Qikiqtani Qimuksiqtiit Program

Personal Information / ᐃᕝᕕᑦ ᒥᔅᓵᓄᑦ ᑐᑭᓯᐅᒪᔾᔪᑎᔅᓴᑦ

All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ

What will you use the funds for? (check all that apply) / ᑭᓱᒧᑦ ᑮᓇᐅᔭᑦ ᐊᑐᖅᑕᐅᓂᐅᓴᕙᑦ? (ᐅᓇᓂ ᓇᓗᓇᐃᕐᑕᐃᓐᓇᕆᓗᒋᑦ ᐱᔾᔪᑎᒋᔪᒪᔭᓐᓄᑦ)*

Small Equipment / ᒥᑭᔫᑏᑦ ᓅᑦᑐᖅᓯᐅᑏᑦ

Safety Equipment / ᓱᓇᒃᑯᑏᑦ ᐊᑦᑕᓇᕐᔭᐃᕈᑏᑦ

Insurance Coverage / ᓇᓪᓕᐅᒃᑯᒫᓄᑦ

Disaster Relief / ᐱᕐᓗᐊᕿᓂᕐᒧᑦ ᐃᑲᔫᑎᑦ

Please enter your name / ᐊᑏᑦ ᑎᑎᕋᙳᐊᑕᕐᓯᓐᓇᕈᒃ*

First Name / ᐊᑏᑦ Last Name / ᐊᑎᕈᓰᑦ

Date of Birth / ᑎᑎᕐᓯᕕᒋᓗᒍ ᐅᑭᐅᑎᑦ ᓇᓛᓃᕝᕕᖏᑦ

You must be 16 years or over to apply / 16ᓂᑦ ᐅᑭᐅᖃᕆᐊᖃᖅᑐᑎᑦ ᐅᖓᑖᓂᓘᓐᓃᑦ ᑐᔅᓯᕋᐅᓯᐅᕈᒪᒍᕕᑦ

Day / ᐅᓪᓗᖅ*

Month / ᑕᖅᑭᖅ*

Year / ᐊᕐᕌᒍ*

Select your community / ᓂᕈᐊᕆᑦ ᓄᓇᖃᕐᕕᓐᓂᒃ*

NTI number / ᓄᓇᕗᑦ ᑐᙵᕕᒃᑯᓐᓂᑦ ᐃᓚᒋᔭᐅᔾᔪᑏᑦ ᓈᓴᐅᑖ*

Please enter a number from 999999999 to 10000000000.

Do not include dashes or spaces with your NTI number / ᐱᖃᓯᐅᔾᔨᑦᑕᐃᓕᒋᑦ ᑎᑎᖅᓯᒪᔪᓂᑦ ᓈᓴᐅᑎᐅᙱᑦᑐᓂᑦ ᐊᒻᒪᓗ ᑲᑎᙵᑎᑦᑕᐃᓐᓇᕆᓗᒋᑦ ᓄᓇᕗᑦ ᑐᙵᕕᒃ ᑎᒥᖓᓄᑦ ᓈᓴᐅᑎᕆᔭᑎᑦ

Email / ᐃᕐᖐᓈᖅᑕᐅᑖ

Daytime Phone Number / ᐅᖄᓚᐅᑖ*

Mailing Address / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᑐᕌᕈᑖ*

House number / ᐃᒡᓗᕕᑦ ᓈᓴᐅᑖ P.O Box / ᑎᑎᖅᑲᓂᐊᕐᕕᖓ Community / ᓄᓇᓕᒃ Province / ᓄᓇᓕᐅᑉ ᐊᕕᒃᑐᖅᓯᒪᓂᕆᔭᖓ Postal Code / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᓇᓗᓇᐃᒃᑯᑕᖓ

Address must be in Nunavut / ᓄᓇᕗᒥᐅᑕᐅᔭᕆᐊᓕᒃ

Household Information / ᐃᓪᓗᒥᐅᖃᑎᒌᑦ ᖃᓄᐃᓕᖓᒻᒪᖔᑕ

Name of Spouse / Common-law / ᐊᐃᑉᐸᖓᑕ ᐊᑎᖓ / ᐊᐃᑉᐸᕇᒃ ᑲᑎᑎᑕᐅᓯᒪᖏᑦᑑᖕ

Relationship / ᖃᓄᖅ ᐃᓚᒋᕕᐅᖕ

Have you or your household received funding from NHSP this fiscal year? / ᐃᕝᕕᑦ ᐃᓪᓗᒥᐅᖃᑏᓪᓘᓐᓃᑦ ᑮᓇᐅᔭᕐᑖᓚᐅᕐᓯᒪᕕᓰ ᓄᓇᕗᒥ ᐊᖑᓇᓱᑦᑎᓄᑦ ᐃᑲᔫᓯᐊᓂᑦ ᐊᕐᕌᒍᑦᑎᓂ?*

Yes / ᐄ

No / ᐋᒡᒐ

There is an annual funding limit of $1,000 per application and $2,000 per household per fiscal year. Your household includes your legal or common-law spouse. / ᐊᕐᕌᒍᑕᒫᑦ ᑮᓇᐅᔭᕐᑖᕈᓐᓇᕐᑐᑦ ᑭᓪᓕᖃᕐᑎᑕᐅᔪᑦ $1,000ᓄᑦ ᐊᑐᓂ ᑐᑦᓯᕋᕐᑐᑦ ᐊᒻᒪ $2,000 ᐊᑐᓂ ᐃᓪᓗᓖᑦ ᐊᕐᕌᒍᑕᒫᑦ. ᐃᓪᓗᒥᐅᖃᑎᑎᑦ ᐱᖃᓯᐅᔾᔨᓯᒪᔪᑦ ᒪᓕᒐᕐᑎᒍᑦ ᑲᑎᑎᑕᐅᓯᒪᑉᐸᑎᖕ ᐅᕝᕙᓘᓐᓃᑦ ᐊᐃᑉᐸᕇᓐᓂᕋᕐᑖᖕ ᑲᑎᑎᑕᐅᓯᒪᒐᑎᖕ.

