Priority Industry Capability Innovation Program

(PIC IP)

Grant Application Form

(Round Two, Version 1.0)

Deadline for applications: 2pm, 7December2012 (AEDT)

No late applications will be accepted

Introduction

The purpose of this form is to:

assess the eligibility of your company and project, for a PIC IP grant;
assess the relative level of merit of the project against the program’s merit criteria;
ensure appropriate evidence is provided to support the application; and
determine the level of financial support that may be offered, if successful.

The form has sixparts, plus one appendix:

Part A.Company Details

Part B. Project Details

Part C.Merit Criteria

Part D.Compliance with General Funding Conditions

Part E.Declaration by Applicant

Part F.Attachments to the Application

Appendix A Project and Commercialisation Plan including: (1) Budget Calculator

(2) Project Summary

(3) Projected Sales Summary

Please check your eligibility against the criteria in the PIC IP Program Guidelines, and Applicant Guidelines, available at before you complete this Application Form.

NB.If you are wishing to apply for funding for more than one project,please complete a separate Application Form for each project.

If you require any assistance filling out this form, please call the Defence Materiel Organisation (DMO) Industry Programs hotline on 1800 651 292.

Instructions for the completion of the PIC IP Grant Application Form

Guidelines for word processing

Required format

Questions on the Application Form must be either answered or markednot applicable.
The Application must be completed in full. It is not acceptable to refer to documents not supplied with the Application in lieu of answering the questions in full.

Submission

Applications must be submitted electronically to .

If concerns exist regarding the sending of confidential or classified documents via email, please contact a Program Advisor by no later than Tuesday 27 November 2012 to discuss alternate submission methods.

PIC IP Advisors

For any questions regarding the program, or completing the Application Form, contact the Defence Materiel Organisation (DMO) Industry Programs hotline on 1800 651 292.

Word processing

The information in the Application Form is presented as a series of tables, and the input areas where applicant’s type are table cells. The table will expand as you type into each cell. You are able to view the layout of the table by ensuring that the paragraph markers are on (Tools Options  Non-Printing Characters All).

Ensure the font used to answer the question is Arial size 10.

Page formatting

Do not delete ‘Page Break’ and ‘Section Break’ breaks. Do not remove headers and footers, or other information. Margins should not be altered. Removing these breaks or changing the margins will affect the formatting of the Application Form.

Substantiating evidence

The responsibility for providing substantiating evidence within the required timeframe lies with the Applicant and not with anyone else (for example, a contractor).

General Information for Applicants

Guidelines on the grant

Applicants should complete thisApplication Form in conjunction with the PIC IP Applicant Guidelines (available at the PIC IP website -

Multiple projects

Companies are not limited in how many projects they put forward, however a separate Application Form must be completed for each project.

Contacts

Potential Applicants that want to discuss their project prior to completing an Application Form should contact the Industry Programs hotline on 1800 651 292.

Assessment

Please allow at least three months for the assessment process to be completed.

Round Two Application Form – v1.0 (Oct, 2012)

Part A. Company Details

Please refer to Section 4 of the Applicant Guidelines for guidance on completing this section

A1. / Registered Company Name
Trading Name(s)
ABN / ACN / (If applicable)
Country of incorporation / (If applicable)
Exit Point 1:
Only Companies with an Australian Business Number (ABN) and based in Australia are eligible for PIC IP funding.
A2. / Business Address / Address Line 1
Address Line 2
Suburb
State
Postcode
A3. / Postal Address / Same as business address? / Yes / No (delete incorrect response)
If no, please enter postal details below.
Address Line 1
Address Line 2
Suburb
State
Postcode
A4. / Company Website
A5. / Company general email address
A6. / Current Full Time Equivalent (FTE) staff level / Please provide your company’s current FTE employee number
A7. / Company contact nominated to receive correspondence regarding this application / Name
Position
Phone
Fax
Mobile
Email Address
A8. / Do you have any related corporate entities? / Yes / No (delete incorrect response)
If yes, please provide details below
Entity Name / ABN / Relationship / Will they be involved in the project?
Yes / No
Yes / No
Yes / No
A9. / Please briefly describe your company’s core business and corporate strategy(Maximum 200 words)
A10. / How many years has your company been trading?
A11. / Is your firm solvent? / Yes / No
A12. / Can you confirm that there are no judicial decisions pending against your company relating to employee entitlements, for which the claim has not yet been paid? / Yes / No
A13. / Is your company compliant with all laws, including without limitation, Equal Opportunity for Women in the Workplace Act 1999 (C’wth)? / Yes / No
A14. / By the time the project commences will your company have ownership of, access to, or the beneficial use of, any background or third party intellectual property necessary to undertake the project? / Yes / No
A15. / (a) / Are you willing and able to match the requested funding on a dollar for dollar basis? / Yes / No
(b) / If you answered yes to A15(a), please provide copies of your financial statements from the previous three financial years, and a cash flow statement for the Year-to-Date. / Attached
Exit Point 2.
If you answered NO to any of the Questions A11 – A15 you are not eligible for PIC IP funding at this time.

