AgriAssurance Program: Small and Medium-sized Enterprise Component – Consent for Use, Disclosure and Copyright

The purpose of this document is to obtain your written consent for the disclosure of personal information and/or business information to Agriculture and Agri-Food Canada (AAFC). With your consent, the Applicant will use this information in or with a Project Application Form that requests funding under the applicable AAFC program.

I acknowledge that by signing this form I agree to the following:

Use and/or Disclosure

The personal and/or business information in this application is being collected under the authority of the Department of Agriculture and Agri-Food Act and may be used by AAFC, or disclosed to third parties including other Government Departments, to:

assess and review the eligibility of the Applicant and the Project under the applicable AAFC program
verify the accuracy of the information provided in or with the Application Form and additional documents
determine eligibility for other AAFC, Government of Canada or provincial programs from which the Applicant might benefit; and
evaluate the scope, direction and effectiveness of agricultural programming and research in Canada

The Applicant consents that the information may also be used for the purposes of: contacting you should additional information be required; validating your credentials; facilitating payment of the contribution in the event your application is successful; program administration; and evaluation, reporting, and statistical analysis.

Personal information will be treated and disclosed in accordance with the Privacy Act. You have the right to access your personal information held by Agriculture and Agri-Food Canada and to request changes to correct personal information by contacting the AAFC Access to Information and Privacy Director at aafc.atip-aiprp.aac@agr.gc.ca

For more information about AAFC’s privacy practices, you may refer to the following Personal Information Banks: Public Communications PSU 914 and Outreach Activities PSU 938. If there is an AAFC-specific Personal Information Bank it will be available in the Program’s Applicant Guide.

Business information will be disclosed only in accordance with the provisions of the Access to Information Act.

For information about the Privacy Act and the Access to Information Act, visit Privacy Act and Access to Information Act. For further information about these Acts please contact the Access to Information and Privacy Director at aafc.atip-aiprp.aac@agr.gc.ca.

Copyright permission

AAFC may disclose, reproduce and distribute any part of or the whole of the documentation provided in or with this Application Form, within AAFC and to its authorized third parties, including other Government Departments, for purposes consistent with the receipt, assessment and subsequent treatment of the Application.

I hereby consent to the provision of my personal information and/or business information by the Applicant:

for the purpose of the submission of the Project Application Form for funding to the applicable AAFC program

Print name

Print business name (if applicable)

Signature

Date (YYYY-MM-DD)

Alternative formats

Consent for Use, Disclosure and Copyright (PDF version, 1.3 MB)