Geelong Region Innovation and Investment Fund (GRIIF) Grant Application Form

Geelong Region Innovation and Investment Fund (GRIIF) Grant Application Form

Deadlines apply to this program

Round 1 of GRIIF closes at 5:00pm Australian Eastern Standard Time (AEST) on Thursday, 26 September 2013. All applications must be submitted by the program closing time.

About the GRIIF Program

The GRIIF Program gives effect to an announcement by the Australian and Victorian Governments on 23May2013 to provide funding support to those regions affected by Ford Australia’s announcement that it will cease its vehicle and engine manufacturing operations in Australia from October 2016.

The GRIIF competitive grants program will support investment by businesses leading directly to new sustainable jobs in the Geelong regionto assist the region to diversify its economic base. Eligible projects will focus on encouraging new investment to create new or additional business capacity that results in sustainable jobs. The Geelong region is defined as the five Local Government Areas of Greater Geelong, Queenscliffe, Surf Coast, Colac-Otway and Golden Plains.

Privacy and confidentiality

Applications will be treated as ‘commercial-in-confidence’ but applicants should note that the application will be reviewed by both the Australian and Victorian governments.

Applicants should note that AusIndustry may disclose any information to Australian Government or State agencies for law enforcement or audit purposes. AusIndustry and the Victorian Government Department of State Development, Business and Innovation may also disclose information with the consent of the applicant.

Completing an application

Information on GRIIF is available in the GRIIFGuide for Applicants. Applicants should familiarise themselves with the Guide for Applicants prior to completing this application. An AusIndustryrepresentative can help explain program requirements (contact the AusIndustry hotline on 13 28 46). When completing an application, applicants are advised to be factual and concise in all responses.

To be eligible for consideration under Round 1, completed GRIIF applications on the AusIndustry application form with attachments must be received electronicallyby 5:00pm AESTThursday, 26 September 2013either by e-mail on a CD posted to the following address:

Geelong Region Innovation & Investment Fund
AusIndustry

GPO Box 85
MELBOURNE Vic 3001

An unbound, signed hard copy of your application and attachments must also be received at the above address within 3 business days of the electronic submission.

Eligibility Check

Please make sure you meet the following eligibility criteria.

Are you a nontax exempt, Australian incorporated entity:

• with an ABN;
• that is registered for the Goods and Services Tax; and
• able to issue tax invoices?

/ YesNo
YesNo
YesNo
Can you demonstrate that your project:

• involves at least $100,000 in eligible expenditure (see GRIIF Guide for Applicants, Section 6.3 & 6.4);
• will generate sustainable new jobs in the Geelong region and not involve the movement of business activity from other areas of Australia to the Geelong region; and
• if there are any activities to be continued after the project completion date, these can be undertaken without any further grant funding.

/ YesNo
YesNo
YesNo
Can you demonstrate that you:

• can fund the costs of your project which are additional to the government grant funding sought;and
• have access to, or the beneficial use of, any intellectual property necessary to carry out and commercialise the project?

/ YesNo
YesNo
If your application is successful and a GRIIF funding agreement is executed with your eligible entity (being the company that is applying for the GRIIF grant), you understand that you must:

• currently be, and continue to be for the life of the grant, engaged in trading or financial activities that form a substantial or significant proportion of the applicant company’s overall current activities; and
• acquire and own any plant and equipment covered by the funding agreement and that these items must be capitalised in your own accounts.

/ YesNo
YesNo

If you have not answered yes to all of the questions above, you are not eligible to apply for the GRIIF. For further details please consult the GRIIF Guide for Applicantsor contact .

Part A - Applicant Details

A1Name of applicant

Note: For applicant eligibility requirements refer to Section 6 of the GRIIFGuide for Applicants. If your application is successful, this is whom the Government will execute the funding agreement.

Registered business name:
Trading name (if trading under a name other than the registered business name):

Is the applicant applying as a trustee* on behalf of a trust?YesNo

If ‘Yes’, please also complete Section A4

* The trustee must be incorporated to be eligible to apply.