Round Two Application Form – v1.0 (Oct, 2012)

A16.(a) / Has your company applied for, or received, any other government assistance (Federal, State, Territory or Local) in relation to the project?
This includes Capability Technology Demonstrator (CTD), Tailored Advisory Service (TAS) grants, Commercialisation Australia, New Air Combat Capability-Industry Support Program funding and any other direct support, tax offsets, apprenticeship support, and other monetary or non monetary support that will be utilised for the development of this project. / Yes/No
A16.(b) / If you answered Yes to A16(a), please provide the details of the funding you are receiving or have applied for in the table below.
Name of Funding Program / Funding Source
(Agency) / Total Funding Value / Was Funding Awarded?
(Yes / No) / Period or Date received / What is/was the funding for? / What is the relationship between the funding and the proposed project?
Capability Technology Demonstrator / Defence Materiel Organisation / $2.3m / Yes / 1/1/2010-30/6/2013 / The development of a working prototype system / Funds are being used to employ staff who will be transferred to the commercialisation portion of the project on completion of CTD.

Round Two Application Form – v1.0 (Oct, 2012)

A17. / To be eligible for PIC IP funding, a company must demonstrate that it supports an Australian defence contract or subcontract, or that it has the technical and corporate capacity to support a defence capability publicly foreshadowed for tender in the Defence Capability Plan.
A17(a) / Provide the details of any Defence contract or subcontract your company currently holds, or has completed in the past three years.
Contract or Project Name / DCP Project Number / Prime Contractor / Defence SPO / Scope of work undertaken/anticipated within the Contract / Expected date for contract completion / Does your project relate to this contract?
Yes / No
A17(b) / Provide the details of any Defence contracts and/or subcontracts foreshadowed in the current public Defence Capability Plan that your company intends to tender for.
Contract or Project Name / DCP Project Number / Prime Contractor / Defence SPO / Scope of work undertaken/anticipated within the Contract / Expected date for contract completion / Does your project relate to this contract?
Yes / No
A17(c) / Provide evidence that your company has the corporate and technical capacity to tender for the contracts listed in Question A17(b). (maximum 300 word)
Exit Point 3. If your company does not currently support a contract with the Australian Defence Organisation or, cannot demonstrate its ability to support one in the future, it is not eligible for funding under this Program.

Round Two Application Form – v1.0 (Oct, 2012)

PartB.Project Details

Please refer to Section 5 of the Applicant Guidelines for guidance on completing this section

