APPLICATIONFORM

FARM INNOVATIONFUND

Have you applied previously for assistance from the NSW RuralAssistance Authority? (Please tick either ‘Yes’ or‘No’) / Yes / No
NOTE: If you select ‘Yes’ please provide your 6 digit BP number, ifavailable. / BP:5

1.BORROWING ENTITY (Individual, Partnership, Company or Trustee of Trust)

FULLNAME(S)
(If a Company also show details of allDirectors) / Position (Director, Trustee, Partner) / Date ofBirth
//
//
//
//
//
//
Trading Name: (Ifapplicable)
ABN: / ACN:
Phone: / Mobile: / Fax:
E-mail address:
PropertyAddress:
Postcode
Postal Address: (If different to property’saddress)
Postcode
Howwouldyou like toreceive futurecorrespondence fromthe RAA?
Mail / Fax / Email(Please tick)
Briefly detail the nature of yourenterprise:

PREFERRED TERMS AND CONDITIONS

What is the amount of the loan required? / $
Please outline your preferred repayment terms.
Please specify the months you wish to make repayments for Quarterly, Halfyearly & Annual Payments / Monthly / Last day of the month
Quarterly
Half Yearly
Annual

2.DETAILS OF PROPOSEDWORKS

Please provide an estimate of costs for each work to be carriedout. Permanent capital improvements including but not limitedto:

DroughtPreparedness / FarmInfrastructure
Stock & Domestic watersupply/ new or upgrading irrigation / $ / Fodder storage facilities (Silo– Hayshed) / $
Cap & Piping of artesianbores / $ / Farm/shearingsheds / $
Refurbishing/desilting groundtanks / $ / Fencing/roadworks / $
Planting PerennialSpecies / $ / Storm/ Exclusionnetting / $
Other(Describe) / $ / Other(Describe) / $
Environment / NaturalResources
Soil Conservation/Erosioncontrol / $ / Planting trees for shade/wildlife corridors / $
Woody/Noxiousweed/Serrated Tussockcontrol / $ / Fencing offenvironmentally sensitiveareas / $
Solar PowerConversions / $ / Livestock effluentcontrol / $
Other(Describe) / $ / Other(Describe) / $

Total estimated cost of works (exGST)$

Less any Grant (ifapplicable)$

Net Cost ofworks$

Loan required$

Full details of the proposedworks

How will the work complement your Farm Business & Risk Assessment Plan and ensure thelong term productivity and profitability of the farmingenterprise?

3.DETAILS OF PROPERTY(s) WHERE WORKS ARE TO BE CARRIEDOUT

It is most important that this information is completedaccurately.

Total Area Held (ha) / Situated kms / North, South,East,Westof

Please attach a copy of latest Council and LLS rate notice for eachproperty

PropertyA

PropertyAddress
RegisteredProprietor/s / Area / (ha)
DatePurchased / Current Market Value$ / Amount Owing$
TitleReference / PlanReference (DPNo.) / Portion/Lot No. / Parish / County
Deeds HeldBy
Local Government Area (LGA) ofproperty:
Local Land Service (LLS) ofproperty:
Property Identification Code(PIC) / N

4.OTHER PROPERTY AVAILABLE ASSECURITY

PropertyAddress
RegisteredProprietor/s / Area / (ha)
DatePurchased / Current Market Value$ / Amount Owing$
TitleReference / PlanReference (DPNo.) / Portion/Lot
No. / Parish / County
Deeds HeldBy:-
Local Government Area (LGA) ofproperty:
Local Land Service (LLS) ofproperty:
Property Identification Code(PIC) / N

