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{"sheet":"Application for Review","index":0,"n_rows":51,"n_cols":34,"rows_kept":51,"cut":false,"hidden":false,"merged":[[47,0,47,33],[43,0,43,20],[45,0,45,33],[33,0,33,33],[34,0,34,33],[36,0,36,33],[44,23,44,33],[44,0,44,20],[42,0,42,33],[43,23,43,33],[37,0,37,33],[41,0,41,33],[38,0,38,33],[39,0,39,33],[40,0,40,33],[16,26,16,33],[22,0,22,25],[17,0,17,33],[18,0,18,33],[19,0,19,25],[19,26,19,33],[20,0,20,25],[21,27,21,32],[20,27,20,32],[21,0,21,25],[5,0,5,33],[14,0,14,25],[14,26,14,33],[13,0,13,33],[10,29,10,33],[10,0,10,7],[10,10,10,17],[6,0,6,33],[7,0,7,33],[9,20,9,27],[9,29,9,33],[12,0,12,33],[26,22,26,33],[26,0,26,7],[26,8,26,13],[27,8,27,13],[23,0,23,25],[23,27,23,32],[24,0,24,32],[3,0,3,33],[0,0,0,12],[1,0,1,33],[0,13,0,33],[4,0,4,33],[2,0,2,33],[49,0,49,5],[49,6,49,33],[50,0,50,5],[50,6,50,33],[27,16,27,21],[27,22,27,33],[32,0,32,33],[35,0,35,33],[29,0,29,33],[30,30,30,33],[31,30,31,33],[30,0,30,24],[30,25,30,29],[31,25,31,29],[31,0,31,24],[46,0,46,33],[28,0,28,33],[27,14,27,15],[8,0,8,33],[27,0,27,7],[48,0,48,33],[26,14,26,15],[26,16,26,21],[11,0,11,33],[10,20,10,27],[9,0,9,7],[9,10,9,17],[16,0,16,25],[15,0,15,25],[15,26,15,33],[22,27,22,33],[25,0,25,33]]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Version : 2022-12-01"]
["Application for Review"]
["This form is to be used by a company that wishes to contest a decision rendered by Investissement Québec when issuing a certificate of eligibility for a tax measure or when amending or revoking such a document."]
["The application for review must be filed within 60 days of the notification of the contested decision or the issue of the document whose content differs from that applied for."]
["To be admissible, the application for review must be filed using this form, which must be duly completed, signed and accompanied by payment of the applicable fee, the breakdown of which can be found on our website at http://www.investquebec.com/iq/tarification"]
["1. IDENTIFICATION OF THE COMPANY"]
["Company name"]
[]
[]
["NEQ (Québec enterprise number)",null,null,null,null,null,null,null,null,null,"IQ file number*"]
[null,null,null,null,null,null,null,null,null,null,"D"]
["*This is the file number shown on correspondence from Investissement Québec."]
[]
["Mailing adress"]
[]
[]
[]
[]
["Authorized company representative or agent"]
[]
["Title of authorized representative or agent",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Telephone",null,null,null,null,null,"Ext."]
[]
["E-mail address of authorized representative or agent",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Cellular"]
[]
[]
["2. FISCAL YEAR COVERED BY THIS APPLICATION FOR REVIEW"]
["Fiscal year from:",null,null,null,null,null,null,null,null,null,null,null,null,null,"to :"]
[null,null,null,null,null,null,null,null,"(yyyy-mm-dd)",null,null,null,null,null,null,null,"(yyyy-mm-dd)"]
[]
["3. CONTESTED DECISION"]
["Issue date of the document for which this application for review is being filed:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(yyyy-mm-dd)"]
[]
["4. GROUNDS FOR THIS APPLICATION FOR REVIEW"]
["Please indicate on what grounds you are contesting this decision and enclose any supporting documents, additional evidence or new information (if there is insufficient space, enclose an additional file)."]
[]
[]
[]
["5. PARTIAL REFUSAL"]
["In case of a partial refusal (refusal of some of the employees claimed), please complete the \"Partial Refusal\" tab."]
[]
["6. DECLARATION OF THE AUTHORIZED COMPANY REPRESENTATIVE OR AGENT"]
["I, the undersigned, duly authorized representative or agent of the company, declare that the information provided in this application and the related documents is complete and accurate in all respects."]
[]
["Signature of the company's authorized representative or agent",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[]
["MAILING ADDRESSES FOR THE APPLICATION FOR REVIEW FORM"]
["Regardless of its point of origin, the application for review (including this form, supporting documents and the prescribed fee) must be sent to:"]
["By e-mail: mfrevision@invest-quebec.com, accompanied by proof of payment via your financial institution;\nor"]
["By mail:",null,null,null,null,null,"Investissement Québec\nDirection, Mesures fiscales (Québec)\nÉdifice Iberville 1\n1195, avenue Lavigerie, bureau 060\nQuébec (Québec)  G1V 4N3\n"]
[null,null,null,null,null,null,"accompanied by a certified cheque or a money order made out to Investissement Québec – FDE or proof of payment via your financial institution."]

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[null,null,null,null,null,"Version : 2022-12-01"]
[]
[]
["Appendix A – Partial Refusal"]
["List of Employees Covered by the Application for Review"]
["(Appendix A is an integral component of this Application for Review)"]
["Complete this appendix for all contested employees. "]
["Company name",null,null,"File number",null,"Fiscal year"]
[{"$f":"IF('Application for Review'!A8=\"\",\"\",'Application for Review'!A8)","v":""},null,null,{"$f":"IF('Application for Review'!K11=\"\",\"\",'Application for Review'!K11)","v":"D"},"from",{"$f":"IF('Application for Review'!I27=\"\",\"\",'Application for Review'!I27)","v":""},"to",{"$f":"IF('Application for Review'!Q27=\"\",\"\",'Application for Review'!Q27)","v":""}]
[]
[]
["Name(s) of employee(s) covered by this Application for Review","Position",null,"Reason(s) for contesting "]
["Last name (1 space) First name"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["Non"]