Part-funded by the European Union

DIGITAL FILM LAB (RAVENSBOURNE DMIC)

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Professional Contact Details

In order to receive support from the European Regional Development Fund, please confirm the following, regarding your professional contact details and those of your company (where appropriate).

First Name:

Last Name:

Company Name:

Company Registration Number or Unique Tax Reference Number:

Company Address

Number & Street:

London Borough:

Post Code:

Telephone:

Email:

Company Website:

Company owner’s gender (please circle):

Male / Female

Doesthe company owner have a disability?(please circle)?

Yes / No

Attendee’s employment status:

a) Self employed / Freelancer / 
b) Employee of SME (1 - 249 employees) / 
c) Unemployed / 
d) Other / 

Part-funded by the European Union

Does the company have fewer than 250 employees (please circle)?

Part-funded by the European Union

Yes / No

Please specify exactly how many employees work in the company?

Sector (please circle):

Camera / DIT / Sound / Production / Post production/Animation

Photography / Other – please specify:

Ethnicity of thecompany owner/or freelancer:

White – British
White – Other / 
 / Asian or Asian British – Indian
Asian or Asian British– Pakistani / 
 / Black or black British– African / 
Mixed– white & black Caribbean
Mixed– white & black African / 
 / Asian or Asian British– Bangladeshi
Black or black British– Caribbean / 
 / Chinese
Other / 

Mixed – white & Asian / 

CONFIRMATION THAT ERDF ELIGIBILITY CRITERIA IS SATISFIED:

(tick below)

A)[Company] Based in London□

B) Registered freelancer or part of a small-medium company □

An SME is defined as a business that meets the following two conditions:

  • It employs fewer than 250 persons; □

and

  • its annual turnover is below €50m (approximately £45m) and/or its balance sheet is below €43m (approximately £39m). □
  • SME’s must confirm that they are not a subsidiary /under the control of larger non SME entity. □

C)'De Minimis aid' regulation abided by. □

Amount of public funding received over past 3 years does not exceed €200,000.

Previous Experience

Has your company engaged with Four Cornersbefore (please circle)?

Yes / No

(Have you participated (as far as you are aware) in an ERDF sponsored event in the last 3 years and received less than 500,000 Euros of support from ERDF in the last 3 years (please circle)?

Yes / No

Received information on the Ravensbourne Creative Industries Business Network (Lead project partner in Digital Film Lab) if so, please circle.

Yes / No

Beneficiary declaration

I declare the information given on this form is true to the best of my knowledge.

Signature

Date