ESCF Authorization
Statement
I hereby submit this application for the Early Stage
Commercialization Fund Program (the “Program”). I certify
that I am the Principal Investigator of the project and that the information
provided in this application and its attachments is true and correct to the
best of my knowledge and belief.
I confirm that I meet the Program eligibility rules
as outlined in the competition guidelines, summarized as follows: applicants
must be the Principal Investigator of the project, and a Nova Scotia university
and college faculty member, or staff, clinician or researcher in a
university-affiliated institution.
I authorize
Invest Nova Scotia or its designate to make any enquiries of such persons,
firms, corporations, and federal and provincial government agencies/departments
required to collect and to share information with them, including business
information and personal information as defined in the Freedom of Information
and Protection of Privacy Act, as Invest Nova Scotia deems necessary, in order
to reach a decision on this application; to administer and monitor the
implementation of the Activities; and to evaluate the results of the Activities
and this Program after the Activities are completed. I acknowledge the
requirements of the Personal Information International Disclosure Protection
Act (Nova Scotia) and authorize Invest Nova Scotia or its designate to
provide any business or personal information deemed necessary to the Program
Partners even if outside Canada. I hereby waive confidentiality of such
information and agree that its collection and disclosure will not be the basis
of any liability, claim or order against Invest Nova Scotia.
Should the
application be successful, I hereby give Invest Nova Scotia permission
to release my name and the assistance in any form and through any media for
purposes of marketing this Program. By signing below, I consent
to Invest Nova Scotia releasing my contact information to any third-party
service providers retained for the purposes of evaluation of the Program. This
consent is valid whether the application is successful or not. I agree to being
contacted by any such third-party service provider and will cooperate with them
in the collection of information for evaluation of the Program.
Annually, for two
(2) years following the completion of the Activities under the Program, I shall
participate in Invest Nova Scotia's corporate data collection process. Invest
Nova Scotia may request data on the impact of the Program including, but not
limited to, sales, cost reductions, productivity improvements, enhanced competitiveness,
increased profits, improved product quality, payroll and other factors which
Invest Nova Scotia considers relevant. Failure to participate in the data
collection process within the given timeline may impact future funding or
assistance and application eligibility with Invest Nova Scotia. I also
understand that information completed in the businesses of diversity section of
the application will be used by Invest Nova Scotia for the purposes of: (1)
making businesses of diversity aware of Inclusivity, Diversity, Equity, and
Accessibility (IDEA) opportunities and programming available through Invest
Nova Scotia and its partners, and (2) measuring the participation of
businesses of diversity in Invest Nova Scotia export development programs and
services. I hereby waive confidentiality of such information and agree that its
collection and disclosure will not be the basis of any liability, claim or
order against Invest Nova Scotia.
I agree to release Invest Nova Scotia and its staff from
any claims, causes of action, suits, actions and liabilities of every nature
and kind whatsoever arising from, as a result of or in any way related to the
aforementioned authorized release of contact information, information in my
business account record and subsequent collection and use of information. If I
do not consent to the disclosure of contact information, I understand that I
cannot participate in this application.