I.R.D. Duhallow CLG.

FundúireachtShéamaisUíChaoimh, ÁthTrasna, Co. Chorcaí, Éire, P51 C5YF.

James O’Keeffe Institute, Newmarket, Co. Cork, Ireland, P51 C5YF.

Guthán / Tel: (029) 60633 Facs / Fax: (029) 60694

Ríomhphost / email:

Láithreángréasáin / website:

Grant Application Form
Rural Development Programme
(LEADER) 2014-2020
NOTE: Please complete all sections of the application form, regardless of whether or not you are including supplementary information. Please use the Application Checklist provided to ensure you include all the required documentation with your application. Incomplete applications cannot be processed. Applications are not accepted unless previous communication has been entered into with the relevant Rural Development Officer. / Stamped as Received
SECTION A: PROMOTER’S/APPLICANT’S DETAILS
1. / NAME OF
PROMOTER/APPLICANT:
CONTACT PERSON:
TITLE/POSITION:
ADDRESS:
TELEPHONE: / FAX:
MOBILE: / EMAIL ADDRESS:
2. / Status of the Promoter Applicant (Please tick all that apply):
Farmer □ Sole Trader □
Formalised Community/Voluntary Group □ Trust □
Companies Limited by Guarantee □ Partnership □
Designated Activity Company Limited by Shares □ Private Individual □
Registered Charity □ Charity No: ______Public Body □
Community Council □ Limited Company □
Co-Operative society registered under the Industrial & Provident Societies Act □
Other □ (Please Specify) ______
3. / Is the Application being submitted by an individual? (if Yes, please complete the following information and attach a Curriculum Vitae) / Yes □
No □
Date of birth ______
4. / Tax Details
Are you VAT Registered? / Yes/No / If YES, VAT Number: ______
If NO, please attach letter of confirmation from Revenue.
Information Required to verify Tax Clearance Cert
Tax Reference No. ______Access No:______
5. / Promoter’s/Applicant’s Background including any significant achievements
6. / Type of Proposal: / Community Project □ New Enterprise □ Existing Enterprise □ Other □
If other, please explain:

COMMUNITY/CO-OP/OTHER GROUP – question 7-10

7. / When group was established:
8. / Promoter Committee Membership (if applicable)
Please list all your current Committee Members, along with their position and whether they are representing Community or Commercial interests.
Name: / Position: / Community(√) / Commercial(√) / Non-Commercial(√)
9. / Is your group registered with the Kerry Public Participation Network? / Yes □
No □
10. / Aims & Objective of Group:
SECTION B: PROPOSED PROJECT
11. / Please Provide background information for Proposed Project (Attach Plans/Specifications/Tenders etc. as appropriate)
12. / What are the specific aims of your project?
13. / Outline the benefits of your project to the wider community?
14. / Have you undertaken market research/other research appropriate to the project?
If Yes, please give details and outline your findings
If No, how have you identified the need for the proposed project? / Yes □
No □
15. / Will the project have any competitors? (if yes, please give details below) / Yes □
No □
16. / Will this project adversely affect or displace any of the above, or other similar businesses? / Yes □
No□
17. / What differentiates your product/service from theirs?
18. / What skills or expertise do you have which are relevant to the proposed project?
19. / What skills or expertise do you require to complete the proposed project?
20. / What is the nature of assistance sought?
Capital Expenditure □ Marketing □ Analysis&Development □ Training □ Co-Operation □
21. / Which Theme are you applying under? (please see guidelines and consult with your Rural Development Officer)
1.Rural Economic Development/Enterprise Development and Job Creation / Rural Tourism □
Enterprise Development □
Broadband □
Rural towns □
2. Social Inclusion through building community capacity training and animation / Basic Services targeted at hard to reach communities □
Rural Youth □
3. Rural Environment / Protection and sustainable use of water recourses □
Protection and improvement of local biodiversity □
The development of renewable energy □
22. / Project Location:
23. / Project Schedule
What date is the project due to begin:
What date will the project be completed by:
Number of Phases in the project:
24. / What geographical area will be covered by the Project’s product or service?
25. / If you are incorporating the use of land or premises in your Project Proposal, is it:
(please attach evidence of ownership or letter of intent to lease) / Owned □ Leased □
26. / Is planning permission needed for the completion of your project?
If YES, please attach full planning permission with your application
If NO, please attach confirmation from Local Authority / Yes □
No □
27. / Is this a Heritage Project?
If YES, please see additional guidelines / Yes □
No □
28. / Is Appropriate Assessment (for special areas of protection or conservation) or an Environmental Impact Assessment required for your project?
(If YES please attach) / Yes □
No □
29. / Are Statutory Approvals Required (e.g. HACCP, AIRE etc)
If Yes, please give details / Yes □
No □
30. / Please state why your project is innovative and why you think it should receive RDP funding:
31. / Does your project support the following? (Please give details)
Environment □ Climate Change □
32. / Is your project for the provision of Training?
If yes please provide the details requested below, and attach an outline of the training programme your group is proposing. / Yes □
No □
Please explain the reason why the Training is needed:
Numbers to be trained:
Course Title: / Course Provider:
Is the Course Accredited? (if YES, please provide details of Accreditation below) / Yes □
No □
Please note that all training courses supported by RDP LEADER funding must provide evidence of course participation and outcomes, including Participant Registrations, course registers and Evaluations. Please ask your Rural Development Officer if you require templates for these Documents.
33. / Is your proposed project Analysis and Development (i.e. feasibility study, product development etc.)
If YES, please provide the details below, and attach a terms of reference for the work your group is proposing. / Yes □
No □
SECTION C: FINANCIAL DATA
34. / Finances of the Promoter
Present Fund of the Promoter: / €
Annual Income/Turnover: / €
Please attach Audited Accounts for the past three years where available. If not available, please consult with your Rural Development Officer to agree an appropriate alternative, such as Financial Statements.
35. / Do you have any debts or liabilities outstanding (if YES, pleaselist) / Yes □
No □
36. / Please provide details of any grant aid or other supports previously received from other sources in the past three years(e.g. Local Enterprise Office, Enterprise Ireland, Fáilte Ireland, Board Bia, BIM, Teagasc, etc.)
Project/Propose / Source / Amount / Dates
37. / Have you received funding under the previous Rural Development Programme (LEADER) 2007-2013?
If YES, give details of project funded.
Give details of any penalties or issues that arose regarding the funded project over the 5 year contract period / Yes □
No □
38. / Are you a farmer or have you made an application the Single Payment Scheme (SPS)?
If YES, provide a copy of your most recent SPS application form and details of your:
-Herd number:
-Flock number:

-Cereal number:

-or other Department of Agriculture, Fisheries &
Food (DAFF) identifier number: / Yes □
No □
39. / If you are a farmer please complete the attached List of Agricultural De Minimis Scheme
40. / Have you ever had a penalty applied under any DAFF Scheme since 2000 e.g. Single Payment Scheme (SPS), Young Farmer Installation Aid (YFIA), Early Retirement Scheme (ERS), Farm waste Management Scheme (FWM), Scheme for Organics (ORG), Rural Environment Protection Scheme (REPS)?
Please note that this does not disqualify you from applying for RDP funding. / Yes □
No □
41. / Please complete the following table summarising the overall total project cost.
COST BREAKDOWN / Cost
(a) / CAPITAL (Incl. Equipment) / €
(b) / TRAINING / €
(c) / MARKETING / €
(d) / ANALYSIS & DEVELOPMENT / €
(e) / CO-OPERATION / €
OVERALL TOTAL
PROJECT COST / €
42. / What is the total cost of the Project?
How do you intend to finance it? Own Funds
Loan
Grant
Contribution-in kind
Other (Specify) / €
€
€
€
€
€
Total Grant Aid Requested / € / ____%(Rate of Aid)
43. / Is a Contribution-in-kind being used as part of the project?
IF yes, please complete the relevant forms which are available from your Rural Development Officer). (A Contribution-in-Kind must be certified by an appropriately qualified third party) / Yes □
No □
44. / Please outline any attempts you have made to source funding this project from other grant agencies: (Attach evidence where available)
45. / Have you sought/received aid from other sources in respect of this project? If YES, please provide details. / Yes □
No □
Source / Amount / Dates
€
€
€
SECTION D: PUBLICITY AND PERMORMANCE INDICATORS
Please note that when applying for LEADER RDP funding, details of the grant and the amount received will be published on the websites of the Department of Arts, Heritage, Regional, Rural and Gaeltacht affairs and Department of Agriculture, Food and the Marine and may also be published on the website and/in publications for IRD Duhallow Ltd.
In addition, SKDP is obliged to collect performance indicator data at application stage, payment stage and for a period of 5 years after the grant payment, and it is requirement of those receiving funding to co-operate with this process. Your assistance with this is greatly appreciated.
DE MINIMIS AID DECLARATION
The aid being sought is provided under the European Commission Regulation on De Minimis Aid. Small amounts of State aid up to 200,000 Euros in any three-year period to any one enterprise, are regarded as too small to significantly affect trade or competition in the common market. Such amounts are regarded as falling outside the category of state aid that is banned by the EC treaty and can be awarded without notification to or clearance by the European Commission. A Member State is required to have a mechanism to track such aid (called ‘De Minimis aid’) and to ensure that the combined amount of De Minimis aid payments from all sources to one enterprise in any three-year period respects the 200,000 ceiling Plus provide details of all other De Minimis aid which has been granted to your company within the past three years. It should be noted that a false declaration by a company resulting in the threshold of 200,000 Euros being exceeded could later give rise to the aid being recovered with interest.
I wish to apply for LEADER funding under the De Minimis Regulation (EC) 1407/2013 of 18 December 2013. I confirm that (name of Promoter______) has been granted only De Minimis aid within the past three years as stated in questions 36 and 37.
SECTION E: DECLARATION
46. / I/We hereby apply for Rural Development Programme (LEADER) 2014-2020 Assistance towards the cost of the project described above.
I/We hereby declare that the information contained herein is accurate and we understand that the provision of misleading or false information will automatically disqualify this application and that this project could not proceed without Rural Development Programme LEADER funding.
Signature:
Position:
Witness’ Signature:
Witness’ Position:
Date: