To the Economic Development Agency of Canada for the Regions of Quebec (hereinafter "the Agency"),
I, the undersigned, _________________________ a person duly authorized by _________________________, (legal name) (hereinafter the "client") undertake and certify the following:
I undertake to disclose any other other government assistance or financial assistance requested or received for the project, as well as any other government assistance or financial assistance requested or received for a similar project by a company with which the client has a non-arm’s-length relationship within the meaning of section 251 of the Income Tax Act (R.S.C. (1985), c 1 (5th Sup)..
The Agency must ensure that lobbyists and their clients understand and comply with the federal government Lobbying Act, R.S.C. (1985), c 44 (4th Sup) .
Please indicate whether you have any pending legal proceedings
I hereby authorize the Agency to proceed with any consultation or verification, in particular with suppliers, financial institutions, accounting firms, funding agencies, credit agencies and any government agencies, that it deems necessary to assess the application for financial assistance or the administration ans follow-up of any resulting contribution agreement, and I agree to the parties contacted disclosing the information requested.
I also authorize the Agency to disclose the information in its possession with regard to the client and the project to other government departments and agencies.
I understand to provide the Agency, at no charge, without delay and in the form requested, with any information required to complete the evaluation of the application for financial assistance. Lastly, I attest that the information provided in the application and all the documentation provided is complete, truthful and accurate.
Name of authorized person:_________________________
Signature : ____________________________________
Date : ____________________________________
Please print this document before submitting your application and mail the original, duly signed by the authorized person, to the following address:
Canada Economic Development for Quebec RegionsBusiness Development and Infrastructure800 René-Lévesque West BLVD., Suite 500Montréal, Quebec H3B 2T9
All the information on your business or project created, retained or collected by Canada Economic Development for Quebec Regions is subject to the Access to Information Act and the Privacy Act.