FINANCIAL PRODUCTS – FINANCING OF REFUNDABLE TAX CREDITS (financing of refundable tax credits regarding the construction or major repair of access roads or bridges in forest areas) Financing of Working Capital for Export Projects (construction or major repair of access roads or bridges in forest areas)
LOAN / GUARANTEE APPLICATION
Please complete this form and send it to Investissement Québec.
Additional documents to provide
In the case of a guarantee application, the “Declaration of the lender (Schedule A)”, which you can obtain from Investissement Québec, is required to process your application. You must send it to the lender for completion, then send us the original copy. If the financing of your project comprises one loan for a number of tax credits, file only one declaration.
You also have to send the following additional documents to the Investissement Québec business centre in your region in order for your application to be reviewed:
A) Complete and sign the “Authorization to exchange information with the Canada Revenue Agency (Schedule B)” that you can obtain from Investissement Québec;
B) Complete and sign “Declaration of the company” that you can obtain from Investissement Québec;
A description of the project including:
the purpose of the project; the timetable for completing the project (main steps and corresponding levels of advancement);
D) Financial statements for the last two years (if not, opening balance) and the most recent internal financial statements;
A copy of the most recent provincial and federal income tax returns and the related notices of assessment;
The company’s business plan;
The budgeted financial statements of results as well as the cash budgets for the current and subsequent fiscal year (including existing and future contracts as well as the likehood of realization);
A brief description of the company (products, markets, competition, etc.);
In the case of a guarantee, a copy of the letter offering financing from your financial institution;
A copy of confirmations of government and non-government assistance (non-refundable financial contributions), where applicable;
A copy of the eligibility certificate from the Ministère des Ressources naturelles et de la Faune (MRNF);
The company statutes;

Please include any documents concerning the company or its projects that will be relevant to the assessment of this application.

Investissement Québec Service Outlets

Brossard 4805, Lapinière, suite 4100 Brossard (Québec) J4Z 0G2 Telephone: 450 676-2123 Fax: 450 676-5270	Québec 1200, route de l’Église, bureau 500 Québec (Québec) G1V 5A3 Telephone: 418 643-5172 Fax: 418 528-2063
Chandler Case postale 1360 500, rue Daigneault, bureau 10 A Chandler (Québec) G0C 1K0 Telephone: 418 689-2549 Fax: 418 689-4108	Rimouski 70, rue Saint-Germain Est, bureau 100 Rimouski (Québec) G5L 7J9 Telephone: 418 727-3582 Fax: 418 727-3686
Drummondville 1100, boul. René-Lévesque, suite 102 Drummondville (Québec) J2C 5W4 Telephone: 819 478-9675 Fax: 819 478-9717	Rouyn-Noranda 170, Principale, bureau 202 Rouyn-Noranda (Québec) J9X 4P7 Telephone: 819 763-3300 Fax: 819 763-3462
Gatineau 230, boulevard St-Joseph Gatineau (Québec) J8Y 3X4 Telephone: 819 772-3211 Fax: 819 772-3271	Saguenay 3950, boulevard Harvey, 2e étage Saguenay (Québec) G7X 8L6 Telephone: 418 695-7865 Fax: 418 695-8156
Laval 3030, boul. Le Carrefour, bureau 902 Laval (Québec) H7T 2P5 Telephone: 450 680-6161 Fax: 450 680-6171	Saint-Georges 11535, 1re Avenue, bureau 303 Saint-Georges (Québec) G5Y 7H5 Telephone: 418 222-5768 Fax: 418 222-5786
Montréal East Island of Montréal 7100, rue Jean-Talon Est, bureau 1250 Montréal (Québec) H1M 3S3 Telephone: 514 873-9292 Fax: 514 873-1484	Sept-Îles 454, avenue Arnaud Sept-Îles (Québec) G4R 3A9 Telephone: 418 964-8160 Fax: 418 964-8164
West Island of Montréal 413, rue Saint-Jacques, bureau 500 Montréal (Québec) H2Y 1N9 Telephone: 514 873-4375 Fax: 514 873-5786	Sherbrooke 200, rue Belvédère Nord, bureau 3.10 Sherbrooke (Québec) J1H 4A9 Telephone: 819 820-3224 Fax: 819 820-3825
Saint-Laurent 3300, boul. de la Côte-Vertu, bureau 210 Saint-Laurent (Québec) H4R 2B7 Telephone: 514 873-1401 Fax: 514 864-8267	Trois-Rivières 100, rue Laviolette, bureau 318 Trois-Rivières (Québec) G9A 5S9 Telephone: 819 371-6012 Fax: 819 371-6792

Toll free number in Québec: 1 866 870-0437

1.	IDENTIFICATION
Name of the company submitting the application:
NEQ (Québec business number):
Address of head office:
Address of main office (if different from head office):
Person Investissement Québec should contact:
Title:	Telephone:
Fax:
Email:
Address (if different from head office):
Number of employees before the project:	after the project:
2.	INFORMATION ON THE COMPANY AND THE LOAN REQUESTED
Registration number with Revenu Québec:	(see “Corporation Income Tax Return”, CO-17)
Date of incorporation:	Beginning of operations:
(yyyy-mm-dd)	(yyyy-mm-dd)
Is the company associated (as defined in the Taxation Act) with other companies?	Yes	No
(if so, append a list and organization chart to your application)
Is the company in arrears on any account with
the Canada Revenue Agency or Revenu Québec?	Yes	No
Are any disputes or notices of objection outstanding in respect of the
Canada Revenue Agency or Revenu Québec? (if so, append the details to your application)	Yes	No

