West Midlands Combined Authority
Land Remediation Fund

Application for Funding (Grant or Loan)

This form is to be completed when applying for WMCA LRF funding. Please fill in all appropriate answers, giving as much correct detail as possible. The text entry areas within this form are of a fixed size and therefore please ensure that answers are contained within the set boundaries as shown in print view.

For further information or advice on filling out this form contact Nick Oakley on 0121 233 4903 or email .

1.Applicant Details
Applicant name
Company Name / Registered company number
Project name
SPV entity or Borrowing entity (if any)
Company contact address
Email address
Telephone number / Mobile number
Amount of Funding requested (£)
Type of Funding Requested ( e.g Grant, Feasibility or Loan)
☐ Grant
☐ Feasibility
☐ Loan
Total project costs (£)
2.Site Details
Site address (including postcode)
Area size of site (km2)
Historic occupiers and uses of the site
Is the site occupied at present
If yes, please answer, else leave blank:
Will the occupier vacate / Has suitable alternative accommodation been found
Who are the adjacent occupiers and uses (e.g Industrial, Commercial or Residential)
Who currently owns the land
Please answer appropriate column:
Land needs to be acquired / Landowner already
Has purchase price been agreed / Date of acquisition
Is the offer conditional / Cost of acquisition
Any other bidders or has applicant got exclusivity / Current estimated value
Basis of valuation
What is the current planning status
If a new application is being made, please answer, else leave blank:
What is the site use applied for / Current status of the new application
Are planners supportive of new proposal
What are the likely sectional costs/agreements (e.g s106, s278, CIL etc)
3.Project Details
Please provide a description and information on the intended development (e.g. industrial units, office, commercial, leisure or residential)
Please attach a copy of your detailed development appraisal, with assumptions on costs and sales revenues, when submitting your application.
4.Project Timescales
Anticipated start on site
Anticipated completion date
Anticipated sale or repayment date

Please attach a copy of your forecast development programme, when submitting your application.

5.Economic & Social Impact / Outputs
Please provide details of the economic growth and social impact of the proposed development (e.g. number of jobs created or safeguarded, acres remediated, commercial space or housing units delivered, community regeneration etc.)
6.Financial Appraisal
Total costs
Amount of equity contribution and source
Gross development value (and assumptions)
Proposed funding structure (eg Equity, Mezzanine, Debt)
Other lenders involved (please provide details of agreed terms and security required)
Amount of Grant/Viability Gap and security available
7.Land Remediation/Viability Gap
Please describe the type of remediation required or viability gap
Have site investigations and geotechnical investigations been undertaken
If yes, please attach copies of these reports, when submitting your application
Have costings been obtained on remediation required
If yes, please attach copies of these (generally three quotes should be obtained), when submitting your application
8.Developer Details
Please provide details on preferred contractors (name, contact details etc), their capabilities and track record of delivery on similar projects
Please provide details ofyour management and development team (internal and external)
Please attach copies of your management and development team’s CVs, when submitting your application.
Please attach a copy of your financial track record, providing a minimum of 2 years of audited accounts and management, when submitting your application.
Ownership shareholding of applicant entity, if a plc, leave blank
Please provide details of your professional team and advisors to be engaged
What is your sales and marketing strategy (If applicable)
Please attach evidence of market demand and independent advisors used
END OF QUESTIONS

This form is to be completed when applying for WMCA LRF funding. Please fill in all appropriate answers, giving as much correct detail as possible. The text entry areas within this form are of a fixed size and therefore please ensure that answers are contained within the set boundaries as shown in print view.

For further information or advice on filling out this form contact Nick Oakley on 0121 233 4903 or email .

Submitting final applications:

Once all questions have been answered and checked, please save and email over to / ensuring that the following is also attached to the message.

  • A copy of your detailed project appraisal
  • A copy of your forecast development programme
  • If appropriate, copies of site investigation/geotechnical reports
  • If appropriate, copies of the remediation costing quotes (generally 3)
  • A copy of your management and development team CVs
  • A copy of your financial track record, providing a minimum of 2 years of audited accounts and management accounts for the developer
  • Evidence of market demand and independent advisors used
  • A completed state aid assessment form