Request for Extension of Claim Submission Date

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Canada Small Business Financing Act

Request for Extension

Lender
1
Lender's name and address (print)
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
 Postal Code
 
 
 
 
 
2
 Transit no.
 
 
 
 
 
 
 
 
3
 Telephone no.
 
 
 
 
 
 
 
 
 
 
4
 Fax no.
 
 
 
 
 
 
 
 
 
 
5
 e-mail address
Information on Loan
6
 Borrower's name (print)
7
 Loan registration no. or/ Claim no.

line

8
Date loan made
Year
Month
Day
 
 
 
 
 
 
 
 
 
 
9
 Original amount of loan

$line

10
 Principal outstanding

$line

Complete Section A or Section B

Section A — Claim Submission Date Extension
(in situation where the lender is not able to present the initial claim within the prescribed period)
11
 Date specified in Notice of Default. Enter the date the lender has given the borrower to comply with a condition of the loan agreement.
Year
Month
Day
 
 
 
 
 
 
 
 
 
 
 
12
 State reason for default, remedial action taken and / or proposed and reason for requesting an extension of the Claim for Loss Submission Date.
Year
Month
Day
 
 
 
 
 
 
 
 
 
 
 
Section B - Claim Finalization Date Extension
(in situation where the lender is requesting an extension to the submission date initially set in the interim claim)
13
 Existing Claim Finalization Date
Year
Month
Day
 
 
 
 
 
 
 
 
 
 
 
14
  
State reason why Finalization Date must be extended
Proposed New Submission Date
15
   The lender requests that the Claim for Loss Submission/Finalization Date be extended to:
Year
Month
Day
 
 
 
 
 
 
 
 
 
 
 
Name and title of authorized representative of the lender (print)
Signature
Date
Year
Month
Day
 
 
 
 
 
 
 
 
 
 
 
Approval (by CSBF Program)
Based on the information contained herein, the Claim for Loss Submission/ Finalization Date is herewith extended to:
Year
Month
Day
 
 
 
 
 
 
 
 
 
 
 
Approved on behalf of the Minister
Name and title (print)
Signature
Date
Year
Month
Day
 
 
 
 
 
 
 
 
 
 
 
Notes:
The Minister's approval of the extended Claim for Loss Submission/ Finalization Date in no way provides or implies concurrence with any action taken or proposed by the lender.
 
The Minister is not liable to pay any loss with respect to this loan unless the lender has complied with the requirements of the Acts and respective Regulations.
Forward To:
Industry Canada
Canada Small Business Financing Program
235 Queen Street,
Ottawa, Ontario K1A 0H5
Fax: (613) 952-0290
INFORMATION ON THE PROGRAM AND FORMS AVAILABLE AT:
www.ic.gc.ca/csbfp