Checklist. Please submit the following with your application:

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INDIVIDUAL Checklist Please submit the following with your application: Full Personal Tax Returns for last 3 years Notices of Assessment for last 3 years Applicant confirmation of all fishing

1 INDIVIDUAL Checklist Please submit the following with your application: Full Personal Tax Returns for last 3 years Notices of Assessment for last 3 years Applicant confirmation of all fishing licenses currently held (print out) via National Online Licensing System Include Bill of Materials from this application signed and sealed by the boat builder and by the Applicant plus the Quote(s) from builder or complete Quote Details section of this application Quotes must include: 1) Engine Quote, and 2) Electronics Quote Builder s Risk Insurance Life Insurance Confirmation from Canada Revenue Agency that there are no outstanding taxes owed to Canada Revenue Agency either corporate and/or personal Photocopies of two (2) pieces of government ID (Birth Certificate, Driver s License) NOTE: All applications are subject to an Administration Fee and a Mortgage Registration Fee. RETURN ALL DOCUMENTS TO: Nova Scotia Fisheries and Aquaculture Loan Board 74 Research Drive Bible Hill NS B6L 2R2 Phone: (902) Fax: (902)

2 INDIVIDUAL My loan will help me to (check all that apply): Begin fishing Create jobs for: full time or seasonal (½ year) Expand my business Apply new technology Improve my business profitability Maintain my vessel and equipment Allow me to survive a low-price cycle or poor production year

3 1 Give your details (please print) Last name: First name: Mailing address: Civic address: INDIVIDUAL Middle name: Telephone: Cell: Fax: Date of birth (dd/mm/yyyy): Postal code: In the county of: Social Insurance Number: Alternative Contact Person Name: Tel: Your Spouse s First and Last Name: Your Spouse s Date of Birth (dd/mm/yyyy): Your Spouse s Social Insurance Number: Your Spouse s Current Occupation: Your Spouse s Your Spouse s Employer: Your Spouse s Gross Income: Number of Dependents and Ages: 2 Give loan information A. Total amount required: $ B. Deposit (10% minimum): $ C. Net loan (A B): $ State Source of Equity Deposit: Upon loan approval, I/we prefer payments to begin the month of: Continuing: Annually Semi-annually (please check one) Do you have any existing or previous loans with the Loan Board? Yes No Homeport: Port of Registry: Number of years of fishing: Fishing Master Certificate held: Number of years as captain: Please list fishing licenses (include license # s) Please provide copies of SVOP / Fishing Master Class and/or other certificates. 3 List references (fish buyer, bank, credit union, merchant, co-op, etc. please provide 3 from the selection): A reference letter from your financial institution (eg. bank / credit union) is preferred. This letter should provide all balances for loans, savings accounts, chequing accounts, stocks, bonds, RRSP, etc. Name Address Business Telephone

4 INDIVIDUAL 4 Authorization I/we hereby authorize the exchange of credit and production or landings information on the applicant(s) by the Nova Scotia Fisheries and Aquaculture Loan Board with any businesses providing credit, insurance coverage with whom the applicant(s) has/have or propose to have financial arrangements with during the period of time the applicant(s) has/have a loan with the Board. By initialing this box, I/we hereby authorize the exchange of application information between the Nova Scotia Fisheries and Aquaculture Loan Board and the Nova Scotia Provincial Coastal Resource Coordinator in my area. All information on the loan will be subject to the disclosure and protection of privacy provisions of the Nova Scotia Freedom of Information and Protection of Privacy Act. The consent is irrevocable during the period of time the applicant(s) has/have financial arrangements with the Board. As well, the applicant authorizes the Department of Fisheries and Oceans to provide the Board with his/her statistical fish catch information. Signature of applicant(s) Date 5 Return all pages to Nova Scotia Fisheries and Aquaculture Loan Board 74 Research Drive, Bible Hill NS B6L 2R2 Phone: (902) / Fax: (902)

5 ADDITIONAL INFORMATION 1 Provide Details of Fishing Experience 2 Employment History Date Employer/Address/Contact Name/Phone Number Duties Signature Date

6 PERSONAL FINANCIAL STATEMENT 1 Give your details (please print) Last name: First name: Middle name: Social Insurance Number: 2 Financial History Have you personally declared bankruptcy in the past 6 years? Yes No Are you involved in any lawsuits? Yes No Have you ever had a judgment filed against you? Yes No Are you financially obligated? (co-signor, guarantor, endorser) Yes No Do you currently have life insurance? Life insurance face value: Yes No $ If yes, what is the total amount of the obligation? $ 3 List Assets Item House and land: $ Furniture: $ Boat Name: Length: Age: $ Sell or keep: Fishing licence(s) state type of licence and estimated value of each: 1. $ 2. $ 3. $ Lobster traps number: $ Other fishing gear type: $ Car year and make (no leased vehicles): $ Truck year and make (no leased vehicles): $ Other please describe $ Estimated Value Savings account, chequing account, RRSP, GIC or other investments (please detail below or on reverse if more space is required): Item Financial Institution Account Number Current Balance 4 List Liabilities Mortgages/Loans/Credit Cards/Lines of Credit/Leased Vehicles (please detail below or on reverse if more space is required): Financial Institution Purpose Original Amount Payment Current Balance