Is the applicant part of a group?YesNo

If ‘Yes’, please also complete group financial information in Section A8

Applicant business street address (Head Office):

Address / Suburb/town / State/TerritoryACTNSWNTQLDSATASVICWA
Postcode

Is your mailing address the same as the Head Office address above?YesNo

If ‘No’, please provide the mailing address below:

Address / Suburb/town / State/TerritoryACTNSWNTQLDSATASVICWA
Postcode

Is the project street address (where project activities will be undertaken) the same as the Head Office address? Yes No

If ‘No’, please provide the project street address below:

Address / Suburb/town / StateVictoria
Postcode

Please check the box for the Local Government Area* where the proposed project activities will be undertaken:

Greater Geelong:

Surf Coast:

Golden Plains:

Queenscliffe:

Colac-Otway:

* Refer to GRIIF Guide for Applicants, Appendix 2 for a map of the Geelong Region

A2Applicant businessregistrations

To be eligible to apply for funding, an applicant must be incorporated and registered for GST.

Note: ABN and ACN must both belong to the same entity.

Australian Business Number
(ABN) / Australian Company Number
(ACN) / Date of Incorporation
(dd/mm/yyyy)

A3Related bodies corporate

Do you, or will you, have any related bodies corporate?YesNo

If yes, provide details of your ultimate holding company:

Legal name:
Country of Incorporation:

Please attach a diagram of your company group to the application. This diagram must show the name and country of incorporation of each body, the relationships and the relative shareholdings within the group.

A4Trustee applying on behalf of a trust (where applicable)

Name of trust:
ABN used by the applicant in its role as trustee* for the trust:
ACN of the trustee for the trust:

*The trustee must be incorporated to be eligible to apply.

* A copy of the Deed of Trust must be provided.

A5Primary contact details for this application

Title: / MrMrsMsDrAssoc. ProfProfOther
Full Name:
Mailing Address (if different from company):
Suburb/town:
State/territory: / ACTNSWNTQLDSATASVICWA / Postcode:
Telephone number:
Mobile telephone number:
E-mail address:
Company web address:

Is the applicant the contact’s employer?YesNo

If ‘No’, please describe the contact's relationship to the applicant
If ‘Yes’, please provide theposition in applicant company:

A6Applicant organisation background

What is the core business of your organisation?

• Describe your product or service?
• Who are your major customers?

Do you have a business plan?YesNo
If ‘Yes’, please attach the business plan to the application.

ANZSIC Code* for the applicant company’s core business:
ANZSIC Code for the proposed project activities:

* Refer ANZSIC Class Codes 2006 listing on the AusIndustry website (

A7Applicant financial information

Please complete the following table.

Note: The information provided must agree with the financial statements provided by the applicant.

Recent Trading Performance / FY 2010/11 / FY 2011/12 / FY 2012/13
Sales Revenue / $ / $ / $
Export Revenue / $ / $ / $
Taxable Income / $ / $ / $
Current Assets / $ / $ / $
Total Assets / $ / $ / $
Current Liabilities / $ / $ / $
Total Liabilities / $ / $ / $
Net Assets / $ / $ / $
Number of Employees (including working proprietors and salaried directors)
Number of Independent Contractors
Full Time Equivalent Staff (FTE) *
Salaries / $ / $ / $
R&D Expenditure / $ / $ / $
What is the end date for the applicant’s 2012/13 financial year? (dd/mm/yyyy)

Company Group financial information

If you are part of a group, please complete the following table for the group and provide a diagram of the group structure (see Part D for list of attachments required).

Note: The information provided must agree with the group financial statements provided.

Recent Trading Performance / FY 2010/11 / FY 2011/12 / FY 2012/13
Sales Revenue / $ / $ / $
Export Revenue / $ / $ / $
Taxable Income / $ / $ / $
Current Assets / $ / $ / $
Total Assets / $ / $ / $
Current Liabilities / $ / $ / $
Total Liabilities / $ / $ / $
Net Assets / $ / $ / $
FTEs*
Salaries / $ / $ / $

*Note: FTE is measure of the total level of staff resources used. The FTE of a full-time staff member (e.g. 37.5 hours per week) is equal to 1.0. The calculation of FTE for part-time staff is based on the proportion of time worked compared to that worked by full-time staff. For example, a staff member working 2 days per week, at 7.5 hours per day, is equivalent to 0.4 FTE.

Part B - Project Details

B1Project Title (maximum 10 words)

Note: Please provide a straightforward concise project title, not a descriptive sentence, suitable for publicity purposes. If the application is successful, this title may be used by the Australian and Victorian Governments in published material.

