Financing of Working Capital for Export Projects (increase in total payroll)
APPLICATION FOR A GUARANTEE
Refundable tax credits based on an increase in total payroll:
Processing operations in resource regions (AT) - Expired 31-12-2010
Gaspésie and certain maritime regions of Québec (GM) - Expires 31-12-2015
Aluminum Valley (VA) - Expires 31-12-2015
The tax measure listed below was abolished in the June 12, 2003, Budget Speech (only companies that obtained an eligibility certificate before that date can benefit from it).
E-business activities (AE) - Expires 31-12-2013
If your project also involves other tax credits not mentioned in this form, please fill out the appropriate application for a guarantee. If the financing of your project comprises one loan for all the tax credits, file only one Schedule A.

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):
Contact person:
Title:	Telephone:
Fax:
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:
Is the company associated (as defined by the Taxation Act) with other companies?	Yes	No
(if so, enclose a list of companies and an organization chart with your application)
Does the company hold an eligibility certificate from Investissement Québec (1)?	Yes	No
(if so, enclose a copy of the eligibility certificate with 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?	Yes	No
(if so, enclose the details with your application)
Amount of the loan applied for from the lender indicated in Schedule A:	$	(2)
E-business activities, processing operations in resource regions, Gaspésie and certain maritime regions of Québec and Aluminum Valley. May not exceed 85% of the total tax credits indicated in section 3 on page 4, according to the provisions of the program.

3.	PROJECT(S)
Check off the tax credits claimed
Processing operations in resource regions (PAT) *
Gaspésie and certain maritime regions of Québec (GM) *
Aluminum Valley (VA) *
E-business activities (AE)
* Applicable rate according to the year covered: before 2003, 40%; 2003, 35%; from 2004 to 2010, 30% for (AT) and (VA); 40% for (GM); from 2011 to 2015, 20% for (VA) and (GM).
Please complete the following table concerning salaries and eligible employees for the calendar year financed that ends during the applicant's taxation year1 (Attach additional pages if needed) 1 Fiscal year for which tax credits will be claimed from Revenu Québec.
Calendar year:	Fiscal year:
Calculation of the estimated total payroll for the calendar year financed
Eligible employee	Position	Salary paid or anticipated for the calendar year financed (A)	Ineligible expenses included in A (except performance bonuses and commissions related to marketing) (B)	Governmental and non-governmental assistance (and any benefit or advantage applicable to these salaries) (C)	Net estimated eligible total payroll for the calendar year financed (D)
Total
N.B. Ineligible expenses (column B above and column F on the following page) are: directors' fees, bonuses, remuneration for work performed outside of normal working hours, production bonuses or commissions (unless they are related to marketing), taxable benefits, and salaries paid to employees who enable the company to benefit from other tax credits. For processing activities, the total wages paid by the company to its eligible employees will be reduced by 2% for calendar year 2008, by 4% for calendar year 2009 and by 6% for calendar year 2010.

3.	PROJECT(S) (CONTINUED)
Please complete the following table concerning salaries and eligible employees for the reference calendar year (use additional pages, if needed). For the tax credits in respect of the “Biotechnology development in certain designated sites,” “Cité de l’optique” and “Technopôle Angus,” the reference year must be the year preceding the calendar year financed. For the tax credits in respect of “Processing operations in resource regions,” “Gaspésie and certain maritime regions of Québec (GM)” and “Aluminum Valley (VA),” the reference calendar year is 2000, in the case of eligible companies whose eligibility certificate for this credit came into force before January 1, 2002. For other eligible companies, the reference calendar year is the calendar year preceding the year in which the company’s eligibility certificate comes into force. As of calendar year 2003, if a company holds more than one eligibility certificate for one or more tax credits available in the regions, it must use a single reference calendar year, i.e. the one applicable to the first eligibility certificate issued to it. For the “Gaspésie and certain maritime regions of Québec” and “Aluminum Valley” tax credits, as of January 1, 2011, the reference calendar year will be 2010 if the company was previously eligible for tax credits at the rate of 30% for the (VA) and 40% for the (GM) and if it has not yet elected to claim the tax credit at the rate of 20%. For the “E-business activities” credit, since the first calendar year that may be financed is 2001, the first potential reference year (preceding year) is 2000. For the “Innovation centres” and “Nutraceuticals and functional foods” credits, since the first calendar year that may be financed is 2002, the first potential reference year is 2001. The review engagement report in section 4 must be completed by a CPA.
Calendar year:	Fiscal year:

Calculation of the total payroll for the reference calendar year
Eligible employee	Position	Salary paid during the preceding calendar year (E)	Ineligible expenses included in E (except performance bonuses and commissions related to marketing) (F)	Governmental and non-governmental assistance (and any benefit or advantage applicable to these salaries) (G)	Net eligible payroll for the reference calendar year (H)
Total	*
N.B. No adjustment is anticipated in the total payroll even if the business operated during only part of the reference calendar year. * This total cannot exceed the total in column C on page 3.

4.	REVIEW ENGAGEMENT REPORT
Name of company:
At the request of Investissement Québec, I have reviewed the expenses in respect of the total payroll for the reference calendar year (column H of section 3) in the amount of:
$
My review was made in accordance with Canadian generally accepted accounting standards for review engagements and accordingly consisted primarily of enquiry, analytical procedures and discussion related to information supplied to me by the company. A review does not constitute an audit and consequently I do not express an audit opinion on these payroll expenses. Based on my review, nothing has come to my attention that causes me to believe that these payroll expenses are not, in all material respects, in accordance with Canadian generally accepted accounting principles.
City
Date	Given name Surname, CPA auditor, accounting designation prior to the coming into force of the Act (CA, CGA, CMA)

5.	CALCULATION OF TAX CREDITS
Total payroll for the calendar year financed indicated in column D (I)	Total payroll for the calendar year financed indicated in column H (J)	Increase in payroll attributable to employees of the company (column I less column J) (K)	Tax credit rates (L)*	Tax credits available (column K multiplied by column L) (M)	Maximum percent- age (N)	Maximum available for financing (column M multiplied by column N) (O)
75 %
*	Applicable rate according to the year covered by the eligible programs:
before 2003: 40% for all except e-business activities, for which the rate is 35% for calendar year 2003: 35% from 2004 to 2010: 30% for processing operations in resource regions and Aluminum Valley. The rate is 40% for the “Gaspésie and certain maritime regions of Québec” credit. Extension of the refundable tax credit at a rate of 20% until December 31, 2015, for the “Aluminum Valley” and “Gaspésie and certain maritime regions of Québec” credits.

6.	PRINCIPAL EXECUTIVES AND SHAREHOLDERS OF THE COMPANY
Management	Years of experience
Title	Surname and given name	Diploma(s)	in the industry	with the company
President
General manager
Production manager
Sales manager
Chief financial officer
Head of R&D
Other:

Ownership (list shareholders and their addresses, the number and percentage of shares in each category that they own and the organization charts of the companies, if applicable)
Name	Address	Common shares	Preferred shares
Number	%	Number	%

7.	TAX INFORMATION
This section must be completed for each fiscal year during the execution of the project(s)
Name of company:
Canada Revenue Agency
Fiscal year ended (1)
Pre-tax accounting income
Taxable income
Tax payable (2)
Taxable capital if in excess of $10,000,000
Revenu Québec
Fiscal year ended (1)
Pre-tax accounting income
Taxable income
Tax payable (2)
Tax on capital payable
In the case of a fiscal year that has already ended, refer to the appropriate tax returns. As calculated before the deduction of refundable R&D tax credits.
Over the last two years, has the company claimed tax credits from Revenu Québec based on an increase in total payroll, such as those listed on page 1?
Yes	No	If so, please provide details (years, amounts, nature of projects, and so on) below.

Over the last two years, has the company claimed scientific research and experimental development tax credits from the Canada Revenue Agency or Revenu Québec?
Yes	No	If so, please provide details (years, amounts, nature of projects, and so on) below.

7.	TAX INFORMATION (CONTINUED)
Over the last two years, has the company claimed tax credits from Revenu Québec related to the knowledge-based economy or any other field?
Yes	No	If so, please provide details (years, amounts, nature of projects, and so on) below.

Amount of the latest tax credits based on an increase in payroll received to date:
-	from Revenu Québec:	$	for the fiscal year ending:
date
Amount of the latest R-D tax credits received to date:
-	from Revenu Québec:	$	for the fiscal year ending:
date
-	from the Canada Revenue Agency:	$	for the fiscal year ending:
date
Amount of the latest tax credits regarding the knowledge-based economy and other fields received to date:
-	from Revenu Québec:	$	for the fiscal year ending:
date

8.	SIGNATURE
Signature	Title of signing officer (duly authorized representative of the company)	Date

9.	DOCUMENTATION TO BE ENCLOSED WITH THIS APPLICATION
To be complete, this application must contain answers to all of the questions, be signed by the duly authorized representative of the company submitting the application and contain the estimated refundable tax credits (section 3), the review engagement report duly signed by a CPA auditor (section 4), the tax information (section 7), and the Declaration of the Lender (Schedule A). Moreover, it must be accompanied by the documents indicated below: A description of the project including: the purpose of the project; the timetable for completing the project (main steps and corresponding levels of advancement); Financial statements for the last two fiscal years (if these are not available, the opening balance sheet) and the most recent internal financial statements available; Copies of the most recent provincial and federal tax returns and the related notices of assessment; The business plan; Budgeted statements of results as well as the cash budgets for the current and subsequent fiscal year (including existing and future contracts as well as likelihood of realization); A brief description of the applicant company (products, markets, competition, etc.); A copy of the letter offering financing from your financial institution; Copies of the confirmations of government assistance (non-refundable financial contributions), where applicable; A copy of the eligibility certificate from Investissement Québec or the ministère de l’Économie, de la Science et de l’Innovation; The company’s articles of incorporation. Please include all documents concerning the company or its project that will be relevant in assessing this application.

Send the completed form to the nearest office of Investissement Québec:
QUÉBEC CITY	MONTRÉAL
Édifice Iberville 1 1195, avenue Lavigerie, bureau 060 Québec (Québec) G1V 4N3 418 643-5172	413, rue Saint-Jacques, bureau 500 Montréal (Québec) H2Y 1N9 514 873-4375