7 5 List Major Household Expenses PERSONAL FINANCIAL STATEMENT Item Monthly Cost Yearly Cost Groceries Utilities Property Tax Home Maintenance Child Care Insurance Other please describe TOTAL Amount owing to Revenue Canada: $ Repayment terms: Signature Date

8 A) Income Species Price Year 1 Price Year 2 Price Year 3 Price Year 4 Price Year 5 Lbs. Total Lbs. Total Lbs. Total Lbs. Total Lbs. Total Other Income (EI, spouse, etc.) $ Total Income $ B) Direct Operating Expenses Expense Item Year 1 Year 2 Year 3 Year 4 Year 5 Fuel Gear Food Bait/Ice Refit and Maintenance Worker s Compensation Insurance Loan Board Payment (Principal and Interest) Crew Wages and Benefits Captain s Wage Dockside Monitoring Licence Fees/Dues Berthage/Wharf Fees General/Admin./Professional Fees Vehicle Telephone Household Expenses (from Financials) Other Total Expenses $ $ $ $ $ C) Income before tax (Total A Total B) D) Income tax E) Net income (Total C Total D) F) General Information Areas to be fished: Projected number of trips: Last years gross stock for present vessel: Fish Buyer: Signature Date

9 1 Give contact information (please print) Applicant: Mailing address: Civic address: Telephone: Cell: Fax: Builder: Address: Telephone: Cell: Fax: Port of Registry (Transport Canada): 2 List Contract Prices (do not include sales tax (HST or GST) BILL OF MATERIALS Postal code: County: Postal code: Description Builder *Owner* *Vendor* 1. Hull and Structures (frames, stiffeners, bulkheads) $ 2. Decks and Superstructures $ 3. Outfitting, Fire and Safety $ 4. Electronics and Electrical Systems $ 5. Propulsion (engine to prop), Fuel System (see Note 3) $ 6. Mechanical and Hydraulic Systems $ 7. Miscellaneous (additional items) $ Sub-Totals $ $ $ Total Contract Price *OFFICE USE ONLY LESS Payments made directly to supplier or builder. Receipts required. 3 Other Information $ $ Vessel Dimensions Type of Vessel Hull Material Construction Start Date Length Overall Length for Licence Breadth Depth Hull Maker Construction End Date NOTES: 1) Quotes required for Board financed equipment supplied by owner/vendor/builder and must be attached to specification (Engine, Generator, Electronics & Hydraulics if applicable) 2) Builder must complete attached costed Bill of Materials or submit detailed, costed quote for build 3) Only new and rebuilt diesel engines that comply with emission provisions set forth by Transport Canada, are eligible for Loan Board Financing. Please confirm compliance with engine supplier & provide documentation. 4) It is the responsibility of the Owner & Builder to ensure all equipment & materials are in compliance with the regulations and standards set forth by Transport Canada. 5) All extras intended for Board financing must be submitted and approved by Loan Board before construction; failure to do so may disqualify funding for extras. 4 Signatures and Notarizations (Hardcopy of this page, with company seals, must be sent via mail) Applicant Builder Date Date 5 Return the form Inspector Approval Nova Scotia Fisheries & Aquaculture Loan Board 74 Research Drive, Bible Hill NS B6L 2R2 Loan Number

10 QUOTE DETAILS complete only if no builder quote is attached 1) Hull & Structures (frames, stiffeners, bulkheads) Item Component Type Material Size Qty. Cost Aft (Lazz) Tank AntiFouling Paint Bulkheads Curb Irons Filled Keel Fish Hold Frames Hull Protect. IWO Hauler Hull Ribbons Live Wells Name and Registry Raised Stempost Rope Locker Rub Rail Steering Gear Cmpt. Stern Extension Stiffeners Vertical Floors Tanks Insulation Refrigeration Grating Gelcoat WT Non-WT Insulation WT Bhd Gland Compartments Pen Boards Insulation Refrigeration Grating Gelcoat Compartments Insulation Refrigeration Grating Gelcoat Total for Hull and Structures

11 QUOTE DETAILS complete only if no builder quote is attached 2) Decks and Superstructures Item Component Type Size Material Qty. Cost A-Frame Anchor Shoot Boom Bow Rail Forward Deck Gunnels Hand Rail Hatches Hawse Plates Insulation Interior Finish Ladders Lobster Derrick/Block Main Deck Mast Radar Arch Radar Reflector Scuppers / Freeing Ports Slaughterhouse Doors Staples / Cleats Stern Extension / Tray Stern Pipe Tailgate Toe Rail Trap / Pot Rail Vent Cowls Washboard Rails Engine Room Deck Foredeck Fish Hold Wheelhouse Engine Room Deck Wheelhouse Engine Room Deck Foredeck Wheelhouse Engine Room Deck Fish Hold Foredeck

12 QUOTE DETAILS complete only if no builder quote is attached Wheelhouse Exterior Top Total for Decks & Superstructures 3) Outfitting, Fire and Safety Item Component Type Size Material Qty. Cost Anchor Anchor Windlass Blowers / Fans Bunks Cabinet Hardware Chart/Plate/Cup Rack Chart Table Clearview Compass Cupboards Doors EPIRB ER Floor Plates Exhaust Trunk Fire Buckets Flares / Rockets Furnace Heater Helm Horn Hyd. Cabinet Liferaft Life Jackets Life Rings Life Ring Lights Mattress Microwave Mooring Lines Pilot Chair Propane Box Propane Sensor Propane Tanks Fixed Sliding

13 QUOTE DETAILS complete only if no builder quote is attached Refrigerator Seats Ship Bell Shower Shutters Sink / Faucet Stove Survival Suits Toilet Table Vents Visor Windows Window Blower Window Heater Wet Locker Wipers Fixed Sliding Total for Outfit, Fire and Safety $

14 QUOTE DETAILS complete only if no builder quote is attached 4) Electronics and Electrical Systems Item Component Type Size Material Qty. Cost Alternator Anodes Autopilot Auxilliary Panel Batteries Battery Charger Battery Isolation Switch Converter Electrical Panels Flood Lights GPS GPS WAAS Hull Ground Plate Inverter Lights / Receptacles / Switches Main Shutoff Switch Monitor Navigation Lights Navigation Light Panel Plotter Radar Radar Reflector Satellite Tel. Search Light Shore Power Sounder Sound System SSB Transducer VHF Weather Fax Wheelhouse Engine Room Fish Hold Lazarette Deck Slaughterhouse Wheelhouse Engine Room AC DC AC DC AC DC Total for Electronics and Electrical Systems $

15 QUOTE DETAILS complete only if no builder quote is attached 5) Propulsion and Fuel Systems Item Component Type Size Material Qty. Cost Allen Bearing Bow/Stern Thruster Cutlass Bearing Deck Fills Emergency Tiller Exhaust System wet ( ) dry ( ) Exhaust Insulation Engine Engine Bed Engine Controls Engine Mounts Fuel Filters Fuel Tanks Fuel Lines Generator Jack Shaft Propeller Prop Cage Prop Shaft Reduction Gear Shaft Covers Steady Bearing Stuffing Box Stern Tube Surge Tank SW Strainer Skeg Shaft Spurs Vent Lines Waterlock WT Bulkhead Gland Diesel HP RPM Model Ratio Total for Propulsion and Fuel Systems $

16 QUOTE DETAILS complete only if no builder quote is attached 6) Mechanical and Hydraulic Systems Item Component Type Size Material Qty. Cost Bait Cutter Fish Hold Bilge Pumps & Float Switch Hanging Block C02 System Deck Washdown Dump Table Engine Cooling Pipes Fairlead / Roller Hauler Hauler Pump High Water Alarms Hydraulic Tank Hydraulic Filter Hyd. Temp. Gauge Hot Water Heater Net Drum Propane Tanks Propane Tank Box Pullmaster Raw Water Strainer Rudder Rudder Stock Rudder Packing Box Steering System Steering Cooling Pipes Stabilizers Vent / Fans Water Pump Winch Washdown Pump Lazzarette Engine Room Forward Capacity Cooling Pipes Clutch Tank Direct Drive Belt Driven Demand Engine Room Wheelhouse Gear ( ) Vane ( ) 200 ft-lb 400 ft-lb 1000 ft-lb Total for Mechanical and Hydraulic Systems $

17 QUOTE DETAILS complete only if no builder quote is attached 7) Miscellaneous Item Component Type Size Material Qty. Cost Total for Miscellaneous $

MLA Non-Profit Boat Protection Cooperative, Ltd. (Bermuda) HULL INSURANCE APPLICATION FORM

MLA Non-Profit Boat Protection Cooperative, Ltd. (Bermuda) HULL INSURANCE APPLICATION FORM Please print clearly and complete all sections. If something doesn t apply, please mark N/A in the space provided