Your parent, children or other family members or relatives living in the same house who are 16 years of age of older are considered separate households. / ᐊᖏᔪᖅᑳᑦ, ᕿᑐᕐᖓᑎᑦ ᐅᕝᕙᓘᓐᓃᑦ ᐊᓯᖏᑦ ᖃᑕᓐᖑᑎᑎᑦ ᐃᓚᑎᓪᓘᓐᓃᑦ ᐃᓪᓗᒥᐅᖃᑎᒋᔭᑎᑦ ᐅᑭᐅᓖᑦ 16ᓂᑦ ᐅᖓᑖᓄᓪᓘᓐᓃᑦ ᐃᓱᒪᒋᔭᐅᓂᐊᕐᑐᑦ ᐃᒻᒥᒃᑰᖓᓗᑎᖕ ᐃᓪᓗᖃᕆᐊᖏᑦ.

Disaster Relief / ᐱᕐᕈᓗᐊᕿᔪᓄᑦ

All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ

Do you need to replace or repair your large harvesting equipment? / ᑭᖑᕝᕕᖅᑕᐅᒋᐊᖃᖅᑲᑦ ᐱᖁᑎᑎᑦ ᐊᖏᔪᑦ ᐊᖑᓇᓱᒋᐊᕈᑎᑎᑦ?*

I need to replace my large harvesting equipment ᐊᖏᔪᑦ ᐱᖁᑎᒃᑲ ᐊᖑᓇᓱᒋᐊᕈᑎᒃᑲᑦ ᑭᖑᕝᕕᖅᑕᐅᒋᐊᖃᖅᑐᑦ

I need to repair my large harvesting equipment ᐋᖅᑭᒃᓱᖅᑕᐅᒋᐊᖃᖅᑐᑦ ᐱᖁᑎᒃᑲ ᐊᖏᔪᑦ ᐊᖑᓇᓱᒋᐊᕈᑎᒃᑲ

Incident Date / ᐅᓪᓗᖓ ᑕᐃᒪᐃᓕᕕᒥᓂᖓ

Day / ᐅᓪᓗᖅ*

Month / ᑕᖅᑭᖅ*

Year / ᐊᕐᕌᒍ*

Name of Witness (1) / ᐊᑎᖓ ᖃᐅᔨᔪᒥᓃᑦ ᑕᑯᓐᓇᕐᑐᒥᓂᑦ (1)

First Name / ᐊᑏᑦ Last Name / ᐊᑎᕈᓰᑦ

Name of Witness (2) / ᐊᑎᖓ ᖃᐅᔨᔪᒥᓃᑦ ᑕᑯᓐᓇᕐᑐᒥᓂᑦ (2)

First Name / ᐊᑏᑦ Last Name / ᐊᑎᕈᓰᑦ

Location of incident / ᓇᒥ ᖃᓄᐃᓕᓐᓂᕐᒪᖔᑕ*

Closest community / ᓂᕈᐊᕆᑦ ᓄᓇᖃᕐᕕᓐᓂᒃ*

Details of Incident / ᓇᓗᓇᐃᕐᓗᒍ ᖃᓄᐃᓕᓐᓂᕐᒪᖔᑕ*

Replacement Equipment / ᑭᖑᕝᕕᖅᑕᐅᓂᖏᑦ ᐱᖁᑎᑦ

All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ

The following documentation is required for the Disaster Relief Program:

Receipt for the purchase of the equipment that was lost (if possible)
Witness statement(s)
HTO Letter of Support
Quote for replacement of the same make, model and year of equipment that was lost
Photos, if any

Maximum amounts are 75% of cost to a maximum of: Snowmobiles: $7,000, ATVs or UTVs (Side-by-sides): $6,000, Boats: $10,000, Outboard motors: $7,000

To qualify for this program, the equipment must be lost or damaged beyond repair. “Net replacement cost” for equipment refers to the purchase price (including shipping costs) of replacement equipment minus any payment from insurance and/or government program on the same equipment or accident/disaster.

ᑖᒃᑯᐊ ᑎᑎᖅᑲᐃᑦ ᑐᓂᔭᕆᐊᓖᑦ ᐱᕐᕈᓗᐊᕿᔪᖃᖅᑐᒥᓂᐅᑎᓪᓗᒍ ᐃᑲᔫᓯᐊᔅᓴᓄᑦ:

ᓇᓕᖅᑲᐃᑦ ᓂᐅᕕᐅᑎᒥᓃᑦ ᓱᓇᒃᑯᑖᓂᑦ ᐊᓯᐅᔨᔭᒥᓂᕐᓄᑦ (ᐊᔪᕐᓇᖏᑉᐸᑦ)
ᑕᑯᓐᓇᖅᑐᒥᓂᐅᑉ(ᓃᑦ) ᓇᓗᓇᐃᕈᑎᖓ(ᖏᑦ)
ᐆᒪᔪᕐᓂᐊᑎᒃᑯᓐᓂ ᑎᑎᖅᑲᑦ ᐃᑲᔪᕐᓯᕆᐊᕈᑏᑦ
ᐊᑭᒋᒐᔭᖅᑕᖓ ᑭᖑᕝᕕᖅᑕᐅᔾᔪᑎᔅᓴᖓᑕ ᐊᔾᔨᓴᐃᓐᓇᖓᓂᒃ ᓴᓇᐅᒐᐅᑉ, ᖃᓄᐃᑦᑑᓂᖓᑕ ᐊᕐᕌᒍᖓᑕᓗ ᓱᓇᒃᑯᑖᓕᐊᖑᓯᒪᔫᑉ ᐊᓯᐅᔨᔭᒥᓂᐅᑉ
ᐊᔾᔨᙳᐊᑦ (ᐱᑕᖃᖅᑲᑦ)

