RRRF Form Application Online

Economic Benefits*

Please estimate the number of full-time equivalent jobs to be maintained as a result of this funding

The Government of Canada recognizes that many under-represented groups face unique economic challenges and may be dis proportionately affected by the COVID-19 crisis.

If applicable, please indicate if your business or organization is led or majority led by one or more of the following under-represented groups

Other please specificy

maximum 200 characters

Applicant must provide the following documentation to accompany this application by using the Add Attachments button:
• Historical financial statements for the last two (2) fiscal years
• The most recent interim financial statement
• Incorporation Documents or Business Documents
• Completed Officer’s Certificate

Applicant that is a sole proprietor must provide the following documentation to accompany this application by using the Add Attachments button:
• T2125 Statement of Business or Professional Activities
• Statement of Account of latest Canada Revenue Agency Source Deduction form (RP)
• Statement of Account of latest Canada Revenue Agency HST Form (RT)
• Statement of Personal Assets & Liabilities or Current Internal Financial Statements

Other attachments are permitted as supporting information, but not as replacements for responses to the questions on the application form. The Add Attachments button can be used for submitting this additional information.

Add Attachment

Drop files here or

Add Attachment

Please confirm that the mandatory documentation, as described above, is attached to this application.

Yes
No

On behalf of the Applicant, I hereby acknowledge and certify that: (a)I have read and understand this request for support and will submit all the required information with this proposal. I understandincomplete applications cannot be assessed easily and may be deemed ineligible. (b)I have authority to submit this request for support on behalf of the Applicant. (c)The information provided herein is complete, true and accurate. I make this attestation acknowledging that making a false statementor providing misleading information may result in the Minister exercising any remedy available to him/her at law. (d)Any other information given in the future in connection with the carrying out of the activities will also be complete, true and accurate. (e)The information provided regarding funding from other federal COVID-19 support measures/programs is accurately recorded inthis application. (f)The revenue and fixed operating costs amounts provided on this application form are accurate. (g)Financial assistance from WWCF is a significant factor in the decision to proceed, and I authorize WWCF to make credit checks or other inquiries it deems necessary to evaluate this request. I agree to provide any further information that may be required for WWCF to makea decision. (h)Costs incurred by the Applicant in the absence of a signed agreement with WWCF are incurred at the sole risk of the Applicant and any such costs may not be considered eligible for WWCF assistance. (i)WWCF, its officials, employees, agents and contractors may share this request for support and/or make inquiries of such persons, firms, corporations, federal, provincial and municipal government departments/agencies, and not-for-profit, economic development or other organizations as may be appropriate, and to share information with them, as WWCF deems necessary in order to assess this request for support or to refer the application. (j)Information provided to WWCF will be treated in accordance with the Access to Information Act and the Privacy Act. These laws govern the use, protection and disclosure of personal, financial and technical information by federal government departments and agencies. Information provided to WWCF is secured from unauthorized access. (k)The Applicant has not engaged any person to solicit financial assistance for a commission, contingency fee or other form ofconsideration dependent upon the approval of this application for financial assistance. (l)Any person who has been lobbying on behalf of the Applicant to obtain financial support as a result of this request is registered pursuant to the Lobbying Act and was registered pursuant to that Act at the time the lobbying occurred. Where the lobbying duties of the employees of the Applicant constitute a significant part of the employee’s duties, the Applicant is in compliance with the Lobbying Act. (m)Any former public office holder or public servant employed by the Applicant is in compliance with the provisions of the Values andEthics Code for the Public Sector, the Policy on Conflict of Interest and Post-Employment and the Conflict of Interest Act. (n)The Applicant agrees to comply with the Official Languages Act as may be required, specifically where activities involve services toor activities with the public. (o)As part of its assessment process, WWCF requires that all applicants conform with the Impact Assessment Act (2019). (p)As a sole proprietor, I attest that my taxes are up to date

I agree*

Name of Officer with Signing Authority for the Organization*

Title*

Date*

DD-MM-YYYY

RRRF Loan application

Step 1 of 5

Applicant Information

Authorized Organization Contact

COVID-19

Total Revenues from all sources *

Net Income/Loss

Current Assets

Current Liabilities

Long-Term Assets

Long-Term Liabilities

Operating Expenses

Interest Charges

Utilities

Insurance

Bank Interest Charges

Professional Fees

Rent

Wages

Property Taxes

Other

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