Project Summary (maximum 50 words)

Note: Please include what the project ultimately intends to achieve. If the application is successful, this summary may be used by the Australian and Victorian governments in published material.

B2Overview of the Investment Proposal

Provide a description of the investment proposal you wish to undertake with the assistance of GRIIF grant funding. Include:

• Key activities (eg a new product/process/service, purchase of new equipment etc).
• Expected outcomes (eg expanded business, new product/service, increased employment etc).
• What is the demand for your proposed project (product/service) from the target market?
• Outline any identified risks associated with your project.
• Outline the research that has been undertaken to support your claims of projected demand.

Approvals

Does your project require any approvals?YesNo

If ‘Yes’, please advise of the required approvals and their status (eg planning, LGA):

B3Number ofongoing FTE jobs expected to be created by your project

Note: If the application is successful, this summary may be used by the Australian and Victorian governments in published material.

Expected increase in ongoing FTEs at project conclusion:

B4Project Timeline

Please provide the proposed start and end dates for your project.

Note: Grant funding is available for project activities up to 30 June 2016. No project activities will be funded prior to the execution of a funding agreement with the Government.

Start date (mm/yy): / End date (mm/yy):

B5Project Milestones and Major Activities

Please outline the applicant’s key milestones and describe the major activities to be undertaken to achieve each milestone. Please ensure that the start date of Milestone 1 and the end date of the last Milestone match the start and end date as stated in B4 of the application.

Note:Additional rows automatically appear when you hit 'Tab' at the end of that last row of table

Key Milestones and Related Major Activities / Start Date
(mm/yy) / End Date
(mm/yy) / Estimated expenditure
(GST Exclusive)
Milestone 1:
Outcomes: / $
Milestone 2:
Outcomes: / $
Milestone 3:
Outcomes: / $
Milestone 4:
Outcomes: / $
Total expenditure for project / $

B6Other government assistance

Has the applicant received or applied for any Commonwealth/State government assistance (including the R&D Tax Incentive/Concession) in the last 5 financial years?

YesNo

If ‘Yes’, provide details of the source, timing and amount of other government assistance (include current applications, grants received and unsuccessful applications):

Note:Additional rows automatically appear when you hit 'Tab' at the end of that last row of table

Assistance source (program and agency) / From
(mm/yy) / To
(mm/yy) / Amount / P (pending)
S (successful)
U (unsuccessful)
$ / PSU
$ / PSU
$ / PSU

B7Grant amount sought

Please note that the minimum grant size is $50,000 GST Exclusive and the applicant’s contribution must be at least equal to the grant amount sought.

Note: Applicants must attach evidence of ability to fund applicant’s share of project cost (refer to instructions in Appendix A).

A. Applicant’s contribution (GST Exclusive) / $
B. Grant amount sought (GST Exclusive) / $
C. Other funding (if relevant) *(GST Exclusive) / $
D. Total expenditure for project (A+B+C) (GST Exclusive) / $0

Whilst grants will be up to 50% of eligible expenditure, applicant projects that demonstrate a higher level of investment in relation to the grant sought will be favoured.

*C. Other funding

Please provide a breakdown of other funding sources (GST Exclusive)

Note:Additional rows automatically appear when you hit 'Tab' at the end of that last row of table

$
$
$
Total other funding / $

B8Project budget

a)Please complete the table below detailing the total costs and key activities of the project across the relevant financial years.

Refer to GRIIF Guide for Applicants, Section 6.3 and 6.4 for detailed information on eligible expenditure.

Expenditure type
(GST Exclusive) / FY 2013/14 / FY 2014/15 / FY 2015/16 / Total Project Costs
Eligible expenditure / $ / $ / $ / $0
Ineligible expenditure / $ / $ / $ / $0
Total FY expenditure for project / $0 / $0 / $0 / $0

b)Provide a breakdown of eligible new machinery and/or equipment costs:

Note: Additional rows automatically appear when you hit 'Tab' at end of last row of table

Plant item / What will it be used for in the project? / Estimated Cost ($)
(GST Exclusive) / Expected procurement date
(mm/yy)
$
$

c) Provide a breakdown of construction or fit-out of a new building or extension to premises cost:

Note: Additional rows automatically appear when you hit 'Tab' at end of last row of table

Building item / What will it be used for in the project? / Estimated Cost ($)
(GST Exclusive) / Expected procurement date
(mm/yy)
$
$

d)Provide a breakdown of project management and direct labour costs:

