Integrated Market Enforcement Teams Reserve Fund
Applicant Information Form

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Language preferred for correspondence / Langue de correspondance:

English Français

Applicant Information

Name of government body applying for funds: ______________________________

Address ___________________________________

Street _____________________________________

P.O. Box __________________________________

City ______________________________________

Province or Territory _________________________

Postal Code ________________________________

Contact Name ______________________________

Title ______________________________________

Telephone _________________________________

Fax ______________________________________

E-mail Address _____________________________

Project Information

Title/Case Identifier _________________________

Amount Requested _________________________

Start Date DD/MM/YY______________________

Completion Date DD/MM/YY_________________

Declaration

• The information in this application is accurate and complete.
• No employees are in conflict with the Post-Employment Code of the federal government.

I acknowledge that should a project be approved, I will be required to enter into a formal agreement which will outline the terms and conditions.

Name of authorized Organization Officer _________________

Title ________________________

Telephone ____________________

Fax _________________________

E-mail Address ________________

Signature _____________________

Date ________________________

Please forward your completed project proposal to:

Policy Planning Directorate
Programs Branch
Department of Justice Canada
280 Wellington Street, 6th Floor
Ottawa, Ontario  K1A 0H8
Fax:  613-941-5446