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Have you had to alter your regular operations to manufacture PPE? *
Branch Number (transit): * Financial Institution Number: * Account Number: *
Name of Account Holder(s): *
If Name of Account Holder is not the
Legal Name of the organization,
please explain:
Email a copy of a blank "VOID" cheque from the account you wish to use for electronic payments, OR
Obtain a bank letter/confirmation directly from the bank (eg. Direct Deposit Notification form):
*
AUTHORIZED OFFICIAL OF THE APPLICANT ORGANIZATION ACKNOWLEDGEMENTS
The application form must be submitted by a member of your organization with signing power/authority to enter into a legal agreement.
On behalf of the Applicant Organization I declare that:
The organization suffered a financial hardship resulting from COVID-19 pandemic. *
The information provided in this application is accurate. *
The organization acknowledges its intention to continue to operate its business in British Columbia.*
The organization has applied and been declined for Canada Emergency Business Account funding, is not eligible for Canada Emergency Business
Account funding, or will not apply for Canada Emergency Business Account funding if their application to the RRRF is successful. *
An audit may be conducted by the Government of Canada or any of its agents to ascertain the veracity of this attestation and the eligibility of the
applicant under the program. *
The organization will provide Women’s Enterprise Centre or any of its agents with required financial information.*
The organization will use any funding received as working capital in the categories outlined in the operating costs section of this application.*
On behalf of the Applicant Organization, I hereby acknowledge and agree that:
• This application does not constitute a commitment from Women’s Enterprise Centre for funding.
• Any funds received under this program are repayable contributions to Women’s Enterprise Centre, less conditionally forgivable portions.
• The terms and conditions of any financing which may be authorized will be set forth in a Letter of Offer, for agreement and acceptance by the
Applicant Organization.
• By signing this form, you are granting Women’s Enterprise Centre access to personal information under the Personal Information Protection
and Electronic Documents Act (PIPEDA). This information will be protected and used in conformity with PIPEDA and the Privacy Act. Under
these Acts, each Recipient has access to their personal information and has the right to demand any modification. This information will be
maintained by Women’s Enterprise Centre.
I authorize Women’s Enterprise Centre, its officials, employees, agents, and contractors to make enquiries of such persons, firms, corporations, federal,
provincial and municipal government departments/ agencies, and non-profit, economic development, or other organizations as may be appropriate, and
to collect and share information with them, as Women’s Enterprise Centre deems necessary in order to assess this application, to administer and monitor
the implementation of the subject project and to evaluate the results of the project and related Programs.
I have read and agree with the above acknowledgements and certify that all statements and information furnished in this application are true,
complete, and correct to the best of my knowledge *
Authorizing Official Contact Information - Official signing affidavit.
First name * Last Name *
