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I confirm that I have come to WOCFDCA of my own free will and that I am interested in obtaining information about financing a business. This waiver is given by me in consideration of WOCFDCA offering me advice and suggestions for / about my business/not for profit or social enterprise.

I understand that I am solely responsible for the planning, implementation, financing, operation, success and development of my business. Any advice or suggestions made by representatives of WOCFDCA are for my consideration only and I am not bound to take any such advice or suggestions and can obtain advice and assistance from any source, but ultimately any decision pertaining to my business is my responsibility. I confirm that I am not in any way relying on any advice or suggestions made to me by representatives of WOCFDCA, but that I have sought such advice or suggestions as part of my independent planning for my business. Any choice or decision made by me to accept, adopt, or reject any suggestion or advice made or given by any representative of WOCFDCA to me or anyone representing me or my business is my responsibility alone. I understand it is my responsibility to ensure that any financial information, estimates or projections developed are accurate and complete and represent the current financial situation and realistic future prospects of my business venture.

I agree to hold WOCFDCA free and harmless for any repercussion, consequences, claim or loss to me or my business which could result from my either taking or not taking the advice or following the suggestions of the representatives of WOCFDCA, or which could result from any failure by WOCFDCA to provide me with complete, appropriate or correct advice or suggestions, or which might result to me or my business, directly or indirectly, for any reason whatsoever. I confirm that WOCFDCA has no obligation to ensure that I take any advice or suggestions provided by it or anyone else; or to follow up on advice, suggestions or business planning; or to oversee my business in any way.

I release the employees, agents, directors and officers of WOCFDCA from any claim that I may have at any time for any loss or damages that might be suffered by me or my business or by any other person, in connection with any counseling or consultation provided to me by any of the employees, agents, directors or officers of WOCFDCA. I confirm that I am signing this waiver freely and voluntarily with full understanding of its meaning and consequences, and that I have had an opportunity to obtain independent legal advice prior to signing it, and have either obtained such advice or do not need it.

I acknowledge that Federal Economic Development Agency for Southern Ontario or their successor(s) may have access to the records pertaining to me or my business that are now or in future become in the possession or control of WOCFDCA and that WOCFDCA, and/or the Federal Economic Development Agency for Southern Ontario may make public announcements or publish information about or pertaining to any assistance or advice given or loan made by WOCFDCA to me or my business. This waiver of liability and consent shall be effective immediately.

I have read and agree to the conditions of the waiver.

The following are ineligible businesses:

• Federal and Provincial government departments, agencies, boards, corporations and commissions.
• Post-secondary institutions (e.g. colleges, polytechnic institutes, universities and teaching institutions).
• Not-for profit corporations; and
• Municipal governments.

Does the business currently employ people in Southern Ontario?
YesNo

Is the Business/project located in a community facing long-term vulnerabilities as a result of structural and socio economic factors?
YesNo

Is the business and/or project considered innovative?
YesNo

Does the project clearly demonstrate potential for new job creation or job maintenance?
YesNo

Does the project have a reasonable expectation of economic viability and ability to repay a loan?
YesNo

Does the principal(s) have personal financial involvement in the business?
YesNo

Is the business suitable for public funding?
YesNo

Is the business/project pre-revenue?
YesNo

Does the business/project support women, youth, Indigenous, newcomers and entrepreneurs in rural and les diversified geographic area?
YesNo

Does the business/project align with one of the following:
Digital Industries
Advanced Manufacturing
Agri-food
Clean Technologies
Health & Biosciences
Other
YesNo

Is the business/project having challenges accessing capital?
YesNo

(Main Product / Service, General Operations and Markets Served: Briefly describe your business its Key Success Factors, operations strategy, the market(s) it competes in, market size, competitors, competitive advantage and competitive risk management.)

Describe your management team, management gaps and strategy to offset gaps. Provide a summary profile of your Board of Directors and/or outside Management Advisory Team.

Does the business have a current borrowing relationship?
YesNo

How it leads to innovation and improves your company’s competitiveness, product or service uniqueness, leads to sales growth, margin improvement, profit enhancement, leverages existing strengths, employment opportunities.

Provide an overview of the technical application to markets, stage of commercialization, Intellectual Property Rights protection existing or planned. Describe any results of research and development, completed third party assessments or technical reviews and complexity of the technical aspect.

Provide a detailed timeline for implementation of the project, project milestones and estimated date of completion.

(3 years of financial statements and year to date internally prepared financial reporting)

Please include any additional information which you feel is relevant to the project and its intended impact on the business. (may include business plan, pitch deck, technical assessments. 3rd party market assessments)

Other attachments:

Project Budget and Funding Sources: Provide a summary of the project activities, detailed funding sources (external and internal),

Economic Contribution: Provide a summary of the estimated employment created and / or maintained. Provide the current export sales and export sales in each of the forecasted years.

The organization agrees information provided will be disclosed to third parties for purposes of assessing the project for funding. All third parties in receipt of this information have signed agreements to maintain the confidentiality of this document and its contents.

By submitting this application the applicant hereby certifies the application and supporting documentation are true and complete in all respects. I am an Officer or Director legally authorized by the applicant to bind the organization.

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