FINANCIAL PRODUCTS – FINANCING OF REFUNDABLE TAX CREDITS (Financing of refundable tax credits for ship construction or conversion) Financing of Working Capital for Export Projects (Ship construction or conversion)
LOAN / GUARANTEE APPLICATION
1.	IDENTIFICATION
Exact name of the company submitting the application:
NEQ (Québec business number):
Address of head office:
Address of principal office (if different from head office):
Person Investissement Québec should contact:
Title:	Telephone number:
Fax number:
Address (if different from head office):
Number of employees prior to project:	after the project:
2.	INFORMATION ON THE COMPANY AND THE LOAN REQUESTED
Revenu Québec registration number:	(see “Corporate Return,” CO-17)
Date of incorporation:	Date on which operations began:
Is the company a private Canadian corporation (as defined by the Taxation Act)?	Yes	No
Is the company a public Canadian corporation?	Yes	No
Is the company associated (as defined by the Taxation Act) with other businesses?	Yes	No
(if yes, append a list and organization chart)
Does the company hold an eligibility visa issued by the ministère des Finances et de l’Économie
for its project(s)?	Yes	No
(if so, append a copy of the eligibility visa)
Is the company in arrears in any amount whatsoever in respect of the Canada
Customs and Revenue Agency or Revenu Québec?	Yes	No
Are any disputes or notices of objection outstanding in respect of the Canada
Customs and Revenue Agency or of Revenu Québec?	Yes	No
(if yes, provide details in an appendix)
Loan amount requested from the lender indicated in Schedule A:	$	* (for a guarantee)
Loan amount requested from IQ:	$	*
* May not exceed 75% of the estimated total tax credits mentioned on page 5 (form CO-1029…) and according to the provisions stipulated in the financial product.
Applies to Financing of Working Capital for Export Projects * May not exceed 85% of the estimated total tax credits mentioned on page 5 (form CO-1029…) and according to the provisions stipulated in the financial product.

3.	SUMMARY OF THE COST OF THE PROJECT(S) AND FINANCING
Anticipated commencement date:	Anticipated termination date:	(maximum 3 years)
Sites where operations will be carried out:
3.1 VESSEL	CONSTRUCTION PROJECT(S)	Fiscal year ended:
Total
CONVERSION PROJECT(S)
(in dollars)
Salaries or wages
Consideration (non-arm's-length relationship)
Contract
Consideration (arm's-length relationship) X 50 % (1)
Sub-total of eligible expenses
Other ineligible expenses
Total
Person having a non-arm’s length relationship with a shareholder of the company or holding less than 10 % of the capital stock.
3.2 FINANCING (in dollars)	Fiscal year ended:	Total
Investment
Term debt
Non-repayable contributions financing
Working capital
Other (please specify):
Québec tax credits
Total

4.	PRINCIPAL EXECUTIVES AND SHAREHOLDERS OF THE COMPANY
Management	Years of experience
Title	Surname and given name	Degree(s)	in the industry	with the company
President
Chief Executive Officer
Production Manager
Sales Manager
Chief Financial Officer
Director 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 as the case may be)
Name	Address	Common shares	Preferred shares
Number	%	Number	%

5.	TAX INFORMATION
[this section must be completed by fiscal year during the realization of the project(s)]
Name of company:
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 already ended, refer to the appropriate tax returns. As calculated before the deduction of refundable R&D tax credits. Over the past two years, has the company claimed tax credits for vessel conversion or construction from Revenu Québec?
Yes	No	If yes, please provide details (years, amounts, nature of projects, and so on) below.
Amount of the most recent tax credits received to date:
-	From Revenu Québec:	$	For the fiscal year ending:
Date

6.	ESTIMATED REFUNDABLE TAX CREDITS
[the estimate must be provided for each fiscal year(1) during the realization of the project(s)]
-	FOR THE CONSTRUCTION OF VESSELS:
Please use the form CO-1029.8.36.55 (available from Revenu Québec) to calculate the estimated tax credits anticipated for your project and append a copy of the estimate to this application form. The aforementioned form will subsequently be used to apply for the disbursement of credits from Revenue Québec.
-	FOR THE CONVERSION OF VESSELS:
Please use the form CO-1029.8.36.56 (available from Revenu Québec) to calculate the estimated tax credits anticipated for your project and append a copy of the estimate to this application form. The aforementioned form will subsequently be used to apply for the disbursement of credits from Revenu Québec.
(1) For a fiscal year overlapping June 12, 2003 (date of the Budget Speech), please note that the tax credits were reduced as of June 13.

7.	SIGNATURE
Signature	Title of signatory (duly authorized representative of the company)	Date

8.	DOCUMENTATION TO BE APPENDED TO 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 provide the tax information (section 5) and the estimated refundable tax credits in respect of the construction or the conversion of vessels (section 6). In addition, in the case of a guarantee, the Declaration of the Lender (Schedule A) must be completed and forwarded when this application is made. Moreover, it must be accompanied by the documents indicated below: a description of the project, including, in particular: the purpose of the project; the timetable for carrying out the project (main steps and corresponding level of advancement); the list and the qualifications of persons assigned to the project; a duly completed and signed “Declarations and Consents” form that you can obtain from Investissement Québec; financial statements in respect of the last two (2) fiscal years (in the absence of such financial statements, the opening balance sheet) and the most recent internal financial statements available; a copy of the most recent provincial and federal tax returns and the attendant notices of assessment; the business plan; the budgeted financial statements of results as well as the cash budgets for the current and subsequent fiscal year; a brief description of the company submitting the application (products, markets, competition, and so on.); a copy of all correspondence pertaining to this project with Revenu Québec; a duly completed ESG Questionnaire; in the case of a guarantee, a copy of the letter offering financing from your financial institution; a copy of confirmations of government assistance (non-repayable contributions financing), as the case may be. Please include all documents concerning the company or its project that are relevant to an assessment of this application.
Send the completed form to the nearest Investissement Québec office as indicated below:
QUÉBEC CITY	MONTRÉAL
Édifice Iberville 1 1195, avenue Lavigerie, bureau 060 Québec (Québec) G1V 4N3 418 643-5172	1001, boulevard Robert Bourassa, bureau 1000 Montréal (Québec) H3B 4L4 514 873-4375