OEDU Prototype Fund – Application Form

Applicants are advised to read theApplication Guide before completing this form.

All the information/fields requested in this form are MANDATORY and failure to complete mayresult in the return of the application.

1.Project Details

Project title
(descriptive)
Project location
(If there is more than one location please indicate the principal location)
County
Project start date
Project completion date
At what stage is the project?
(e.g., outline, developed, etc)
Brief summary of project proposal (Provide a brief description of the project and its objectives)
List any permissions, permits, licences or other authorisations necessary for the project. Identify those which have been attained and provide an estimated approval date for those which are still outstanding.
Permissions, permits, licences / Date of approval / Comments
Planning permission (if required)
Permissions, authorisations and/or consents from the CER or evidence of the related application(s) to the CER as lodged with the CER

2.Applicant Details

Principal Applicant

To be completed by the main applicant.

Organisation
Principal business activity
Project Contact Name
Position
Address
County
Telephone / Fax
Mobile / Email
Web
Is a copy of Tax Clearance Certificate attached Y/N?
Please note a copy of a valid TCC must be included before any application can be processed

Applicant Bank Details

Bank Name
Bank Branch/Address
Account Name
Account Sort Number / - / -
Account Number

For Cross Border Payments

IBAN
SWIFT

Project Co-ordinator- if different from Principal Applicant

Project Co-ordinator name
Position
Organisation
Principal business activity
Address
County
Telephone / Fax
Mobile / Email
Web

Other Participant Details

To be completed foreach participating organisation and partner involved in delivering the project and state whether a formal relationship has been established, (extend the summary table as necessary).

Participants name
Position
Organisation
Principal business activity
Address
County
Web
Telephone / Fax
Mobile / Email
Web
Formal Relationship (Y/N)
Letter of support / contract attached to application

Contractor / Supplier Details

List all project contractors and suppliers who will be carrying out different stages of the project, (extend the summary table as necessary).

Supplier name
Position
Organisation
Principal business activity
Address
County
Telephone / Fax
Mobile / Email
Web
Formal Relationship (Y/N)
Letter of support / contract attached to application
Supplier name
Position
Organisation
Principal business activity
Address
County
Telephone / Fax
Mobile / Email
Web
Formal Relationship (Y/N)
Letter of support / contract attached to application

3.Project Funding

Any costs outlined should be exclusive of VAT

Table A - Total project funding

Please enter details of other funding sources, public, private, in-kind contributions (including details of the provider of funding)

Project Funding Sources / (€)
Sustainable Energy Ireland – grant support requested
Other Funding Source / Funding secured
(Yes / No) / (€)
Other public bodies
EU Commission
Own resources
Other ______
Total Project Funding

Table B - Summary Estimates of Eligible Costs

Eligible Costs / (€) / Requested Funding Level (%) / Requested Funding (€)
Materials/equipment/installation
From Table B1
External Consultant Costs
From Table B2
Internal Staff Costs
From Table B3
Other ______
Other ______
Total

Table B1 - Material & Equipment Cost–Itemised

Please list all material/equipment costs and include description outlining to which task it relates

Materials/equipment / Cost
(€)
Total

Table B2 -Consultancy Cost - Itemised

Name of Organisation / Details / Daily Rate / No. of Days / Cost
(€)
Total

Table B3-Internal staff costs - Itemised

Name of Organisation / Name of
Staff Member / Daily Rate / No. of Days / Cost
(€)
Total

Note: Internal staff costs should be calculated on the basis of actual salaries paid, inclusive of employers PRSI charges, within the frame of a full complement of 230 available working days per annum.

Additionality
Briefly state the additionality of funding from this application? i.e. state to what extent the project will go ahead without/with the requested funding.

Table C Previous Funding:

Summarise details of any other Public Funding received to date. Extend this summary table as necessary.

Funding Agency
Principal activity
Address
Project 1
Date
Value of Grant
Project 2
Date
Value of Grant
Add rows for additional projects or funding agencies

4.ProjectTechnical Details

Product / Concept Description
Describe in detail the concept / operation of your proposed project; include illustrations, diagrams or charts if appropriate.
Previous Development.
Describe relevant previous developments to date; include illustrations, diagrams or charts if appropriate.
Project objectives
State the objectives of the project, in measurable and verifiable terms.
Project technical description (max. 1-2 pages)
Describe in detail theproject tasks, timelines, resources, deliverables, energy performance/output.
The call for Expressions of Interest references a number of requirements. Please address these as appropriate, below:
Describe how the project enables technical and other barriers to the development and introduction of Ocean Energy to be overcome
Describe how the project facilitates and accelerates the development and deployment in Ireland of competitive ocean energy products, processes and systems
Describe the environmental compatibility of the technology/project
Describe how the project contributes to the development of an indigenous OE industry

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OEDU Prototype Fund – Application Form

5.Project Work plan and Budget

Project management methodology

Briefly outline how the project will be managed.

Proposed resources and intended utilisation

Briefly describe the facilities available for this project.

Project team detailing the skills and experience balance

Briefly describe the project team describing how the project team (applicant and suppliers) have the appropriate skill and experience to successfully carry out the project.

Gantt chart of major tasks and project milestones

Please provide a detailed project plan and Gantt chart setting out the schedule of key tasks, owners, milestones and deliverables. This should relate back to tables in section 3. This can be attached as appendix or separate document.

Project Budget Profile

Pleaes provide a spend profile and cash flow projection for the life of the project including expediture linked to milestones and deliverables

Project Risks

Please decribe all risks idenitified with the project, estimate likelihood of risk and mitigation plan to reduce the risk or effects should it occur.

6.Intellectual PropoertyRight

Please state status of IPR for the project, whether fully owned, licensed or search required, etc…

7.Supporting Documentation

All applications must include a valid Tax Clearance Certificate for Principal Client.

8.Relevant Documentation

Please include any relevant information which has not been covered in the application form

9.Authorised Declarations

Declaration of applicant

I hereby undertake that the information given in this form is correct and that all conditions attaching to the provision of a grant have been met and where applicable, will continue to be met in the ongoing operation of the project.

Signature of Applicant[1]Date

…………………………………………………………………..……………

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[1]Electronic signature is acceptable.(a scanned image of your signature)