Integrated Market Enforcement Teams Reserve Fund
Applicant Information Form

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