3.	INFORMATION ON THE FINANCIAL INSTITUTION (for a guarantee)
Name of lender (company name):
Address (branch):	Transit number:
Name of the person responsible for the account at the financial institution:
Telephone:	Fax:
4.	ELIGIBILITY
4.1	ELIGIBILITY PERIOD
This tax credit applies for the period starting March 24, 2006 and ending March 31, 2013. An annual forest management plan must be submitted to the ministère des Ressources naturelles et de la Faune du Québec (MRNF) before January 1, 2012. In addition, construction or major repairs must begin prior to January 1, 2012.
4.2	ELIGIBLE COMPANY
To receive the tax credit, the company must carry on a business in Québec and have concluded one of the following three agreements with the MRNF: timber supply and forest management agreement (TSFMA) forest management contract (FMC) forest management agreement (FMA) In addition, the eligible company cannot be an “excluded corporation”, i.e. a company exempt from tax for the year, a Crown corporation or a wholly-controlled subsidiary of such a corporation. The company must also satisfy other eligibility conditions.
Does the company hold an eligibility certificate issued by the ministère des Ressources naturelles et de la Faune du Québec (MRNF)? (if so, enclose a copy of the certificate)	Yes	No
4.3	HISTORY OF TAX CREDITS RECEIVED
Year	Level	Amount claimed	Date	Amount received	Date
Provincial
Provincial
Provincial
5.	PROJECT
Brief description of the project and timetable for completion

6.	SHAREHOLDERS AND MANAGEMENT
Name and address	Title or position within company (if shareholder not employed by company, write n/a)	Years of experience in the industry	Years of experience with the company	% of voting shares
Total

LOAN / GUARANTEE APPLICATION Calculations for tax credits to be financed
1.	ESTIMATE OF TAX CREDITS TO BE FINANCED
Location where activities will be carried out:
Eligible expenses 1	Fiscal year ending:	Fiscal year ending:
Total costs	Eligible costs	Applicable tax credit %	Tax credits to be financed (Québec)	Total costs	Eligible costs	Applicable tax credit %	Tax credits to be financed	Total costs	Total eligible costs	Total tax credits to be financed (Québec)
A) Access roads
Period from 2006-03-24 to 2006-10-22
− Wages	40 %
− Cost of goods used	40 %
− Cost of the contract	40 %
Less: government assistance	40 %
non-government assistance	40 %
Period from 2006-10-23 to 2010-12-31
− Wages	90 %	90 %
− Cost of goods used	90 %	90 %
− Cost of the contract	90 %	90 %
Less: government assistance	90 %	90 %
non-government assistance	90 %	90 %
Period from 2011-01-01 to 2011-12-31
− Wages	80 %
− Cost of goods used	80 %
− Cost of the contract	80 %
Less: government assistance	80 %
non-government assistance	80 %
Period from 2012-01-01 to 2012-12-31
− Wages	70 %
− Cost of goods used	70 %
− Cost of the contract	70 %
Less: government assistance	70 %
non-government assistance	70 %
Period from 2013-01-01 to 2013-03-31
− Wages	60 %
− Cost of goods used	60 %
− Cost of the contract	60 %
Less: government assistance	60 %
non-government assistance	60 %
Total

Eligible expenses1: (cont’d)	Fiscal year ending:	Fiscal year ending:
Total costs	Eligible costs	Applicable tax credit %	Tax credits to be financed (Québec)	Total costs	Eligible costs	Applicable tax credit %	Tax credits to be financed	Total costs	Total eligible costs	Total tax credits to be financed (Québec)
B) Bridges
Period from 2006-03-24 to 2006-10-22
− Wages	40 %
− Cost of goods used	40 %
− Cost of the contract	40 %
Less: government assistance	40 %
non-government assistance	40 %
Period from 2006-10-23 to 2010-12-31
− Wages	90 %	90 %
− Cost of goods used	90 %	90 %
− Cost of the contract	90 %	90 %
Less: government assistance	90 %	90 %
non-government assistance	90 %	90 %
Period from 2011-01-01 to 2011-12-31
− Wages	80 %
− Cost of goods used	80 %
− Cost of the contract	80 %
Less: government assistance	80 %
non-government assistance	80 %
Period from 2012-01-01 to 2012-12-31
− Wages	70 %
− Cost of goods used	70 %
− Cost of the contract	70 %
Less: government assistance	70 %
non-government assistance	70 %
Period from 2013-01-01 to 2013-03-31
− Wages	60 %
− Cost of goods used	60 %
− Cost of the contract	60 %
Less: government assistance	60 %
non-government assistance	60 %
Total:
Total A plus B:

1 Eligible expenses include all expenses directly attributable to the construction or major repair of access roads and bridges:

Access roads	Bridges
− impact studies	− impact studies
− siting	− geotechnical studies
− development of plans and specifications	− siting
− deforestation	− development of plans and specifications
− grubbing	− construction of the foundation unit
− shaping	− construction of the superstructure
− filling	− construction of the bridge deck
− drilling and blasting	− construction of approach embankments
− placing of signage	− drilling and blasting
− supervision	− placing of signage
− construction of culverts	− supervision
− roadway foundation
− snow removal

N.B.:	Expenses incurred for preventive and routine maintenance of an existing road or bridge are ineligible.

Calculations for tax credits to be financed
Fiscal year(s) ending:	Total
Total refundable tax credits to be financed (Québec)
Maximum loan at 75%
Applies to Financing of Working Capital for Export Projects Maximum loan at 85%

The total maximum loan must be greater than $25,000.