ᐊᒥᓲᓛᖑᔪᓐᓇᕐᑐᑦ 75%−ᑎᖏᓐᓂᒃ ᐊᑭᖓᓂ ᑭᒡᓕᖃᕐᓗᒍ: ᖃᒧᑕᐅᔭᒧᑦ: $7,000, ᑎᓴᒪᓕᓐᓄᑦ/ᑎᓴᒪᓂᒃ ᐊᒃᓴᓗᐊᓖᑦ ᓴᓂᓕᕇᕐᓗᑎᒃ ᐃᒃᓯᕚᕐᕕᐅᒍᓐᓇᖅᑐᑦ: $6,000, ᐆᒥᐊᖕᒧᑦ: $10,000, ᐊᐅᓚᐅᑎᓄᑦ: $7,000

ᐱᓕᕆᐊᕐᒥᑦ ᐃᑲᔪᖅᑕᐅᔪᓐᓇᖅᑐᑎᑦ, ᐱᖁᑏᑦ ᔭᒐᓐᓂᖅᐸᑦ ᓱᕋᕐᓂᖅᐸᑦ ᐊᒻᒪ ᐋᖅᑭᒃᑕᐅᔪᓐᓇᙱᖦᖢᓂ. “ᐊᑭᖓᓂ ᑭᖑᕝᕕᕐᓗᒍ” ᐱᖁᑎ ᑐᑭᓕᒃ ᓂᐅᕕᖅᑕᐅᓂᖓᓄᑦ ᐊᑭᒋᔭᖓ (ᐱᖃᓯᐅᑎᓗᒋᑦ ᐅᓯᔭᐅᒋᐊᖃᕐᓂᖓᓄᑦ ᐊᑭᖏᑦ) ᑭᖑᕝᕕᖅᑕᐅᔪᒥᒃ ᐱᖁᑎᒥᒃ ᐲᔭᕐᓗᒋᑦ ᐊᑭᓕᖅᑕᐅᔪᑦ ᓇᓪᓕᐅᒃᑯᒫᓂᑦ ᐊᒻᒪᓗ/ᐅᕝᕙᓘᓐᓃᑦ ᒐᕙᒪᒃᑯᑎᒎᖅᑐᓂᒃ ᐱᓕᕆᐊᓂᑦ ᐅᕝᕙᓘᓐᓃᑦ ᐱᕐᓗᐊᕿᓂᕐᒧᑦ

Replacement equipment purchased or to be purchased / ᐊᓯᐊᓂᑦ ᓅᑦᑐᖅᓯᐅᑎᑖᕇᕐᑐᒥᓂᖅ ᐅᕝᕙᓘᓐᓃᑦ ᓂᐅᕕᕋᓱᓐᓂᐅᓴᔪᖅ

Snowmobile / ᖃᒧᑕᐅᔮᒃ

ATV / ᑎᓴᒪᓕᒃ

Boat / ᐅᒥᐊᖅ

Outboard motor / ᐊᐅᓚᐅᑏᖕ

How will you submit your receipts? / ᖃᓄᖅ ᑐᓂᓂᐊᖅᑭᒋᑦ ᓇᓕᖅᑲᑎᑦ?*

Receipts for small equipment are required. / ᓇᓕᖅᑲᐃᑦ ᓱᓇᒃᑯᑖᓄᑦ ᒥᑭᔫᑎᓄᑦ ᓂᐅᕕᐅᑎᒥᓃᑦ ᑐᓂᔭᕆᐊᓖᑦ.

Upload Receipt / ᖃᕋᓴᐅᔭᒃᑰᖅᑎᓪᓗᒋᑦ ᓇᓕᖅᑲᐃᑦ

Email Receipt / ᐃᕐᖐᓈᖅᑕᐅᑎᒃᑯᑦ ᓇᔅᓯᐅᑎᓗᒋᑦ ᓇᓕᖅᑲᐃᑦ

Fax Receipt / ᓱᒃᑲᔪᒃᑯᑦ ᓇᔅᓯᐅᑎᓗᒋᑦ ᓇᓕᖅᑲᐃᑦ

Upload Receipts / ᖃᕋᓴᐅᔭᕐᒨᖅᑲᕐᓗᒋᑦ ᓇᓕᖅᑲᐃᑦ*

Drop files here or

Max. file size: 300 MB.

Email your receipts to NHSP@qia.ca / ᖃᕋᓴᐅᔭᒃᑯᑦ ᓇᓕᖅᑲᑎᑦ ᐃᕐᖐᓈᖅᑕᐅᑎᒃᑯᑦ ᓇᔅᓯᐅᑎᓗᒋᑦ ᐅᕗᖓ NHSP@qia.ca

Fax your receipts to 867•979•3238 / ᓱᒃᑲᔪᒃᑯᑦ ᓇᓕᖅᑲᑎᑦ ᓇᔅᓯᐅᑎᓗᒋᑦ ᐅᕗᖓ 867•979•3238

Replacement Equipment Totals / ᐱᕐᕈᓗᐊᕿᔪᓄᑦ ᑲᑎᓪᓗᒋᑦ

Price of Equipment purchased or to be purchased (including shipping costs) / ᐊᑭᖓ (ᐃᓚᓕᐅᑎᓗᒍ ᐅᓯᔭᐅᔾᔪᑎᖓᓄᑦ ᐊᑭᖓ)*

Total Insurance Coverage Received / ᓇᓪᓕᐅᒃᑯᒫᓕᕆᔨᒃᑯᓐᓂᑦ ᑐᓂᔭᐅᔪᑦ*

Total Eligible Funding / ᑲᑎᓪᓗᒋᑦ ᐋᖅᑭᒃᓱᐃᓂᕐᒧᑦ ᑮᓇᐅᔭᖅᑖᕆᔪᓐᓇᖅᑕᖏᑦ*

Maximum amounts are 75% of net replacement cost to a maximum of: Snowmobiles: $7,000; ATVs or UTVs (Side-by-sides): $6,000; Boats: $10,000, Outboard Motors: $7,000. / ᐊᒥᓲᓛᖑᔪᓐᓇᕐᑐᑦ 75%−ᑎᖏᓐᓂᒃ ᐊᑭᖓᓂ ᑭᒡᓕᖃᕐᓗᒍ: ᖃᒧᑕᐅᔭᒧᑦ: $7,000, ᑎᓴᒪᓕᓐᓄᑦ/ᑎᓴᒪᓂᒃ ᐊᒃᓴᓗᐊᓖᑦ ᓴᓂᓕᕇᕐᓗᑎᒃ ᐃᒃᓯᕚᕐᕕᐅᒍᓐᓇᖅᑐᑦ: $6,000, ᐆᒥᐊᖕᒧᑦ: $10,000, ᐊᐅᓚᐅᑎᓄᑦ: $7,000

