Bdic

Owners/shareholders will need To provide Personal Statement of Financial Affairs when application is submitted

Asset Description

Amount

Debt Description

Amount

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CAD

I the undersigned hereby declare that all information provided herein is true, complete and correct, to the best of my knowledge.

I understand that the information contained herein may be used by the NWT Business Development & Investment Corporation (“BDIC”) to determine program eligibility.

I further consent to Prosper NWT making any credit and general inquiries necessary in relation to this application and to the disclosure of any credit information about me, to any credit reporting agency, organization or person with whom I have a financial relationship. This is to include the GNWT Department of Finance.

Please leave this field blank; it will populate automatically.

2025-07-06

Personal Statement of Financial Affairs

Your Application Code *

Your First Name *

Your Middle Name

Your Last Name *

Your Date of Birth *

Home Address *

Mailing Address (If different from home address)

Community *

Province/Territory *

Postal Code *

Telephone Number *

Email Address *

Your Employer *

Position *

Work Phone

Your Annual Income *

Are you married? *

List All Assets *

List All Debts & Liabilities *

Total Net Worth

Have you ever had an asset repossessed by a creditor? *

Are you involved in any lawsuits or claims that could affect your financial situation? *

Have you ever declared bankruptcy? *

Do you have any outstanding liabilities to the Government of the Northwest Territories, Canada Revenue Agency or the Workers Safety and Compensation Commission? *

Are you a shareholder, director or stakeholder of any other business, corporation, partnership, proprietorship etc? *

Your Full Name *

Date *

Please check the box below to give your consent *