Green Growth Business Loan Scheme
Full Application Form
If you have any questions, please contact Richard Hall on 07770
Term Loan Facility
Information required:
A. Basic information1 / Name of Business:
2 / Company No.
3 / Address (including postcode):
4 / Contact Name
5 / Position
6 / Contact Details: Tel.
7 / Mobile
8 / Email
9 / Company registration number
10 / Company Legal Status (sole trader, Ltd., etc.)
11 / Shareholding: please indicate % ownership for each shareholder
12 / Please list the other business interests of any shareholder owning 25% or more of the company (include all interests whether or not you believe them to be relevant to this application) excluding those of public investment corporations, instutional investors or venture capitalists.
13 / How many employees (FTE) do you currently employ in the business
B. Public Funding Information
14 / Please state whether you have received any public sector funding in the last 3 years
Date of payment / Provider / Amount / Reason for payment
C. Project Plan
15 / Project plan: Please highlight any changes in the proposed project plan from those described in the EOI. Attach a revised Project Plan as a PDF if necessary.
D. External services required for project delivery
16 / If you require significant external services to deliver this project, which provider/s do you intend to use? For each servce, please indicate whether you have a Formal Quotation (FQ); Initial Enquiry (IQ) or have Not Approached the Supplier (NAS).
E. Your Business Case
17 / Please provide us cash flow and profit and loss projections for the next 3 years. You may use your own template or download a template from
Include cost of employment for new jobs, cost of equipment and services. You should include costs to be funded by the loan and match funding.
18 / Explain how this project will generate revenue for your business.
Include information about your markets, competitors and how you plan to grow your turnover
F. More information on the additional jobs you will be creating
19 / Provide a description of each job to be created and when it will be created. Include job title, main duties, hours per week, nature of contract and salary.
Financial Year / Quarter / Job title / Main duties, hours/week, nature of contract and salary
G. Project summary
20 / Estimated project cost
21 / Loan applied for
22 / Matched funding offered
23 / Matched funding source
24 / Number of new jobs created
25 / How will you proceed if your application is unsucessful?
This is an opportunity for you to summarise the current position of your business and the impact that the project will have on your business if your application is successful (max 400 words)
H. Loan information
26 / Amount and purpose of Loan
27 / Date required from:
28 / Repayment date
29 / Primary Repayment Source
30 / Secondary Repayment source (if any):
31 / Security Offered
Personal Guarantee / Personal Property:
Freehold
Leashold
Value
Details of prior mortgages
Joint Names? / Stocks and Shares*
Please attach list and valuation / Other assets:
Business Assets: / Debenture / Charge over debtors / Charge over other assets
(Chattels Mortgage)
I. Bank details
Please provide details of your banking facilities:
32 / Overdraft
33 / Facility letter from:
34 / Expires:
35 / Loans
36 / Monthly/Annual repayments
37 / Monthly fees (if any)
38 / Security provided
J. Other loans
39 / Other Loans / HP / Invoice / Asset Finance: For each loan, plase provide information on:
Amount outstanding / Period of loan / Repayments / Lender / Monthly / Annual / Other
K. Balance Sheet Information (Previous 3 years Minimum)
40 / £/000 / / / / / / / / /
Sales
Gross Profit
Expenses
Profit before Tax
Net Worth
Net Current Assets/(Liabs)
Explain any decline in turnover, low profitability etc. which may cause concerns as to your ability to afford this project. [max 200 words]
L. Creditor List
41 / Please provide details of any special arrangements you have entred into with creditors (i.e. fixed monthly payments, deferrals etc.) Send/Attached
M. Debtor List
42 / Sent/Attached
N. HMRC Time to pay
43 / Are you currently using an HMRC time to pay arrangement? If so please provide details of the agreement.
44 / If you are using an HMRC time to pay arrangement confirm if the the arrangement is working within agreed terms and timescales.
45 / Have you applied for and been refused an HMRC time to pay arrangement?
O. County Court Judgements
46 / Please provide details of any CCJs outstanding or court cases pending
P. Winding Up Orders
47 / Have you received a winding up order within the last 12 months?
48 / Details (if yes)
I confirm that the above information is accurate to the best of my knowledge.
Signature......
Director/Position......
For an on behalf of ......
Date......
______
Green Growth Business Loans Scheme: Full Application Form Page 1 of 5
Local First CIC, 3, The Square, Winchester, Hampshire, SO23 9ES