Repair Equipment / ᐋᖅᑭᒃᓱᕐᓂᖅ ᐱᖁᑎᓂ

All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ

The following documentation is required for the Disaster Relief Program:

Receipt for the purchase of the equipment that was lost (if possible)
Witness statement(s)
HTO Letter of Support
Quote for replacement of the same make, model and year of equipment that was lost
Photos, if any

75% of the net repair costs for any Large Harvesting Equipment damaged in an accident or disaster.

Maximum amounts are 75% of net repair cost to a maximum of: Snowmobiles: $3,500; ATVs or UTVs (Side-by-sides): $3,000; Boats: $5,000, Outboard Motors: $3,500.

To qualify for this program, the equipment must require and has undergone substantial repair that costs more than $2,000. “Net repair cost” for equipment refers to the repair cost minus any payment from insurance and government program on the same equipment or accident.

ᑖᒃᑯᐊ ᑎᑎᖅᑲᐃᑦ ᑐᓂᔭᕆᐊᓖᑦ ᐱᕐᕈᓗᐊᕿᔪᖃᖅᑐᒥᓂᐅᑎᓪᓗᒍ ᐃᑲᔫᓯᐊᔅᓴᓄᑦ:

ᓇᓕᖅᑲᐃᑦ ᓂᐅᕕᐅᑎᒥᓃᑦ ᓱᓇᒃᑯᑖᓂᑦ ᐊᓯᐅᔨᔭᒥᓂᕐᓄᑦ (ᐊᔪᕐᓇᖏᑉᐸᑦ)
ᑕᑯᓐᓇᖅᑐᒥᓂᐅᑉ(ᓃᑦ) ᓇᓗᓇᐃᕈᑎᖓ(ᖏᑦ)
ᐆᒪᔪᕐᓂᐊᑎᒃᑯᓐᓂ ᑎᑎᖅᑲᑦ ᐃᑲᔪᕐᓯᕆᐊᕈᑏᑦ
ᐊᑭᒋᒐᔭᖅᑕᖓ ᑭᖑᕝᕕᖅᑕᐅᔾᔪᑎᔅᓴᖓᑕ ᐊᔾᔨᓴᐃᓐᓇᖓᓂᒃ ᓴᓇᐅᒐᐅᑉ, ᖃᓄᐃᑦᑑᓂᖓᑕ ᐊᕐᕌᒍᖓᑕᓗ ᓱᓇᒃᑯᑖᓕᐊᖑᓯᒪᔫᑉ ᐊᓯᐅᔨᔭᒥᓂᐅᑉ
ᐊᔾᔨᙳᐊᑦ (ᐱᑕᖃᖅᑲᑦ)

75% ᐊᑭᓪᓗᐊᖓᑕ ᐃᓚᖓ ᐊᓐᓇᐃᔪᒥᓂᕐᓄᑦ ᐊᓯᐊᓂᑦ ᓂᐅᕕᕈᑎᒋᓂᐊᕐᑕᖏᓂᑦ ᐊᑭᑐᔫᑎᓂᑦ ᓅᑦᑐᖅᓯᐅᑎᓂᑦ ᐊᓐᓇᐃᓂᕐᐸᑦ ᐱᕐᕈᓗᐊᕿᔪᒧᑦ ᐅᕝᕙᓘᓐᓃᑦ ᓯᓚᒧᑦ ᓱᕋᕐᑎᖅᑐᓄᑦ.

ᐊᒥᓲᓛᖑᔪᓐᓇᕐᑐᑦ 75%−ᑎᖏᓐᓂᒃ ᐊᑭᖓᓂ ᑭᒡᓕᖃᕐᓗᒍ: ᖃᒧᑕᐅᔭᒧᑦ: $3,500, ᑎᓴᒪᓕᓐᓄᑦ: $3,000, ᐆᒥᐊᖕᒧᑦ: $5,000, ᐊᐅᓚᐅᑎᓄᑦ: $3,500

ᐃᑲᔪᖅᑕᐅᓂᐊᕈᕕᑦ, ᑖᓐᓇ ᐱᖁᑎ ᐋᖅᑭᒃᑕᐅᒋᐊᑐᓚᐅᖅᑐᖅ ᐊᑭᖃᓚᐅᖅᐸᑦ $2000 ᐅᖓᑖᓄᑦ. “ᐋᖅᑭᒃᓱᐃᓂᕐᒧᑦ ᐊᑭᖃᕐᓂᖓ” ᐱᖁᑎᒥᒃ ᑐᑭᖃᖅᑐᖅ ᓱᕐᓗ ᐋᖅᑭᒃᓱᐃᓂᕐᒧᑦ ᐊᑭᒋᔭᖓ ᐲᔭᕐᓗᒋᑦ ᐊᑭᓕᖅᑕᐅᔪᑦ ᓇᓪᓕᐅᒃᑯᒫᓕᕆᔨᓄᑦ ᐊᒻᒪ ᒐᕙᒪᒃᑯᑎᒍᑦ ᐱᓕᕆᐊᖑᔪᒥᑦ ᑖᓐᓇᑦᓴᐃᓐᓇᕐᒧᑦ ᐱᖁᑎᒧᑦ ᐅᕝᕙᓘᓐᓃᑦ ᐱᕐᓗᐊᕿᔪᕕᓂᐅᑉᐸᑦ.

Damaged Equipment / ᓅᑦᑐᖅᓯᐅᑏᑦ ᓱᕋᕐᑎᖅᑐᑦ

Snowmobile / ᖃᒧᑕᐅᔮᒃ

ATV / ᑎᓴᒪᓕᒃ

Boat / ᐅᒥᐊᖅ

Outboard motor / ᐊᐅᓚᐅᑏᖕ

How will you submit your receipts? / ᖃᓄᖅ ᑐᓂᓂᐊᖅᑭᒋᑦ ᓇᓕᖅᑲᑎᑦ?*

Receipts for small equipment are required. / ᓇᓕᖅᑲᐃᑦ ᓱᓇᒃᑯᑖᓄᑦ ᒥᑭᔫᑎᓄᑦ ᓂᐅᕕᐅᑎᒥᓃᑦ ᑐᓂᔭᕆᐊᓖᑦ.

Upload Receipt / ᖃᕋᓴᐅᔭᒃᑰᖅᑎᓪᓗᒋᑦ ᓇᓕᖅᑲᐃᑦ

Email Receipt / ᐃᕐᖐᓈᖅᑕᐅᑎᒃᑯᑦ ᓇᔅᓯᐅᑎᓗᒋᑦ ᓇᓕᖅᑲᐃᑦ

Fax Receipt / ᓱᒃᑲᔪᒃᑯᑦ ᓇᔅᓯᐅᑎᓗᒋᑦ ᓇᓕᖅᑲᐃᑦ

Upload Receipts / ᖃᕋᓴᐅᔭᕐᒨᖅᑲᕐᓗᒋᑦ ᓇᓕᖅᑲᐃᑦ*

Drop files here or

Max. file size: 300 MB.

Email your receipts to NHSP@qia.ca / ᖃᕋᓴᐅᔭᒃᑯᑦ ᓇᓕᖅᑲᑎᑦ ᐃᕐᖐᓈᖅᑕᐅᑎᒃᑯᑦ ᓇᔅᓯᐅᑎᓗᒋᑦ ᐅᕗᖓ NHSP@qia.ca

Fax your receipts to 867•979•3238 / ᓱᒃᑲᔪᒃᑯᑦ ᓇᓕᖅᑲᑎᑦ ᓇᔅᓯᐅᑎᓗᒋᑦ ᐅᕗᖓ 867•979•3238

Repair Equipment Totals / ᐋᖅᑭᒃᓱᖅᑕᐅᓂᖓᓄᑦ ᐱᖁᑎ ᐊᑭᖏᑦ ᑲᑎᓪᓗᒋᑦ

Total Repair Costs / ᑲᑎᓪᓗᒋᑦ ᐋᖅᑭᒃᓱᐃᓂᕐᒧᑦ ᐊᑭᖏᑦ*

Total Insurance Coverage Received / ᓇᓪᓕᐅᒃᑯᒫᓕᕆᔨᒃᑯᓐᓂᑦ ᑐᓂᔭᐅᔪᑦ*

Total Eligible Repair Funding / ᑲᑎᓪᓗᒋᑦ ᐋᖅᑭᒃᓱᐃᓂᕐᒧᑦ ᑮᓇᐅᔭᖅᑖᕆᔪᓐᓇᖅᑕᖏᑦ*

Maximum amounts are 75% of net repair cost to a maximum of: Snowmobiles: $3,500; ATVs or UTVs (Side-by-sides): $3,000; Boats: $5,000, Outboard Motors: $3,500. / ᐊᒥᓲᓛᖑᔪᓐᓇᕐᑐᑦ 75%−ᑎᖏᓐᓂᒃ ᐊᑭᖓᓂ ᑭᒡᓕᖃᕐᓗᒍ: ᖃᒧᑕᐅᔭᒧᑦ: $3,500, ᑎᓴᒪᓕᓐᓄᑦ: $3,000, ᐆᒥᐊᖕᒧᑦ: $5,000, ᐊᐅᓚᐅᑎᓄᑦ: $3,500

Insurance Coverage / ᓇᓪᓕᐅᒃᑯᒫᓄᑦ

All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ

What type of insurance coverage do you need? / ᓇᓪᓕᐅᒃᑯᒫᓄᑦ?*

Insurance Coverage for Small Equipment / ᓇᓪᓕᐅᒃᑯᒫᑦ ᒥᑭᔪᓄᑦ ᐱᖁᑎᓄᑦ

Insurance Coverage for Safety Equipment / ᓇᓪᓕᐅᒃᑯᒫᑦ ᐊᑦᑕᕐᓇᐃᔭᐃᒃᑯᑎᓄᑦ ᐱᖁᑎᓄᑦ

Insurance Coverage for Large Harvesting Equipment / ᓇᓪᓕᐅᒃᑯᒫᑦ ᐊᖏᔪᓄᑦ ᐊᖑᓇᓱᒋᐊᕈᑎᓄᑦ

Check all that apply / ᐅᓇᓂ ᓇᓗᓇᐃᕐᑕᐃᓐᓇᕆᓗᒋᑦ ᐱᔾᔪᑎᒋᔪᒪᔭᓐᓄᑦ

Cost of Insurance Coverage for Small Equipment / ᐊᑭᖓ ᓇᓪᓕᐅᒃᑯᒫᓄᑦ ᐊᑦᑕᕐᓇᐃᔭᐃᒃᑯᑎᓄᑦ ᐱᖁᑎᓄᑦ*

For eligible small equipment regularly used for harvesting purposes, 75% of insurance premium to a maximum of $500 per equipment and $1,500 per household each year. / ᒥᑭᔪᓄᑦ ᐱᖁᑎᓄᑦ ᐊᑐᖅᑕᐅᖏᓐᓇᖅᑐᑦ ᐊᖑᓇᓱᒋᐊᕈᑎᒋᔭᐅᓪᓗᑎᒃ, 75%ᖏᓐᓂᑦ ᐊᕐᕌᒍᑕᒫᑦ ᓇᓪᓕᐅᒃᑯᒫᖃᕐᓗᓂ ᐊᖏᓂᖅᐹᕆᓗᒍ $500ᓂ ᐊᑐᓂ ᐱᖁᑎᒧᑦ ᐊᒻᒪᓗ $1500ᓂ ᐊᑐᓂ ᐃᒡᓗᖃᖅᑎ.

