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COVID-19 Emergency Loan request form

Important: Only complete this form if requested by Global Affairs Canada.

To reach a Global Affairs Canada representative:

Telephone (toll-free from Canada and U.S.A.): 1-800-387-3124
Telephone: +1 613 996 8885
Email: CAN.finances.CV19@international.gc.ca

Privacy statement

The information requested in this form is required by the department for the purpose of administering the COVID-19 Emergency Loan Program for Canadians Abroad, and it will be used to this end.

The information is collected under Paragraph 10(2)(a) of the Department of Foreign Affairs, Trade and Development Act. The personal information collected below will be collected, used and disposed of in accordance with the Privacy Act.

Case number

Please make sure to enter the case number provided to you by Global Affairs Canada. Failure to do so correctly may result in delays in processing your loan request.

Personal information

Address in Canada

Destination in Canada (if different from Address in Canada, listed above)

Passport/Permanent Resident card

Please provide a photo or image of your Canadian passport or Permanent Resident card. Do not complete this section if you have already submitted this information.

Photo and image files only (.jpg, .jpeg, .png, .webp, .gif)
Maximum file size per attachment: 10MB

Reference

Please provide the name and contact details of one reference.

Circumstances

Bank account information

Only complete this section if you will be receiving payment by direct deposit to your bank account in Canada. Complete this section unless a consular officer has told you not to.

It is your responsibility to ensure the accuracy and completeness of the information you provide. Any error or omission may result in delays to payment issuance. The banking information provided must be for a bank account in your name.

Upload a photo or image of a void cheque or direct deposit form (found on your on-line or mobile banking platform):

Photo and image files only (.jpg, .jpeg, .png, .webp, .gif)
Maximum file size per attachment: 10MB

If you are unable to upload a photo or image, you can complete the fields below:

Declaration, receipt and promise to repay

I hereby authorize Global Affairs Canada, or its agents, to obtain and verify all information judged necessary in relation to this application. I solemnly declare that all of the information or statements given in relation to this loan application are exact, complete and true. I agree to inform Global Affairs Canada, in writing, of any change in my Address in Canada. I declare that I am unable to obtain financial assistance from relatives, friends or any other source of private funding. I understand that if funds are provided to me by Global Affairs Canada under the COVID-19 Assistance Fund Program, these will be a repayable loan.

By checking the “I accept” box, you acknowledge that you are 18 years of age or older and that you have read, understood, accept and agree to be bound by the terms and conditions contained in this Emergency Loan Request Form.

Receipt and promise to repay

I, the undersigned, agree that I owe the Government of Canada for this total amount loaned or expended on my behalf. I promise to repay this money to the Receiver General of Canada within 180 days of receipt of invoice. No interest shall apply. If I fail to repay this amount, I understand that it may be deducted from any money that may be owing to me by the Government of Canada. I further agree to be responsible for all sums involved in the collection of this debt.

By checking the “I accept” box, you acknowledge that you are 18 years of age or older and that you have read, understood, accept and agree to be bound by the terms and conditions contained in this Emergency Loan Request Form.

Repayment information

** The amount approved may differ from the amount requested. The exact amount owed in Canadian dollars will only be known when payments are complete and payments made in foreign currencies are converted to Canadian dollars in Global Affairs Canada’s accounting system.

This promise to repay is governed by the laws in force in the Province of Ontario. Repayment of this debt should be made by money order, certified cheque or cheque, payable to the Receiver General for Canada and sent by mail to:

Global Affairs Canada
125 Sussex Drive
Cashier’s Office (SMFM)
Ottawa, ON
K1A 0G2

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