KIWINET PRESEEDTIER 1 CLAIM & OUTCOMES REPORT FORM

Instructions: Use this form to claim only for Tier 1 PreSeedproject expenses and summarise the outcomes of the Tier 1 project.
Date Form Submitted
Project Details
Project Name
(for filing purposes) / 2-4 word name for the project that will be used to identify the project (e.g. “Better mouse trap”)
Unique Project ID (if known) / (Issued by KiwiNet or ROS IC)
Project Title / 1 short sentence describing the project (e.g. A novel mouse trap design that re-arms itself after trapping a mouse.)
Lead organisation
Principal researchers and ORCID ID / Please include the ORCID ID of the principal researcher(s) where available (see orcid.org)
Research Funding History / Provide any details of research grants that have contributed to the technology or IP
Commercialisation leader / Name:
Phone:
Email:
PreSeed Funding Details – CONFIDENTIAL
PreSeed funding history / Has PreSeed been used to fund development or commercialisation of this technology prior to the start date below? If so, please explain briefly.
PreSeed Eligible Project? (yes/no) / Yes/No – please refer to MBIE guidelines on KiwiNet website.
PreSeed Investment Start date / The date expenses start (from when PreSeed will be claimed). This date must be no earlier than 1 month before the completed notification form is submitted to KiwiNet
PreSeed Investment End date / The date when PreSeed funding for the project will end. For Tier 1 projects this must not be greater than 6 months after the start date unless prior approved by the KiwiNet Investment Committee.
Total Project Budget / Estimated total budget including PreSeed investment, research organisation contributions and co-investment from industry.
PreSeed Investment Budget / PreSeed investment required. Up to 50% of total eligible project costs up to $25k. Upon receiving the notification, KiwiNet will allocate PreSeed funding for this project provided sufficient funds are available.
PreSeed Project objectives / A brief summary of the intended project outcomes from Tier 1 funding. The overall goal may be “Investor Ready achieved” for a small project or Project Development Plan to be submitted for a Tier 2 PreSeed project. Please give also details on how the funding will be used, for example, legal fees.
Outcomes
Date completed
Project Status /
 / Project completed in Tier 1: (Select one of the below)
 / Commercial deal completed
 / Commercial deal in negotiation
 / Submitted to the Investment Committee for Tier 2 investment
 / Abandoned: (Select more than one option below if applicable)
 / Lack of technical feasibility (e.g. failed to demonstrate prototype)
 / Lack of commercial opportunity (e.g. failed to find commercial partner / market opportunity)
 / Lack of novelty (e.g. not patentable / product already exists elsewhere)
 / Other: (Please explain)
Project Outputs / Tier 1 investment used for: (Select more than one option if applicable)
 / Proof of principle or prototype developed
 / IP protection underway
 / Market validation
 / Other – Please list:
Summary / Provide a brief summary of the commercialisation outcomes to date
Project spend
Actual (exc. GST) / Comments
Internal Costs / $
External Costs / $
Total Project Costs / $
Total PreSeed Claim / $
% PreSeed Contribution / %

Project Outcomes to Date

Only fill in sections applicable to the project.

Inputs
PRO Investment / $
External Investment / $
Outcomes
Commercialisation Status / Active/Complete/ Abandoned
IP Protection Status / Please list details of any activity to protect intellectual property - for instance filing of provisional patents, patents granted, trademarks etc
Number of Companies Meaningfully Engaged / # / Briefly describe any 'meaningful' engagement with companies such as that leading to some form of legal agreement (e.g. an NDA), a site visit, a commercial partnership, an ongoing strategic relationship with the PRO
Number of Meaningful International Connections / # / Please give details
Start Up Company Formed? / Yes/No / Please give details
Tech Incubator Engagement? / Yes/No / Please give details
Number of Commercial Deals / # / Please list any deals that have resulted from the project to date. This could include licence, spin-out, sale etc.
Impact
Number of Individuals Gaining Commercial Experience / #
Number of Jobs Created (FTE) / # / To give an indication of jobs created within the PRO and wider economy, please provide the number of Full Time Equivalents (FTEs) currently working on the project. Where appropriate, please include numbers for individuals now employed in organisations outside of the PRO for instance in Start-up companies or, where possible, individuals employed by licensee organisations to implement the technology. Please also include information on PRO staff who continue to work on the project (NB: for active projects the information here will likely be the same as the information given in the previous field)
Wider Benefits to NZ / Please give details of any other non-economic benefits to NZ. Eg social, environmental, health and well-being, public policy, Vision Matauranga

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This document is Confidential to the KiwiNet Investment Committee (IC). No part of this document may be reproduced or transmitted in any form by any means (electronic, photocopying, recording or otherwise) without prior approval from KiwiNet.