Cost of Insurance Coverage for Safety Equipment / ᐊᑭᖓ ᓇᓪᓕᐅᒃᑯᒫᓄᑦ ᒥᑭᔪᓄᑦ ᐱᖁᑎᓄᑦ*

For eligible safety equipment regularly used for harvesting purposes, 75% of insurance premium to a maximum of $500 per equipment and $1,500 per household each year. / ᐊᑦᑕᕐᓇᐃᔭᐃᒃᑯᑎᓄᑦ ᐱᖁᑎᓄᑦ ᐊᑐᖅᑕᐅᖏᓐᓇᖅᑐᑦ ᐊᖑᓇᓱᒋᐊᖃᑦᑕᖅᑎᓪᓗᒋᑦ, 75%ᖏᓐᓂᑦ ᐊᕐᕌᒍᑕᒫᑦ ᓇᓪᓕᐅᒃᑯᒫᖃᕐᓗᓂ ᐊᖏᓂᖅᐹᕆᓗᒍ $500ᓂ ᐊᑐᓂ ᐱᖁᑎᒧᑦ ᐊᒻᒪᓗ $1500ᓂ ᐊᑐᓂ ᐃᒡᓗᖃᖅᑎ.

Cost of Insurance Coverage for Large Harvesting Equipment / ᐊᑭᖓ ᓇᓪᓕᐅᒃᑯᒫᓄᑦ ᐊᖏᔪᓄᑦ ᐊᖑᓇᓱᒋᐊᕈᑎᓄᑦ*

For Large Harvesting Equipment regularly used for harvesting purposes: 75% of insurance premium to a maximum of $1,000 per equipment and $2,000 per household each year. “Large Harvesting Equipment” refers to snowmobiles, ATV’s or UTVs (Side-by-sides), boats and outboard motors with an initial purchase price of $5,000 or more. / ᐊᖏᔪᓄᑦ ᐱᖁᑎᓄᓪᓕ ᐊᑐᖅᑕᐅᖏᓐᓇᖅᑐᑦ ᐊᖑᓇᓱᒋᐊᕈᑎᒋᔭᐅᓪᓗᑎᒃ: 75%ᓂ ᓇᓪᓕᐅᒃᑯᒫᓂᑦ ᐊᖏᓂᖅᐹᕆᓗᒍ $1000 ᐊᑐᓂ ᐱᖁᑎᒧᑦ ᐊᒻᒪᓗ $2000 ᐊᑐᓂ ᐃᒡᓗᖃᖅᑎᒧᑦ ᐊᕐᕌᒍᑕᒫᑦ. “ᐊᖏᔪᓄᑦ ᐊᖑᓇᓱᒋᐊᕈᑎᑦ” ᐅᑯᓂᖓ ᐅᖃᐅᓯᖃᖅᑐᑦ ᖃᒧᑕᐅᔭᕐᓂ, ᑎᓴᒪᓕᖕᓂ, ᓴᓂᓕᕇᕐᓗᑎᒃ ᐃᑭᒪᒍᓐᓇᖅᑐᓂᒃ ᑎᓴᒪᓖᑦ, ᐅᒥᐊᑦ ᐊᒻᒪ ᐊᐅᓚᐅᑎᑦ ᐊᑭᖃᓚᐅᖅᑐᓂᑦ $5000ᓂ ᐅᖓᑖᓂᓘᓐᓃᑦ.

Total Insurance Coverage Cost /ᑲᑎᓪᓗᒋᑦ ᓇᓪᓕᐅᒃᑯᒫᓄᑦ ᐊᑭᖓ

Total Eligible Insurance Funding / ᑲᑎᓪᓗᒋᑦ ᓇᓪᓕᐅᒃᑯᒫᓄᑦ ᑮᓇᐅᔭᐃᑦ

Funding / ᑮᓇᐅᔭᑦ

All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ

How do you wish to receive funding? / ᖃᓄᖅ ᑮᓇᐅᔭᑦ ᐱᔪᒪᓂᐊᖅᑭᓯᐅᒃ ᐃᓚᒌᒃᑐᓄᑦ ᑮᓇᐅᔭᓂᑦ?*

Direct deposit - only for RBC, CIBC & FNB (attach void cheque) / ᐴᖅᑕᐅᑲᐅᑎᒋᓗᓂ, ᕈᐊᔭᓪ ᑮᓇᐅᔭᒃᑯᕕᒃ RBC ᐅᕝᕙᓘᓐᓃᑦ ᑲᓇᑕᒥ ᑮᓇᐅᔭᖃᕐᕕᒃ CIBC , ᓄᓇᖃᖅᑐᑐᖃᐃᑦ ᑮᓇᐅᔭᒃᑯᕕᖓᓗ FNB (ᐱᖃᓯᐅᔾᔨᒋᑦ ᐊᑐᕈᓐᓃᖅᑎᓯᒪᔪᒥᒃ ᓯᒃᑭᒥᒃ)

Pick up at QIA office in Iqaluit / ᐊᐃᓗᒍ ᕿᑭᖅᑕᓂ ᐃᓄᐃᑦ ᑲᑐᔾᔨᖃᑎᒌᖏᑕ ᐊᓪᓚᒡᕕᐊᓂ ᐃᖃᓗᓐᓂ

Mail cheque / ᐊᐅᓪᓚᖅᑎᓪᓗᒍ ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑎᒍᑦ ᓯᒃᑭᒃ

Where should we send your cheque? / ᓇᒧᑦ ᐊᐅᓪᓚᖅᑎᒃᑲᔭᖅᐸᕗᑦ?*

Mail cheque to this address / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᑐᕌᕈᑖ*

Street Address / ᐃᒡᓗᕕᑦ ᑐᕌᕈᑖ City / ᓄᓇᖓ Province / ᓄᓇᓕᐅᑉ ᐊᕕᒃᑐᖅᓯᒪᓂᕆᔭᖓ Postal Code / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᓇᓗᓇᐃᒃᑯᑕᖓ

How will you submit your void cheque? / ᖃᓄᖅ ᑐᓂᓯᓂᐊᖅᑭᑦ ᐊᑐᕈᓐᓃᖅᑎᓯᒪᔪᒥᒃ ᓯᒃᑭᒥᒃ?*

Upload / ᖃᕋᓴᐅᔭᒃᑯᑦ ᐃᓕᓗᒍ

Email or Fax / ᓇᔅᓯᐅᑎᓗᒍ ᐃᕐᖐᓈᖅᑕᐅᑎᒃᑯᑦ ᓱᒃᑲᔪᒃᑯᓘᓐᓃᑦ

Attach Void Cheque / ᓯᒃᑭ ᐊᑐᕈᓐᓃᖅᑎᓯᒪᓗᒍ*

Max. file size: 300 MB.

Email void cheque to / ᐃᕐᖐᓈᖅᑕᐅᑎᒃᑯᑦ ᓇᔅᓯᐅᑎᓗᒍ ᐊᑐᕈᓐᓃᖅᑎᓯᒪᔪᖅ ᓯᒃᑭsnoble@qia.ca

Fax void cheque to / ᓱᒃᑲᔪᒃᑯᑦ ᓇᔅᓯᐅᑎᓗᒍ ᐊᑐᕈᓐᓃᖅᑐᕐᓯᒪᔪᖅ ᓯᒃᑭ 867•979•3238

Thank you for submitting to the NHSP program. You will receive a confirmation email of your application. If your application is approved, the decision will be publicized through our website community posting and noticed to HTO.

Declaration

I am applying for funding assistance under the Harvesting Equipment Program administered by Nunavut Harvesters Support Program (NHSP).

To the best of my knowledge, all of the statements or information in this application are true. I understand that any false or misleading information will result in my application being denied and may disqualify my organization or myself from receiving future funding assistance from NHSP or Qikiqtani Inuit Association (QIA).

I promise that any assistance received under this program will be used for the proposed harvesting equipment only.

I give permission to NHSP to collected and use my personal information related to this application and to make inquiries needed to evaluate this application. Upon receiving assistance, I will agree to supply any relevant receipts, records or other relevant information requested by NHSP.

My receipt of assistance will not make me an employee, contractor, or agent of NHSP or QIA.

By submitting this application, you agree to the above declaration.

ᖁᔭᓐᓇᒦᖕ ᑐᑦᓯᕋᓐᖑᐊᑕᕐᓯᓐᓇᕋᕕᑦ ᓄᓇᕗᒥ ᐊᖑᓇᓱᑦᑎᓄᑦ ᐃᑲᔫᓯᐊᑦᓴᓂᑦ. ᓇᓗᓇᐃᕐᓯᕕᐅᓛᖅᑯᑎᑦ ᐃᕐᖕᓃᓐᓈᕈᑎᒃᑯᑦ ᑎᑎᕋᕐᕕᐅᓗᑎᑦ ᑐᑦᓯᕌᑎᑦ ᒥᑦᓵᓄᑦ. ᑐᑦᓯᕋᐅᑏᑦ ᐊᖏᖅᑕᐅᓂᖅᐸᑦ, ᐃᓱᒪᓕᐅᕈᑎᒥᓃᑦ ᓴᖅᑭᑕᐅᓛᕐᒥᔪᑦ ᖃᕆᓴᐅᔭᒃᑯᑦ ᐅᓂᒃᑳᕐᕕᑎᓂ ᓄᓇᓕᓐᓄᑦ ᑐᕌᖓᕙᑦᑐᓂᑦ ᐊᒻᒪ ᖃᐅᔨᒃᑲᕐᑕᐅᓛᕆᓪᓗᑎᖕ ᓄᓇᓕᓐᓂ ᐊᖑᓇᓱᑦᑏᑦ ᑲᑐᔾᔨᖃᑎᒌᖏᑦ.

ᓇᓗᓇᐃᕐᓯᒍᑦ ᐊᖏᕐᓂᕐᒧᑦ ᐊᑎᓕᐅᕐᕕᒃ

ᑐᒃᓯᕋᐅᑎᒐ ᑮᓇᐅᔭᑎᒍᑦ ᐃᑲᔪᖅᑕᐅᔾᔪᑎᒃᓴᓂᒃ ᐊᖑᓇᓲᑎᒃᓴᓄᑦ ᐱᖁᑎᓄᑦ ᐃᑲᔫᑎᒃᓴᓂᒃ ᐊᐅᓚᑕᐅᔪᒥᒃ ᓄᓇᕗᒻᒥ ᐊᖑᓇᓱᒃᑎᓄᑦ ᐃᑲᔫᑎᒃᓴᓕᕆᔨᒃᑯᓐᓂᒃ (NHSP).

ᖃᐅᔨᒪᓂᒃᑯᑦ, ᑎᑎᕋᖅᑕᐅᔪᓕᒫᑦ ᑐᓴᕈᑎᓕᐊᖑᔪᓕᒫᓪᓘᓐᓃᑦ ᑖᒃᑯᓇᓂ ᑐᒃᓯᕋᐅᑎᓂ ᓱᓕᔪᑦ. ᑐᑭᓯᔪᖓ ᓱᓕᓐᖏᑦᑐᓂᒃ ᐅᕝᕙᓘᓐᓃᑦ ᐱᔭᖅᑯᒻᒥ ᓱᓕᓐᖏᑦᑐᓂᒃ ᑐᓴᕈᑎᓕᐅᖅᑐᖅ ᑐᒃᓯᕋᐅᑎᖓ ᕿᐱᓗᒃᑕᐅᑦᓴᐅᑎᒋᓂᐊᖅᑐᖅ ᐊᒻᒪᓗ ᐊᔪᓕᖅᑎᑕᐅᓗᑎᒃ ᑲᑐᔾᔨᖃᑎᒌᓐᓃᕕᒃᑲ ᐅᕙᖓᓘᓐᓃᑦ ᓯᕗᓂᑦᑎᓐᓂ ᑮᓇᐅᔭᑎᒍᑦ ᐃᑲᔪᖅᑕᐅᓂᕐᒥᒃ NHSP−ᑯᓐᓂᒃ ᐊᒻᒪᓗ/ᐅᕝᕙᓘᓐᓃᑦ ᕿᑭᖅᑕᓂ ᐃᓄᐃᑦ ᑲᑐᔾᔨᖃᑎᒌᑦ.

