Fondation du maire de Montréal

Transcription

Entrepreneurship Business Plan Contest
Grant Application Form
If more than one person is in charge of the project, this form must be filled in by all the candidates
THE PROJECT SUBMISSION DEADLINE IS
MONDAY, March 7, 2011 4.00PM
Information on the candidate
Candidate’s Address
Full Name
Address
City
Montréal, Québec
Borough
Postal Code
Email
Telephone
Cell
Mother Tongue
English
French
Other
If other, please specify:
Education
University (Specify your degree)
Undergraduate
Graduate
Post Graduate
In what discipline?
College
In what discipline?
High School
Other: please specify
Fondation du maire de Montréal pour la jeunesse
425, place Jacques-Cartier, Suite 10, Montréal, Québec H2Y 3B1
514 872-8401
www.fondationdumaire.ca
1
Demographics
Birth Date:
Sex:
M
F
Canadian Citizen
Permanent Resident
Are you a member of a cultural community?
Do you have dependent children?
Yes
Yes
No
No If so, please specify:
If so, how many?
Current Professional Status
Full-Time Employee
Part-Time Employee
Part-Time Student
Please note that full-time students are not eligible
If other status, please specify:
Income over the last year: $
Specify what year:
Have you ever filed for bankruptcy?
Yes
No
If so, in what year?
If you have filed for bankruptcy, please include a copy of your Discharge Certificate with your
Are you subject to a voluntary deposit scheme?
Yes
514 872-8401
No
2
Personal Financial Statement
Candidate
Last Name:
First Name:
Assets
Value Assets
Amount
Transferred to the
Business
Cash (in hand)
Balance of Checking and Savings Accounts
Certificates of Deposit, Shares, Obligations, Mutual
Funds, etc.
Pension Plan (R.R.S.P., etc.)
Computer Equipment (resale value)
Movable Property (resale value)
Real Estate (house, land, etc.) (resale value)
Automobile (resale value)
Other, specify:
TOTAL:
Liabilities
Value Liabilities
Credit Card Balance
Line of Credit Balance
Bank Loan
Student Loan
Car Loan
Mortgage (land, house, etc.)
Other, specify:
TOTAL:
Net Value
TOTAL (Difference between the assets and the liabilities):
Statement
I certify that the information on this personal financial statement is accurate
Signature:
Date:
514 872-8401
3
Business Description
Business Address
Projected Start-Up Date:
Name of Business:
Business Address
Current
Projected
Street Address:
City:
Montréal, Québec
Postal Code::
Telephone:
Cell:
Fax:
Email:
Website:
Name of Main Contact in Regards to this Application
Last Name:
First Name:
Business Sector
Food Services
Education, Sports and Leisure
Multimedia, Computer
Sciences and Electronics
Health and Wellness
Communications and
Marketing
Literature
Audio and Video
Productions
Interior Decoration and
Planning, Furniture
Fashion
Specialized Products and
Services
Transportation
514 872-8401
4
Business Description (continued)
Business Activity
Distribution
Retail Sales
Production /
Manufacturing
Personal Services
Corporate Services
Business Legal Structure
Company
General Partnership
Sole Proprietorship
Limited Partnership
Business Number:
Cooperative
Effective Date:
Project Description and Business Mission
Grant Requested: $
For a maximum of 25% of the start-up costs as determined on page 9, up to a maximum of $7 500
514 872-8401
5
Financial Structure
Financial Projections and Economic Impact
Estimated Revenues
Year 1
$
Estimated Profits
$
Year 2
$
$
Estimated Full-Time Jobs Created
Estimated Part-Time Jobs Created
Estimated Contractual Jobs Created
Note: Include the candidates in the number of estimated jobs
Projected Start-Up Costs
Note: Please include a detailed list of your start-up costs(in hand and required) for
any category of costs that is higher than $2 000
Fixed Assets
In Hand
+ Required
= Total
Leasehold Improvements
Computer Equipment
Software
Production Equipment (machinery, etc.)
Other Equipment (tools, etc.)
Rolling Stock
Office Equipment (fax, photocopier, etc.)
Office Furniture
Licenses, Permits, Patents
Other, specify:
Sub-Total A
514 872-8401
6
Financial Structure (continued)
Projected Start-Up Costs (continued)
Note: Please include a detailed list of your start-up costs(in hand and required) for
any category of costs that is higher than $2 000
Start-Up Costs
In Hand
+ Required
= Total
Installation Charges (telephone, electricity,
Internet, etc.)
Security Deposits (public utilities, lessor, etc.)
Legal Fees (registration, incorporation)
Professional Fees (accountant, notary, etc.)
Office Supplies (stationery, stamps, etc.)
Promotional Print Material and Tools
(corporate documents, business cards, catalogs,
etc)
Multimedia Promotional Tools (web site, DVD
etc.)
Other, specify:
Sub-Total B
514 872-8401
7
Projected Monthly Operational Costs (maximum 3 months)
Amounts to take into account to meet the needs related to your expenses
over the first 3 months of operation
($) Costs
X 3 Months
= Total
Sub-Contracting
Rent
Electricity and Heating
Insurance (office, automobile)
Taxes and Permits (business taxes)
Maintenance and Repairs
Equipment Rentals
Telecommunications Expenses
Sales and Travel Expenses
Initial Advertising and Promotional Expenses
Office and Computer Supplies
Professional Fees
Other, specify
Sub-Total C
Inventory
($) Costs
X 3 Months
= Total
Raw Materials, specify:
Finished goods, specify:
Sub-Total D
Total Projected Start-Up Costs
(A+B+C+D)
514 872-8401
8
Total Projected Financing
Personal Contribution
($) Amount
Investment by the Candidates in Cash
Investment by the Candidates in Equipment
Sub-Total E
External Financing
Confirmed
Not
Confirmed
($) Amount
Donations by Private Investors (family/friends)
Loans by Private Investors
Fondation du maire Grant
(maximum of 25% of start-up costs)
Jeunes promoteurs Grant
Credit Line
Bank Loan
Small Business Loans (SBL)
Fonds Local d'investissement (FLI)
Other, specify:
Sub-Total F
Total Projected Financing Sources (must be equal to total projected
start-up costs) ( E + F )
514 872-8401
9
Statement by the Business’ Designated Representative
I certify that all the information provided in this form is true and accurate and I consent to it
being divulged. I also agree to provide, upon request by the Fondation du maire, any document
that is pertinent to the present application for financial assistance.
I also agree to provide the Fondation du maire with my credit profile, which I will have obtained
from a credit bureau.
Any inaccurate information, false declaration or significant omission will automatically result in
the final rejection of the grant application or the reimbursement of the grant that was awarded.
Read and approved, in Montréal, on:
(date)
Signature:
514 872-8401
10
Check List – Grant Application
Have you submitted the required documents?
5 copies of each of the following documents are required
Properly filled in Grant Application Form
Business plan including at least all the items listed in Appendix I “Model Business Plan”
Curriculum vitæ of the key individuals involved in the project
Any other document that you deem pertinent (contracts, letters of intent, catalogs,
prototypes, portfolio, letters of recommendation, letters of support, letters confirming the
project’s financing sources, etc.)
Credit File – See Appendix II
1 copy of each of the following documents is required for each of the eligible
candidates
Proof of age (health insurance card, birth certificate or driver’s license)
Proof of Canadian citizenship or permanent residency status (citizenship card, passport,
birth certificate or permanent resident card)
Proof that you have lived on the territory of the urban community of Montréal for at least
three months, such as a lease or two invoices (Hydro-Québec, Bell Canada, Vidéotron or
GazMétro) – a recent one and another dated three months back
Proof of income (summary of the notice of assessment regarding your most recent
income tax return form, provided by the Ministère du revenu du Québec or the Canada
Customs and Revenue Agency)
Proof that your company is incorporated or registered, as the case may be
Proof of your company’s address or upcoming address
If you are including other supporting documentation, please specify
Catalog
Portfolio
Prototype
DVD
Sample
Other, specify:
514 872-8401
11
How did you hear about Fondation du maire?
Word of Mouth
Emploi Québec (Jeunes volontaires)
Youth Employment Services
City of Montréal
Other Fondation du maire grantees
SAJE, specify:
CDEC or CLD, specify:
CJE, specify:
On the web, specify:
Info Entreprises
Communication Québec
Media, specify:
Other, specify:
514 872-8401
12
Appendix I
Model Business Plan
The following must be included with your application