*** PLEASE STATE HOW YOU ARRIVED AT THE ABOVE PROPERTY(S) MARKET VALUE(S)***

5.DETAILS OF FARM ENTERPRISEPROGRAMS

Program / Last 12 months / Next 12months / Normalseasonal program
Cropping Details / (wheat, oilseed,fruit, grapes vegetablesetc) / Ha. / $ / Ha. / $ / Ha. / $
-
-
-
-
Total Hectares undercultivation
WOOL / Number / $ / Number / $ / Number / $
Number of Balessold
Ave FlockMicron
DAIRY
Number ofMilkers
Ave annual litresproduced
LIVESTOCKTRADING / Number / $ / Number / $ / Number / $
Sales
Purchases / Cattle
Sheep
Pigs
Other
Cattle
Sheep
Pigs
Other
LIVESTOCKNUMBERS / No.of Head / No.of Head / No.of Head
Cattle
Sheep / Breeders
Heifers
Steers
Calves
Bulls
Ewes
Wethers
Hoggets
Lambs
Rams

6.MONTHLY CASH FLOW FOR THE NEXT 12 MONTHS (Your own computerised schedule ispreferable)

FarmIncome / Past12 Months / Totals
Livestocksales
Wool
Cropincome
Other
Other
Other
Rebates/grants/subsidies
All Off FarmIncome
TotalIncome
FarmExpenses
CropExpenses
Electricity &Telephone
Fuel,Oil
Lease Rentals(Land)
LivestockExpenses
Repairs/Maintenance
Shearing
WaterRates/Purchase
SundryExpenses
Personaldrawings
BankInterest
LoanRepayments
Lease/HPinstalments
StockPurchases
CapitalPurchases
TotalExpenditure
Surplus(Deficit)
Opening Bank Balance
Closing Bank Balance

7.COMMITMENTSCHEDULE

Part A- Overdraft, Commercial Bills, Credit Card facilitiesetc
Name of Lenderor CreditProvider / Type ofFacility / Term / Int Rate / Limit / BalanceOwing
$ / ReviewDate
TOTAL
Part B -Term Loans, Fixed Rate Loans, Investment, Private or Familyloans
NOTE ! Indicate if (1) interest is a variable (V) or fixed (F) rateand
(2) if instalments are monthly (M) half yearly (H) or annually(A)
Name ofLender / Typeof Advance / Term / Int
Rate / Repayment
Frequency / Repayment Amount / Balance Owing / Expiry Date
TOTAL
Part C - LeaseArrangements
LeaseCompany / Int Rate / Instal Period / Instalment Amount / Instalment DueDate / Balance Owing / Expiry Date
TOTAL
Part D – Hire PurchaseAgreements
HP Company / Int Rate / Instal Period / Instalment Amount / Instalment DueDate / Balance Owing / Expiry Date
TOTAL
Summary ofBorrowings / BalanceOwing / Instalments
Total PartA
Total PartB
Total PartC
Total PartD

8.STATEMENT OF FINANCIAL POSITION OF APPLICANT(S)

(Ifindividualpartnersordirectorsholdassetsorliabilitiesthatarenotshownbelowpleaseprovideaseparatestatement)

WHOLE DOLLARS ONLY- DO NOT USECENTS

Liabilities
(Show presentdebts) / $ / Assets
(Show at present fair marketvalue) / $
Farm Land(s) Held**
Total Borrowings (from previouspage) / PropertyName: / ha
PropertyName / ha
PropertyName / ha
** Exclude value of W.A.L detailedbelow**
Water Access Licence(s)Held
W.A.LNo.Mgl
W.A.LNo.Mgl
W.A.LNo.Mgl
Income/LandTax
Other Real Estate(Details)
Crown LandDebt / Livestock
Type: / No:
Type: / No:
Type: / No:
SundryCreditors
Farm Plant &Machinery
MotorVehicles
Cash atBank
Farm ManagementDeposits
Share Portfolioheld
Co-OperativeShares
Superannuation
GrainPools
Produce on hand(Saleable)
TOTAL / TOTAL
Have you ever been bankrupt, assigned a liquidator, or are there any unsatisfactoryjudgements against you in anycourt?
YES / NO / If YES give details

9.FARM BUSINESS AND RISK ASSESSMENTPLAN

Attach your Farm Business and Risk Assessment Plan including the following information whereapplicable:

1.Background Information

-PropertyHoldings

-Farming History andExperience

-Scale and type ofOperation

2.FarmAssessment

-OperatingStructure

-OperatingInfrastructure

-Adequacy ofInfrastructure

-Natural ResourcesManagement

3.Current Seasonal Outlook and Prospects

4.FinancialPerformance

-Liabilities, Long Term Liabilities, Total Value of FarmLiabilities

-Analysis of past 12 months tradingresults

-Future changes to financial position envisaged over the next 5years

-Farm/plant/machinerypurchases/sales

5.RiskAnalysis

-Risks facing thebusiness

-How these risks are currently beingmanaged

-Proposed plans to minimise the impact of these risks in thefuture

6.Future Strategy

7.S.W.O.T.Analysis

-Strengths

-Weakness

-Opportunities

-Threats

10.CONTACTDETAILS

Solicitor’sDetails

FirmName:
ContactName:
Phone: / Mobile: / Fax:
E-mail:

Accountant’s Details

FirmName:
ContactName:
Phone: / Mobile: / Fax:
E-mail:

Main Financier’s Details

Bank or CompanyName:
ContactName:
Phone: / Mobile: / Fax:
E-mail:

RuralFinancial Counsellor’s Details

Counselling ServiceName:
ContactName:
Phone: / Mobile: / Fax:
E-mail:

11.CONSENT FOR RELEASE OFINFORMATION

I/We have lodged an application with the NSW Rural Assistance Authority for a Farm InnovationFund Loan to carry out works on my/ourproperty.

To allow this application to be assessed, I/we authorise the release of information by relevantauthorities, including Commonwealth, state/territory or local authorities to the NSW Rural Assistance Authorityrelating to my/our application for a Farm Innovation FundLoan.

SignedApplicant:

SignedApplicant:

Date://

Date://

SignedApplicant:SignedApplicant:

Date://

Date://

12.STATEMENTS GeneralStatement

AnypersonwhoknowinglyandwithintenttodefraudtheNSWRuralAssistanceAuthorityoranother person,filesanapplicationforassistancecontaininganymateriallyfalseinformation,orconcealsforthe purpose of misleading information concerning any fact material thereto, commits a fraudulent act, which isa crime under the Crimes Act 1900 and subjects the person to criminalpenalties.

Privacy

The information in this application is provided voluntarily and is being collected by the NSWRural AssistanceAuthorityforpurposesrelatedtotheadministrationoftheschemeofassistanceunderwhich you have applied, including the assessment of the effectiveness of the scheme. This may involvedisclosing theinformationinthisapplicationtocontractorsengagedbytheAuthorityortoeitherStateor Commonwealthgovernmentagencies.Wewillsupplyyouwithdetailsofthosethatwehavedisclosed informationto,ifyouapplytousinwriting.Informationregardingyourapplicationmayalsobediscussed and exchanged with the nominated contact persons listed by you in yourapplication.

Notprovidingtheinformationrequestedinthisapplicationorprovidingfalseormisleadingorincomplete information may impact on the ability of the Authority to accurately assess yourapplication.

TheNSWRuralAssistanceAuthorityagreestotakeallreasonablemeasurestoensurethatthepersonal information collected by it is storedsecurely.

You may access or correct your personal information by contacting the Authority by telephone on 1800678 593 (toll free) (Calls to “1800” numbers from your home phone are free. Calls from a public phoneand mobiles may be timed and attract charges.) or by writing to: Manager Administration, NSW Rural Assistance Authority, Locked Bag 23, ORANGE, NSW,2800.

13.DECLARATION

I/We have read and understood the Farm Innovation Fund InformationBrochure.

I/We have read the Privacy statement above about how information provided in my/our application maybe used.

I/WeunderstandthatcompletedapplicationsundertheSchemewillbeassessedinorderofreceiptand loan offers will be based on the availability offunds.

I/We hereby give approval to the NSW Rural Assistance Authority to obtain and provideinformation relevant to this application from my/our lender(s), accountant or any other nominatedperson.

I/WegiveongoingapprovalfortheNSWRuralAssistanceAuthoritytoobtainandprovideinformationas requiredfrommy/ourlenderregardinganyreview(annualorotherwise)ofmyfacilitieswiththatlender and/or this loan ifapproved.

