Nunavut Harvesters Support Program Application

    Nunavut Harvesters Support Program
    Harvesting Equipment Program Application Form

    1. APPLICANT INFORMATION

    Full Name:(as it appears in your ID)
    NTI Number:
    Date of Birth:
    PO Box #:
    Community:
    Postal Code:
    House # and street address:
    Email Address:
    Home Phone:
    Cell Phone:
    Work Phone:

    PROGRAM INFORMATION (check all that apply)


    APPLICANT ELIGIBILITY


    FUNDING REQUEST DETAIL

    Attach All quotes and/or receipts from suppliers including all taxes and shipping fees to your community. the total must add up to the total on the quotes and/or receipts.

    SMALL EQUIPMENT SUBSIDY

    Select eligible items:
    Equipment Cost:
    Additional Items:
    Equipment Cost:
    Additional Items:
    Equipment Cost:
    Additional equipment - if you need more space, add items with costs here

    Total cost of equipment:
    Total amount requested (50% of total cost to maximum of $500):
    Attach copies of quotes for small equipment (PDF Copies Preferred)

    SAFETY EQUIPMENT SUBSIDY

    Select eligible items:
    Equipment Cost:
    Additional Items:
    Equipment Cost:
    Additional Items:
    Equipment Cost:
    Additional equipment - if you need more space, add items with costs here

    Total cost of equipment:
    Total amount requested (50% of total cost to maximum of $500):
    Attach copies of quotes for small equipment (PDF Copies Preferred)

    DISASTER RELIEF APPLICATION

    Eligible amount is 75% of net replacement cost to maximum limits as follows, for any major equipment lost in an accident or disaster

    i. Snowmobiles-$7000 ii. ATV's-$6000 iii. Boats-$10,000 iv. Outboard Motors-$7000
    Location:
    Details of incident:
    Name(s) of witness(es)
    Damaged Equipment:
    Value of Equipment:
    Replacement Equipment to be purchased:
    Price of Equipment (with shipping):
    If you had insurance for your equipment that covered loss, please detail them here
    Insurance Amount Received:
    Net Loss (Price minus Insurance):
    Attach copies of receipts or quotes for disaster relief equipment replacement (PDF Copies Preferred)

    Household Information

    Enter all names that live in your household and your relationship to them
    Name
    Relationship
    Please list other family in household if more room needed below.

    Declaration and Submission

    By clicking on the submit button below, I declare that I am applying for funding assistance under the Harvesting Equipment Program administered by the Nunavut Harvesters Support Program. I swear that to the best of my knowledge, all of the statements or information in this application are true. I understand that any false or misleading information will result in my application being denied and may disqualify my organization or myself from receiving future funding assistance from NHSP or the Kivalliq Inuit Association (KIA).

    I promis that any assistance received under this program will be used for the proposed harvesting equipment only.

    I give permission to NHSP to collect and use my personal information related to this application to make inquiries needed to evaluate this application. Upon receiving assistance, I will agree to supply any relevant receipts, records or other relevant information requested by the NHSP.

    My receipt of assistance will not make me an employee, contractor or agent of NHSP or the KIA.

    I further believed this declaration to be true and know that it is the same as if made under oath.