Executive Summary (1 page)
Table of Contents
1.
Project
1.1. Business Mission
1.2. Product(s)/Service(s)
1.3. Objectives
1.4. Scheduled Achievements
1.5. Legal Structure and Ownership
2.
Candidates
2.1. Experience of Candidate(s)
2.2. Delegation of Responsibilities / Tasks
2.3. External Resources
3.
Market Analysis
3.1. Global Market Assessment
3.2. Targeted Market
3.3. Assessment of the Competition
4.
Marketing
4.1. Product(s)/Service(s)
4.2. Pricing
4.3. Promotion
4.4. Distribution
5.
Operations
5.1. Location
5.2. Production
5.3. Supplies
5.4. Human Resources
6.
Risk Management
6.1. Identification of Risks
6.2. Measures to Undertake / Scenarios
7.
Financial Forecasts
7.1. Detailed List of Start-Up Costs
7.2. Forecasted Financial Statements for 2 years (income statements, forecasted balance
sheets and your monthly cash budget for a period of 24 months)
7.3. Breakeven Analysis
514 872-8401
13
Appendix II
Credit Profile
You can obtain your credit profile from the following organizations:
Credit Bureaux
Note: You will be required to provide two documents to support your identity when you make
your request, including at least one with a proof of your address.
Trans Union Canada (free)
Consumer Relations Division
1, Place Laval, Suite 370
Laval (Québec) H7N 1A1
Tel.: 1 877-713-3393 or 514 335-0374
Website: www.tuc.ca
Equifax Canada Inc (for a fee)
Consumer Relations Services
Po Box: 190, Station Jean-Talon
Montréal (Québec) H1S 2Z2
Tel.: 514 493-2314 or 1 800-465-7166
Website: www.equifax.ca
514 872-8401
14

Fondation du maire de Montréal

Transcription

Documents pareils

formulaire ici

details! - I Musici

Chief`s Promotional Products - Ministère de la Sécurité publique

unique in québec natasha st.michael weaves beads, one by one

Collaboration Yields Results in Aboriginal Health Education and

FLYMONT - Marie2016.indd

profile form

Mr. Thierry Vandal, President and CEO, Hydro

Soutenons les organismes de bienfaisance d`une manière

machines – the shapes of movement