Note:

• Generally these expenses would be no more than 5% of a project’s total value. Please refer to the GRIIF Guide for Applicants, Section 6.3 for further explanation
• Additional rows automatically appear when you hit 'Tab' at end of last row of table

Position title / Role in project / Anticipated annual salary / Anticipated Start date
(mm/yy) / Anticipated End date
(mm/yy) / Estimated eligible salary cost
$ / $
$ / $

e)Provide a breakdown of ineligible other costs:

Expenditure item / What will it be used for in the project? / Estimated project cost(GST Exclusive)
$
$

B9Project Forecasts

Note: these forecasts should reflect the project outcomes only and not the wider entity.

Financial Year / 2013/2014 / 2014/2015 / 2015/2016 / 2016/2017 / 2017/18
Estimated Sales Revenue / $ / $ / $ / $ / $
Estimated ExportRevenue / $ / $ / $ / $ / $
Estimated project Taxable Income / $ / $ / $ / $ / $
Depreciation of the project’s assets / $ / $ / $ / $ / $
Full Time Equivalent Staff (FTE)*
Salaries / $ / $ / $ / $ / $

Outline key assumptions behind the project forecasts.

Group Sales / Profit Projections (if applicable)

Note: these forecasts should reflect the entire group as consolidated amounts and not just the
applicant entity.

Financial Year / 2013/2014 / 2014/2015 / 2015/2016 / 2016/2017 / 2017/18
Estimated Sales Revenue / $ / $ / $ / $ / $
Estimated Export Revenue / $ / $ / $ / $ / $
Estimated project Taxable Income / $ / $ / $ / $ / $
Depreciation of the project’s assets / $ / $ / $ / $ / $
Full Time Equivalent Staff (FTE)*
Salaries / $ / $ / $ / $ / $

B10Project impacts

a)How will the project contribute to the company’s growth?

b)How will the project contribute to the company’s competitiveness?

Part C - Assessment Criteria

Provide information detailing how your project meets each of the assessment criteria.

Note: For each criterion you must address each of the points under the criterion description. Your response to Part C should be no more than 15 pages in total.

C1The level of net economic benefit that your proposed project will bring to the Geelong Region including:

Number of sustainable, new FTE jobs created through the project.

• The number, type and timeline for the creation of the new jobs. Include estimated or average salaries for new positions (refer to data provided in B1).
• Where will the workforce for the project be sourced?
• Does there exist potential for your project to provide new job opportunities for ex Ford/automotive supply chainworkers?
• The employment impact on other businesses.
• Estimate of indirect ongoing FTE jobs resulting from the project benefit.
• Estimate of expected FTE jobs during construction/preparation phase.
• The contribution of the project towards the diversification of the region’s economy and the extent of new innovation, including new technology.
• A new economic activity, an expansion of an existing activity or diversification of existing businesses.
• Describe the input and output impacts on your supply chain, including where the inputs for the investment proposal will be sourced.
• The generation of further investment.
• Trade impacts on other businesses in the Geelong Region (including competitors).
• The extent to which the project will service market inside/outside Geelong

C2The demonstrated capacity of the applicant(s) to successfully undertake the project outlining the skills, experience and resources to which you will have access.

• Details of management experience required for the project, including the applicant’s track record, or if outside prior business activities, outline the expertise and capabilities to successfully implement the new project.
• Details of the technologies involved in the investment proposal should be provided. Was the applicant involved in the development of these technologies?
• Has the applicant accessed customers and sourced distributors or relevant supply chains relating to the investment proposal?

C3The demonstrated capacity of the applicant to provide matching funding for the project.

• An explanation of how the investment proposal will be funded.
• The level of funds likely to be generated from each source.
• The type of funding (e.g. debt and/or equity) must be provided.

Has private sector funding for the investment proposal been secured or evidence of significant progress in negotiations for funding should be provided, including details of any special conditions applying to the provision of funding

Note: Applicants must attach evidence of ability to fund applicant’s share of project cost (refer to instructions in Appendix A).

Recommended additional evidence may include:

• for internal funding sources - cash flow forecasts, evidence of existing sales pipelines and/or sales contracts; and
• forexternal funding sources such as equity investments or loans - evidence of the commitment and capacity from the investor or finance provider.