I/Wesolemnlydeclarethatthisisatrueandcorrectstatementofallmy/ouraffairsandI/Wemakethis solemn declaration subject to punishment by law provided for any wilful falsestatement.

I/We agree to provide feedback and/or participate in a review of thisScheme.

SignedApplicant:

SignedApplicant:

Date://

Date://

SignedApplicant:

SignedApplicant:

Date://

Date://

14.LODGEMENT OFAPPLICATIONS

Applicants can lodge completed application forms including required documentation with the NSWRural Assistance Authority by post, email, facsimile or personal deliveryat:

Post:Locked Bag23 Orange NSW2800

Email:

Fax:(02)63913098

Inperson:161 KiteStreet Orange NSW2800

Telephone:1800678 593 (TollFree)Website:

If you have difficulty understanding or completing this form you should seek the assistance ofyour rural/financial counsellor, business advisor, accountant or a trusted familymember/friend.

Language Services (Interpreting and Translating) are available by contacting MulticulturalNSW on 1300 651 500 or by

I/WeareapplyingtotheNSWRuralAssistanceAuthority(RAA)foraloanthroughtheFarmInnovationFundtocarryoutworksonmy/our

property listedbelow.

TheRAAwillbetakingassecurityaStatutoryFirstChargesupportedbyaregisteredCaveatoveranyorallofthe propertylistedbelowto supporttheloanshoulditbeapproved.AstheStatutoryFirstChargewillrankinprioritytothedebt(s)securedbyyourexistingmortgage(s) we ask that you endorse yourconsent.

APPLICANT TOCOMPLETEBP:5

Applicant’sName
PropertyAddress
(where works are to bedone)
Loan amount sought fromRAA / $

FINANCIER TOCOMPLETE

Loan Accountsheld

LoanType / Interestrate / Repaymentarrangement
& amount / Limit / CurrentBalance / Review/expiry date

Details of Securityheld

Mortgage No / Ranking (1st, 2ndetc) / TitleReference(s) / Area / Valuation

Credit Accountsheld

AccountType / Balance / AccountType / Balance
In signing this certificate, the Mortgagee agrees the proposed Advance willbesecured by a Statutory First Deed of Charge which will operate as a Statutory Charge against the property pursuant to the provisions of the Rural Assistance Act1989asamended,andpursuanttothisAct,ranksinPrioritytoanymortgageson Title.The Mortgagee also acknowledges that due to the nature of the StatutoryFirst Charge there will be no priority arrangementbetween the Authority and thelender. /
BANKSTAMP
When completed by your Financier/Bank please attach this form to your Farm innovation FundApplication.

FinancierNameSignature

Date ____ / _____ / ______(DD/MM/YYYY)

NSW Rural AssistanceAuthorityFarm Innovation Fund - Existing Mortgagee’s ConsentFormV2.0 11/17Page12

/ APPLICATIONFORM
FARM INNOVATIONFUND

To avoid any delay in the processing of your application,

please ensure you have provided all the information listed below.

CHECKLIST

Signed Mortgage Lenders Consent Form from your existingmortgagee.
Last 3 years balance sheets and Financial Statements of your farm enterprise.
(These include Profit and Loss Statements, Stock Trading account and Depreciationschedules)
Tax Assessment Notices are not acceptable
Last 3 years individual Taxation Returns and a current listing of all Assets &Liabilities held byeach:
-Individual members of a Partnership/ FamilyTrust
-Individual Director(s)/Shareholder(s) of all Companies
In each of the above, each Director/Shareholder, etc. is to provide details includingthe source of income, if they are not primarily dependent on the business for theirlivelihood.
Do not send original Tax Returns
Copy of Farm Business and Risk AssessmentPlan
Monthly Cash Flow Budget for the next 12months
Copy of current LGA (council) rates and LLS rates notice(s)for property(s) where the work is to becompleted
Have all parties (applicants) to the application signed the Consent (Page 9) andthe declaration (Page10)?

NSW Rural AssistanceAuthorityApplication Form - Farm InnovationFundV2.0 11/17Page13