B1 / Project Title (Maximum 10 words)
(Provide a title that would be suitable for publicity purposes)
B2. / Project Summary for Publication Purposes(Maximum 100 words)
(If your application is successful, this summary may be used by the Commonwealth for promotional and reporting purposes including the public announcement of the awarding of the grant)
All Applications must include a Project Plan and Commercialisation Plan that meets the minimum requirements set out in Appendix A. If the minimum requirements are not met, the Application will not be considered eligible for funding.
B3. / Have you developed a Project Plan and Commercialisation Planthat meets the requirements set out in Appendix A? / Yes / No
B4. / Project Description and Planned Outcomes. Please provide, under the sub-headings, an outline of the project for which you are seeking PIC IP support.
a) Outline the aim of theproject (Maximum 200 words)
b) Describe the intended project outcome (Maximum 200 words)
What will be the outcome if the project is implemented successfully?
c) Describe the Key Activities (Maximum 200 words)
(What are the key milestones and activities of the project?)
B5. / What is the primary location where the project work will be undertaken? / Same as Business address
Address 1
Address 2
Suburb
State
Postcode
B6. / What is the primary location where the product/service will be produced and delivered? / Same as above
Same as Business address
Address 1
Address 2
Suburb
State
Postcode
NB. If multiple locations will be used for the development or production of the project output, these should be identified in the Project Plan.
B7. / Which PIC(s) do you identify your project contributing to?
See the PIC fact sheet, available on the PIC IP website, for details on each PIC.
Acoustic technologies and systems / Anti-tampering capabilities
Combat uniform and personal equipment / Infantry weapons and remote weapon stations
‘High end’ system and ‘system of systems’ integration / High frequency phased array radar
Electronic Warfare / In-service support of Collins-class submarine combat systems
Selected ballistic munitions and explosives / Signature Management
Ship dry-docking and common-user facilities / Through-life and real time support of mission-critical and safety critical software
B8. / Howwill your project contribute to the PIC(s) selected in Question B7?
Introduction of a new technology/system which will improve a PIC
Diversification of existing technology/equipment relating to a PIC from one domain (land/maritime/air) to another or across industry sectors (commercial/defence)
Commercialisation of applied research to a PIC
Enhancement of the ability to sustain or upgrade a PIC
Exit Point 4. If your project is not contributing to one or more of the PICs, it is not eligible for funding under this Program.
B9. / To be eligible for PICIP funding, an applicant must provide evidence to demonstrate that their project has reached a Readiness Level 5 or above (see Section 5.3.2 of the Applicant Guidelines).
Please indicate below what level you believe your project has reached.
Readiness Level / Description
9 / Technology or system has been successfully used in its final form under operational conditions
8 / Technology or system is in its final form and has been successfully tested under expected operational conditions.
7 / Prototype of the technology or system, in near operational form, has been successfully tested in an operational environment.
6 / Representative model or prototype successfully tested in a relevant environment; such as simulated field conditions
5 / A breadboard (or above) of the system or technology has been demonstrated to work in a laboratory environment; including integration with realistic support systems; OR
An identical system/unit is operating successfully in a different system/operating environment.
MANDATORY DOCUMENTATION: Please provide evidence with your application to allow the Defence Science and Technology Organisation to verify your Readiness Level claim. Such evidence should include successful test results, evaluation reports or operational feedback.
Suitable supporting documentation has been provided with your application / Yes / No
Exit Point 5. If you cannot demonstrate that your project has reached a Readiness Level 5 or greater it is not eligible for funding under this Program.

PartC.Merit Assessment

The Project and Commercialisation Plan(s) should be developed before completing this part of the Application Form (refer to Appendix A).

Please refer to Section 6 of the Applicant Guidelines for guidance on completing this section.

C1. Strategic Benefit

C1(a) / Explain how the project will provide a strategic benefit to Defence and the Australian defence industry? What capability improvements, efficiencies, competitive advantage or new industry would be gained through this project?
(Maximum 1000 words)
C1(b) / What operational need(s) or future capability requirement(s) does your project align with? Please identify any Defence Capability Plan projects that your project could tender for.
(Maximum 400 words)

C2. Innovation

C2(a) / Detail how your project output is innovative, when compared to the current products in the market, or known competitors.
(Maximum 500 words)
C2(b) / Explain how this project will provide additional support or improve one or more of the Priority Industry Capabilities over currently available technologies, products or systems?
(Maximum 500 words)

C3. Commercial, Exports and Market Development

C3(a) / Based on your market research, describe what markets you intend to target and why. What are your expected sales for each market and in total?
(Maximum 600 words)
Applicants should consider domestic and international commercial and military markets
C3(b) / What competitive advantage will your product have over other products within the market place?
(Maximum 400 words)
C3(c) / Explain the impact the project may have on your company’s current market position. Will the project diversify your company’s current market base, or is it developing a new or upgraded system/product within the company’s current market footprint?
(Maximum 400 words)

C4. Management Capability

All Applications must include a Project Plan and Commercialisation Plan that meet the minimum requirements set out in Appendix A. If the minimum requirements are not met, the Application may not be considered eligible for funding.
When responding to the below questions, if relevant information can be found in these Plans provide a brief summary in your response and include a reference to the relevant section of the plan.
C4(a) / Describe how this project aligns with you company’s core business activities as outlined in Question A9.
(Maximum 200 words)
C4(b) / Explain what skills and experience the project’s key personnel have and how they will benefit the project’s delivery.
(Maximum 350 words)
Who are the key members of the project team? What is their experience in managing similar projects in terms of value and scope? Has your company handled similar projects in the past? What were the outcomes of these projects?
C4(c) / Explain how your project’s timeframes have been developed.
(Maximum 350 words)
What has been taken into account when developing the schedule for this project e.g the development and technology lifecycles?
C4(d) / Describe the key risks associated with this project. How does your company intend to mitigate these risks?
(Maximum 350 words)

C5. Value for Money

C5(a) / What are the key costs associated with this project?
(Maximum 250 words)
C5(b) / What are the benefits that will be realised as a result of this project? Consider how the product differs from others on the market,and the potential gains and/or savingsto Defence and defence industry.
(Maximum 350 words)
C5(c) / Describe how your company will fund its share of project costs, taking into account the eligible expenditure and any additional ineligible costs involved in undertaking the project.
(Maximum 350 words)

Round Two Application Form – v1.0 (Oct, 2012)

PartD. Compliance with General Funding Conditions

NB: / The Commonwealth’s position is to use an unaltered version of the Sample Funding Agreement to formalise any grant under the PIC IP. However, the Commonwealth may be willing to consider minor changes to the Funding Agreement where there is a justifiable reason for doing so.
D1. / Should you be successful in your application, do you agree to the terms and conditions outlined in the Sample Funding Agreement (Round Two)? / Yes / No
D2. / If no, please indicate the specific clauses that you wish to alter, and propose alternate wording:
Clause No. / Comments or justification / Proposed new wording
D3. / Provide a preferred timing for the reports required in Schedule 3 of the Sample Funding Agreement. (NB. Final timing of reports will be at the Commonwealth's discretion).
At a minimum grant recipients will be required to submitan Annual Financial Report and two progress reports each financial year. Additionally, grant recipients must also provide a Final Report at the conclusion of the Project.
Report Type / Report Due Date / Reporting Period
Annual Financial Report / 60 Business Days after the end of the Applicants Financial Year. Clause 6.4(b) of the Funding Agreement.
Progress Report
Progress Report
Add or remove rows as required
Final Report
D4. / Propose any information you would like to be considered for inclusion at Item 12 (Confidential Information) of Schedule1of the Funding Agreement.
Item of Information / Reason for Confidentiality / Period of Confidentiality

PartE. Applicant Declaration

NB: / All Applicants must sign this declaration and attach a scanned copy of the signed declaration to their Application. Failure to sign the declaration will result in your Application being considered incomplete and ineligible for funding.
The declaration must be made by the Applicant’s CEO or Managing Director. By signing this form you are agreeing to the terms and conditions of this declaration.
E1. / By submitting this Application, the Applicant acknowledges and agrees:

that the Applicant has read and understood the Program Guidelines and Applicant Guidelines.
to the Commonwealth’s rights in the Program Guidelines and Applicant Guidelines.
that Applications are prepared in accordance with the Program Guidelines and Applicant Guidelines and are accurate, complete and not misleading.
that the Commonwealth may request further clarification and documentation to verify the information supplied in this form and that the Commonwealth may during the application process consult with other Commonwealth agencies about the Applicant’s claims and may also enlist technical or financial advisers to provide advice on information provided in the Application.
that the Commonwealth can rely on the Applicant in accurately assessing compliance, risks and risk management options in accordance with the Program Guidelines.
that the grant will be subject to acceptance of the terms and conditions of the Funding Agreement.
that the Applicant has the ability to fund in full the costs of the project not met by the Grant Funding.
that if an offer of financial assistance is made, there will be a limited period of 30 calendar days in which to negotiate and finalise a Funding Agreement.
that no legal obligations will arise between the parties until such time as a Funding Agreement is formally executed.
that the Commonwealth will act decisively on any instance of deliberate non-compliance with the Funding Agreement or of fraud and will prosecute to the full extent of law.
that representations made in the Application when incorporated in any resultant Funding Agreement, will be fully complied with by the Applicant.
that the Applicant has read and understood the terms and conditions of the Funding Agreement and that if the application is approved the Applicant must be registered for Goods and Services Tax purposes pursuant to the ANew Tax System (Goods and Services Tax) Act 1999 and must enter into an agreement with the Commonwealth before financial assistance is provided.
that the Applicant has no judicial decisions against it (excluding decisions under appeal) relating to unpaid employee entitlements where the entitlements remain unpaid.
that it is aware of Division 137 of the Criminal Code and that its Application does not contain any false, misleading or deceptive misrepresentations, claims or statements.
that providing false or misleading information or the making of false or misleading statements to the Commonwealth can result in the Application being withdrawn or a subsequent Funding Agreement being terminated.

that this Application has been compiled without the improper assistance of employees or former employees of the Commonwealth, and without the use of information obtained unlawfully or in breach of an obligation of confidentiality to the Commonwealth.

Signature of person authorised to sign the Application on behalf of the Applicant:
Signature: / Date of Signature:
Name: / Position held:
Signature of witness:
Signature: / Name of witness:
Address of witness: