Claim Submission

Part 1 - Progress Report

File No.: __________________________
Project Title: _______________________
Claim No.: _________________________
Period Covered: _____________________
Due Date: __________________________

Activities for this report:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Results
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Issues which may impact on the project's success and timing for completion?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Signature
Project Representative: ___________________________
Date: __________________________________________

Claim Submission

Part 2 - Claim Report

Part 1 - Project Information
File No.: ________________________________________
Project Title: _____________________________________
Completion Date: _________________________________
Claim No.: _______________________________________
Period Covered: ___________________________________
RED % Reimbursement: ____________________________
Final Claim (Yes/No): _______________________________

Authorized Official:
Name of Project Representative: _____________________________
Date: __________________________________
I certify the costs claimed are eligible costs and in compliance with the provincial legal agreement.
Signature: _____________________________

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Part 2 - New Invoices
Attach Invoices and Proofs of Payment as listed above and send to: Rural Economic Development Program

Budget Line # ________________________________
Invoice # ____________________________________
Date _______________________________________
Vendor Name ________________________________
Work Description _____________________________
Invoice Amount _______________________________
GST Rebate _________________________________
Net Claim Amount ____________________________
Paid (Yes/No) _______________________________
Cheque # ___________________________________

Budget Line # ________________________________
Invoice # ____________________________________
Date _______________________________________
Vendor Name ________________________________
Work Description _____________________________
Invoice Amount _______________________________
GST Rebate _________________________________
Net Claim Amount ____________________________
Paid (Yes/No) _______________________________
Cheque # ___________________________________

Budget Line # ________________________________
Invoice # ____________________________________
Date _______________________________________
Vendor Name ________________________________
Work Description _____________________________
Invoice Amount _______________________________
GST Rebate _________________________________
Net Claim Amount ____________________________
Paid (Yes/No) _______________________________
Cheque # ___________________________________

Budget Line # ________________________________
Invoice # ____________________________________
Date _______________________________________
Vendor Name ________________________________
Work Description _____________________________
Invoice Amount _______________________________
GST Rebate _________________________________
Net Claim Amount ____________________________
Paid (Yes/No) _______________________________
Cheque # ___________________________________

Budget Line # ________________________________
Invoice # ____________________________________
Date _______________________________________
Vendor Name ________________________________
Work Description _____________________________
Invoice Amount _______________________________
GST Rebate _________________________________
Net Claim Amount ____________________________
Paid (Yes/No) _______________________________
Cheque # ___________________________________

Budget Line # ________________________________
Invoice # ____________________________________
Date _______________________________________
Vendor Name ________________________________
Work Description _____________________________
Invoice Amount _______________________________
GST Rebate _________________________________
Net Claim Amount ____________________________
Paid (Yes/No) _______________________________
Cheque # ___________________________________

Total Amount Claimed:
Invoice Amount: $________________________
GST Rebate: $__________________________
Net Claim Amount: $_____________________