ᓱᓕᓪᓗᖓ ᐃᑲᔪᖅᑕᐅᔾᔪᑎᓕᒫᒃᑲ ᑖᒃᑯᑎᒎᓇ ᐊᐅᓚᓂᐅᔪᒃᑯᑦ ᐊᑐᖅᑕᐅᓂᐊᕐᓂᖏᓐᓂᒃ ᑐᒃᓯᕋᐅᑕᐅᔪᒧᑦ ᐱᖁᑎᓄᑦ ᐊᖑᓇᓲᑎᒃᓴᐃᓇᕐᓄᑦ.

ᐅᕙᖓ, ᑕᑉᕙᓂ, NHSP−ᑯᑦ ᓄᐊᑦᓯᔪᓐᓇᖁᓪᓗᒋᑦ ᐊᑐᕐᓗᑎᓪᓗ ᐅᕙᓐᓅᖓᔪᓂᒃ ᑐᓴᐅᒪᔾᔪᑎᓂᒃ ᐊᒃᑐᐊᔪᓂᒃ ᑖᑦᓱᒧᖓ ᑐᒃᓯᕋᐅᑎᒧᑦ ᐊᒻᒪᓗ ᖃᐅᔨᒋᐊᕈᓐᓇᖁᓪᓗᒋᑦ ᖃᐅᔨᓴᕐᓗᑎᒃ ᑖᑦᓱᒧᖓ ᑐᒃᓯᕋᐅᑎᒧᑦ. ᐃᑲᔪᖅᑕᐅᔾᔪᑎᑖᓚᐅᖅᑎᓪᓗᖓ, ᐊᖏᕈᑎᖃᕐᐳᖓ ᑐᓂᓯᓂᐊᕐᓂᕐᒥᒃ ᓇᓕᖅᑲᓂᒃ, ᑎᑎᕋᕐᓯᒪᔪᓂᒃ ᐅᕝᕙᓘᓐᓃᑦ ᐊᓯᖏᓐᓂᒃ ᐊᒃᑐᐊᔪᓂᒃ ᑐᓴᐅᒪᔾᔪᑎᓂᒃ ᑐᒃᓯᕌᖑᑉᐸᑕ NHSP−ᑯᓐᓂᒃ.

ᐃᑲᔪᖅᑕᐅᔾᔪᑎᒐ ᐃᖅᑲᓇᐃᔭᖅᑎᕈᕈᑎᒋᔾᔮᖏᑦᑕᕋ, ᑳᓐᑐᓛᒃᑕᐅᓂᕐᒧᑦ, ᑭᒡᒐᖅᑐᐃᓂᕐᒧᓘᓐᓃᑦ NHSP−ᑯᓐᓂᒃ ᕿᑭᖅᑕᓂ ᐃᓄᐃᑦ ᑲᑐᔾᔨᖃᑎᒌᑦ ᓘᓐᓃᑦ.

ᑖᒃᑯᐊ ᑐᓂᓪᓗᒋᑦ ᑐᔅᓯᕋᐅᑎᑎᑦ, ᐊᖏᖅᑐᑎᑦ ᑖᒃᑯᓄᖓ ᖁᓛᓃᑦᑐᓄᑦ ᓇᓗᓇᐃᕈᑕᐅᔪᓄᑦ.

Qikiqtani Qimuksiqtiit Program

NHSP (simple)

Personal Information / ᐃᕝᕕᑦ ᒥᔅᓵᓄᑦ ᑐᑭᓯᐅᒪᔾᔪᑎᔅᓴᑦ

Household Information / ᐃᓪᓗᒥᐅᖃᑎᒌᑦ ᖃᓄᐃᓕᖓᒻᒪᖔᑕ

Small Equipment / ᒥᑭᔫᑏᑦ ᓅᑦᑐᖅᓯᐅᑏᑦ

Small Equipment Totals / ᒥᑭᔫᑏᑦ ᓅᑦᑐᖅᓯᐅᑏᑦ ᑲᑎᓪᓗᒋᑦ

Safety Equipment / ᓱᓇᒃᑯᑏᑦ ᐊᑦᑕᓇᕐᔭᐃᕈᑏᑦ

Safety Equipment Totals / ᓱᓇᒃᑯᑏᑦ ᐊᑦᑕᓇᕐᔭᐃᕈᑏᑦ ᑲᑎᓪᓗᒋᑦ

Disaster Relief / ᐱᕐᕈᓗᐊᕿᔪᓄᑦ

Replacement Equipment / ᑭᖑᕝᕕᖅᑕᐅᓂᖏᑦ ᐱᖁᑎᑦ

Replacement Equipment Totals / ᐱᕐᕈᓗᐊᕿᔪᓄᑦ ᑲᑎᓪᓗᒋᑦ

Repair Equipment / ᐋᖅᑭᒃᓱᕐᓂᖅ ᐱᖁᑎᓂ

Repair Equipment Totals / ᐋᖅᑭᒃᓱᖅᑕᐅᓂᖓᓄᑦ ᐱᖁᑎ ᐊᑭᖏᑦ ᑲᑎᓪᓗᒋᑦ

Insurance Coverage / ᓇᓪᓕᐅᒃᑯᒫᓄᑦ

Funding / ᑮᓇᐅᔭᑦ