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Small Business Grant Application
You do not meet the eligibility requirements for this program
Required fields are indicated with an " * " and bordered in red.
Have you (as applicant) already applied for this program for previous periods?:
Yes
No
Business Start Date:
Number of Full Time Equivalent Employees, including owner (defined as 1,560 hours per year):
Industry Sector:
Choose
Food and Beverage (excluding businesses with drive thru options)
Fitness Facilities
Barber, Hair Stylist or Spa
Casinos/Bingo Hall
Cinemas or Arcade
Large Live Performance Venue
Legal Form of Business:
Choose
Proprietorship
Partnership
Corporation
Co-Operative
Social Insurance Number:
Social Insurance Number:
If your partnership has more than two partners, please call 1 833 799-7966
What is your 9-digit Canada Revenue Agency Business Number for remittances?
Legal Name of Business:
Trade Name/Operating Name of Business (if applicable):
Contact First Name:
Contact Last Name:
Contact Phone Number:
Contact Email:
Confirm Contact Email:
Civic Address (the permanent established address or principal place of business)
Postal Code:
Civic Number:
Street Name:
Street Type:
City, Town or Village:
Apartment Number / Suite:
Province:
Choose
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Zone in which the business is located:
Choose
Health Zone 1:Moncton/South-East Area
Health Zone 2:Fundy Shore and Saint John Area
Health Zone 3:Fredericton and River Valley Area
Health Zone 4:Madawaska and North-West Area
Health Zone 5:Restigouche Area
Health Zone 6:Bathurst and Acadian Peninsula Area
Health Zone 7:Miramichi Area
Maps of health zones and NBHC communities
Mailing Address
Is your mailing address the same as your civic address?
Postal Code:
Civic Number:
Street Name:
Street Type:
City, Town or Village:
Apartment Number / Suite:
Province:
Choose
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Previous Period Sales
If your business started after October 1, 2019, and you did not have a full month of sales for any of the periods below, please input your February 2020 sales
Monthly Sales for October 2019:
Monthly Sales for November 2019:
Monthly Sales for December 2019:
Monthly Sales for January 2020:
Monthly Sales for February 2020:
Current Period Sales
Monthly Sales for October 2020:
Monthly Sales for November 2020:
Monthly Sales for December 2020:
Monthly Sales for January 2021:
Upload Documents
Note:
Please ensure attachments are either in
doc;docx;gif;jpeg;pdf;png;xlsx
format. The maximum file size per attachment is 7 MB and depending on the number of files attached, it may take a few minutes to process the application.
Step
1
-
Income statements for the 8 months noted, with previous year statements for comparable period or February 2020 income statements. These statements should be produced from your electronic accounting package.
NOTE - you may combine all of your financial statements into one document and simply upload one document, or you can upload your financial statements for each period individually.
Step
2
-
Most recent PD7A – Statement of account for current source deductions.
Step
3
-
Direct Deposit Information Form
Step
4
-
Please confirm which documentation you have attached:
Financial statements for the monthly periods inputted into the form
PD7A – Statement of account for current source deductions
Direct Deposit Form
Please Note
ONB reserves the right to request additional information as part of their due diligence to complete the evaluation of the application. Failure to provide this information may be grounds to terminate the application.
Attestation Section
* I attest that the following is true and accurate and agree to the following:
Yes
No
The business is an ongoing, New Brunswick based entity operating in the Province of New Brunswick
The business is current withWorksafe NB, & Canada Revenue Agency
The sales drop of the business was related to the public health order (level change)
The business is open, or plans to reopen following the return to Yellow level
The business is not currently in the process of bankruptcy/insolvency proceedings or proposals
The business has no past defaults of amounts owed to the Government of New Brunswick
I/we acknowledge that amounts owing to the Province of New Brunswick, that are not current, will be deducted from the ONB approved funding, and remitted to the appropriate department to reduce and/or extinguish the debt. The remaining balance, if any, will be remitted to the business.
I/we consent to the verification of the information provided on this application, and on any documents attached, for the purpose of determining the business’s eligibility for the grant. This includes sharing this information with any and all departments of the Province of New Brunswick as identified by Finance and Treasury Board, and collecting information about the business from those departments. This will also serve as my/our consent under the Right to Information and Protection of Privacy Act (S.N.B. 2009, c. R-10.6) for the collection, use and disclosure of personal information for the purposes determining the business’s eligibility for the grant.
By signing this application, I/we declare and certify that the information on this application, and in any documents attached, is correct and complete and I/we are authorized to act on behalf of the business. I/we acknowledge that any misrepresentation of information provided in this application may result in legal action including repayment of any grants
I have legal signing authority for the organization
Name:
Title in Organization:
Phone Number:
Email Address: