whether the proposed expenditures are necessary for the proposed project to be successful; 2 the need for funding; 3 the commitment to the creation, development and sustainability of the business 4 the project costs are properly substantiated and supported by multiple quotes. The BDIC may also take into account: 1 Viability of the business 2 Public interest, including the social and economic impact on the community in which the business will opperate. 3 The amount of the project costs that will be spent in the NWT

(09/12) BDPF APPLICATION APPLICATION INFORMATION

Personal Information Business Information Name: Registered Name: Address: Address: Phone: Phone: Fax: Fax: Email: Email: Social Insurance Business Type: Number: CRA Business Number:

Shareholders, Partners and Officers Name Address Phone Number (%) Ownership

Please Describe your Project Description

Project Start Date: Project End Date:

Project Costs Sources of Financing Eligible Costs Loan $ $ Equity $ $ BDIC BDPF AFTERCARE $ $ SEED Contribution (ITI) $ $ $ Subtotal of Eligible Costs $ $ Ineligible Costs $ $ $ $ Subtotal $ GST Cost $ Shortfall to be covered by BDPF Contribution $ Total Project Costs $ Total Sources of Financing $

Previous BDPF Assistance Year Community Purpose Amount $ $

(09/12) I DECLARE I have personal knowledge of the matters discussed in this application and state that: i. I have contacted the appropriate government representatives and supplied all requested information; ii. To the best of my knowledge that; a. all verbal representations made by me or on my behalf are true and correct; and b. all documents provided by me or on my behalf are genuine; iii. That the proposed business activity complies with all federal, territorial and municipal laws.

I CERTIFY that everything in this declaration is true and acknowledged that it is of the same force and effects as if made under oath.

I CONSENT to the Following: i. That the Northwest Territories Business Development and Investment Corporation (BDIC) or its agents can inspect; a. My business premises; and b. Any financial statements, receipts and business records. ii. If my application is approved, the BDIC may publish the following information in its annual reports; a. The name and location of my business in which it carries on its business in and where its head office is located. b. My name and the community in which I reside or carry on business in; and c. The details of my business activity, including the amount approved under this application and any previous financial assistance I have received from the BDIC or the GNWT.

I AGREE to receive all correspondence at the email address(s) provided in this application. I acknowledge that if I do not agree to receive correspondence by email or have not provided an email address, all correspondence will be sent through regular mail which may delay the decision regarding my application.

I CERTIYFY that I have attached all the documents listed Below: DOCUMENTS: ENCLOSED: COMMENTS: Completed Application Form YES NO N/A Business Plan or Project Summary YES NO N/A Personal Statement of Financial Affairs YES NO N/A Historical Financial Statements (if applicable) YES NO N/A Copy of Business License YES NO N/A Project Costs Quotations YES NO N/A

If you have checked NO in any of the checked boxes above please indicate in your proposal your reasoning.

The Application and all supportive documents should be forwarded to: The NWT Business Development and Investment Corporation #701, 5201-50th Ave, Yellowknife NT, X1A 3S9 Fax: 867-765-0652 Any inquiries call 867-920-6455 Your application can be either mailed or faxed. CONFLICT OF INTEREST - Please confirm with your signature below that any conflicts of interest (actual, apparent, perceived, or potential) relating to this project are disclosed in this application.

Authorised Signature/Seal of Applicant Date

PERSONAL STATEMENT OF FINANCIAL AFFAIRS

All shareholders and/or partners must complete and attach to Application form.

First Name & Initial: Surname: Social Insurance # Birth Date:

Home Address: City/Town: Postal Code:

Rent/Own Home or Other: Occupancy (Years): Home Telephone: Fax Number:

Your Employer: Position: How long? Your Annual Income:

Marital Status: Spouse’s First Name: Spouse’s Surname: Spouse’s Annual Income:

Business Telephone: Primary Bank: Number of Dependants: Total Gross Family Income:

PERSONAL NET WORTH STATEMENT LIST ALL ASSETS LIST ALL LIABILITIES & DEBT Cash & Savings: $ Mortgage - First: $ Term Deposits/G.I.C.: $ Mortgage - Second: $ Stocks/Bonds/Mutual Funds: $ Bank Lines of Credit: $ R.R.S.P. /Company Pension: $ Overdraft Facility: $ Real Estate - Residence: $ Bank Personal Loans: $ Real Estate - Other: $ Credit Cards: $ Automobiles: $ Private Loans: $ Recreational Vehicles: $ Amt of loan cosigned for $ or guaranteed: Other - Describe: $ Other - Describe: $ $ $ TOTAL ASSETS: $ TOTAL LIABILITY: $

PERSONAL NET WORTH (Assets - Liabilities): = $ Detailed Description of Assets Describe your Real Estate: Property Address Reg. Owner Value Mtge Balance Lender

(09/12) Describe your Automobiles and Recreational Vehicles Year & Make Model Value Loan Amount Balance Lender

Describe your Cash, Savings, Term Deposits, G.I.C.s, R.R.S.P.s and Company Pensions Asset Description Financial Institution Telephone Balance Maturity

Describe your Stocks, Bonds, Mutual Funds, and Life Insurance: Asset Description Agent/Brokerage Telephone Cash Value # of Units Maturity

Detailed Description of Liabilities and Debt Describe your Loans, Credit Lines, Credit Cards, and loans you have co-signed or guaranteed for others (excluding mortgages and vehicle loans which have been described under Assets on page 1 & 2):

Debt Description Lender/Creditor Telephone Credit Limit Balance Security

GENERAL INFORMATION

1. Have you ever had an asset repossessed by a creditor? If yes; explain

2. Are you involved in any lawsuits or claims that could affect your financial situation? If so, explain

3. Have you ever declared bankruptcy? If yes, when? Are you discharged? If not why? 4. Do you have any outstanding liability to the receiver General, Workers Safety and Compensation Commission or Canada Revenue Agency? 5. Are you a shareholder, director or stakeholder of any other business, corporation, partnership, proprietorship, ect.? If so, describe the nature of your involvement and/or interest.

APPLICATION DECLARATION

The undersigned hereby declares that all information provided herein is true, complete and correct, to the best of my knowledge. I understand that the information contained herein will be used by the Business Development & Investment Corporation(“BDIC”) to determine BDPF eligibility. I further consent to the BDIC making any credit and general inquiries necessary in relation to this application and to the disclosure of any credit information about me, to any credit reporting agency, organization or person with whom I have a financial relationship. This is to include the GNWT Department of Finance.

DATE: ______SIGNATURE: ______