APPLICATION FORM
1. How to complete
Please complete all sections of this form electronically except for the declaration at the end which you will need to print and sign. Incomplete applications will not be assessed. If you need to continue any section on additional pages or documents, please include the relevant question number from the application form on each additional page/document.
Please support your application with the specified appendices. Once you have completed your application, please use the Applicants’ Checklist to ensure you have included all additional documentation required to support your application.
Please note that should your application be successful, then this application form will constitute part of the funding agreement between your business and WRAP Cymru, once a formal condition of offer letter from WRAP Cymru has been co-signed.
2.How to submit
Once you have completed and signed this form please save the document and e-mail it along with allsupporting documentation to or by post to the address shown above.
- Need more information/guidance?
Should you have any questions or need assistance please contact a member of the team on 02920 100 100
- Business Information
Organisation name
Type of organisation
Registered address
Registration no (Where applicable)
Are you VAT registered? Yes/No / VAT Number
Web Address
Year you commenced operation
Annual turnover £
Number of employees in organisation
Organisation Type / Private enterprise Not for Profit Registered Charity
Other (Please describe)
Is your organisation owned or controlled by another company or through a joint Venture/Partnership? Please give details.
……….
1.2 Main Contact
Title of main contact Mr/Mrs etc
Main contact name
Main contacts position
Contact correspondence address
Office telephone
Mobile telephone
Email address
Project location if different to addresses above / Post Code:
2. In this section we require you to provide an overview of the activities and services your business currently undertakes and the geographic areas that you cover. Please provide as much detail as possible to fully inform the assessment panel.
2.1Please describe your main business activity, services, or products.
2.2Where are your current markets for your services/products? (e.g. Flintshire, South Wales, UK. Worldwide)
2.3 Please describe your current procedures for handling waste, collection options (private contractors or Local authority services) and disposal routes i.e. recycled, landfill, not sure.
Please include your associated annual costs for waste management and disposal.
2.4 How much waste do you currently dispose per annum (tonnes)
tonnes
2.5 What percentage of this waste is currently recycled ( you may need to ask your service provider)
%
3. In this section please tell us about the project you are proposing, what potential impact this will have on your business and how this fits with any wider business plans. In order to be considered you must meet the eligibility criteria detailed in the guidance document.
3.1 Please provide a summary (max 1000 words) of the project you propose to undertake, including the key materials to be considered i.e. food waste, cardboard packaging etc; and any changes you hope to achieve. Please explain how your project will
- Improve management of your waste, or
- Enhance the disposal of your waste
3.2 Is your proposed project ‘New’ to your business? Are there elements that you consider to be innovative, if so, please explain?
3.3 Why are you applying for support and how will this enable you to meet your own organisation’s objectives? How will the proposed project fit with your current business activities?
3.4 Do you consider your project could be easily replicated by others?
3.5 WRAP would like to share information about the benefits and outcomes that are achieved by the projects that we support in the public domain, so that others can learn about and implement such changes to their operations.
We understand that certain information/data maybe sensitive and confidential. We will only share information that Grants Recipients have reviewed and approved in the first instance. If however you are not prepared to share information, or would like to restrict information about your project from being shared, please provide details here:
Important: If your application for support is successful, it will be a condition of the grant to report monitoring information outputs and outcomes as result of the support received to WRAP on a regular basis. The answers to the following questions will form targets within the contract so please be realistic with the figures that you provide.
3.6 What is the cumulative tonnage of material that might be recycled rather than landfilled as a result of this project? if in Year 1 this would be 2 tonnes more than currently, year 1 = 2; if in year 2 you will use a FURTHER annual 2 tonnes, year 2 = 4 etc. (This should be shown for the three year period from the date of project start). Please state the material type (e.g. food, paper, glass, plastic, etc.)and tonnage per material type.
Materials type / Cumulative tonnages
Year 1
Year 2
Year 3
Total / Tonnes
3.7What is the cumulative tonnage of waste material that might be avoided as a result of this project? I.e. waste that is currently generated but could be reduced or avoided in future. Please state the material type (e.g. food, paper, glass, plastic, etc.)And tonnage per material type.
Materials type / Cumulative tonnages
Year 1
Year 2
Year 3
Total / Tonnes
3.8Please provide an indication of any cost savings£ that might be achieved as a result of the project for the next 3 years.
Year 1 / £
Year 2 / £
Year 3 / £
TOTAL / £
3.9 Are there any additional jobs to be created as result of this project? Please state any additional full and part time jobs created as a direct result of the project for the three year period from the date of operation.
YEAR 1 / YEAR 2 / YEAR 3
Full time (30+hours per week)
Part time (<30 hours per week)
4.1 Please provide a detailed breakdown of the project costs in the table below (attach a separate sheet if required) identifying which elements are to be funded by WRAP Cymru, which elements are to be match funded by your organisation and what the sources of match funding are. Please note the maximum grant contribution to the project cannot exceed 60% up to a maximum of £30,000
Item Description Here / Total Costs (exec VAT) / Amount you are match-funding / Method of match-funding (e.g. Internal funds) / WRAP Grant Contribution (exec VAT)
£ / £ / £
£ / £ / £
£ / £ / £
£ / £ / £
£ / £ / £
£ / £ / £
£ / £ / £
£ / £ / £
£ / £ / £
£ / £ / £
TOTAL / £ / £ / £
Please note: Grant funds are exclusive of VAT unless you are not VAT registered or are unable to reclaim VAT through HRMC. If you are unable to reclaim VAT please confirm this in the additional Information section below.
4.2 Please advise the status of your match-funding, have you secured this already? If not, please advise the timescales for securing this. Successful applicants must have secured match-funding in place prior to signing a funding agreement with WRAP.
4.3 We require applicants to demonstrate they have tested the market to ensure value for money has been considered. For items over £1,000 we recommend three formal quotes are obtained.
These must be professional quotes from businesses that can be verified. Please enclose copies of your quotations with your application.
From the quotes obtained, please list below the name of your preferred supplier. If you have not selected the cheapest supplier – please provide your justification for this below. If you have only provided one quote for a particular item, we will require you to provide your reasons for this. Please note, WRAP reserves the right to contact suppliers to verify cost information.
4.4 If you project includes mobile or moveable equipment such as a vehicle – are you intending to use it any other business activities outside of the remit of the project, if so, please provide details below. If your project will operate in areas outside of Wales, please also provide details below:
4.5 Are any of the items you listed above second hand/refurbished equipment, if so please provide details
5.1 In this section we would like to know thetimescales to complete the project and details of the key activities you aim achieve as your project progresses. Please detail the key milestones you plan to achieve during your project, e.g. order of equipment, delivery, installation etc.
Please note we decide to award, we may suggest some amendment to the milestones.
Activity Ref / Key Milestone Description / Target Date / Linked to grant payment £
(Completed By WRAP)
1 / £
2 / £
3 / £
4 / £
5 / £
TOTAL / £
5.2 WRAP is looking to support projects that will have longevity – what plans will you put in place to ensure this project is sustainable.
6. We need to ensure the projects we support comply with legal requirements, so you will be required to provide copies of relevant documents/policies to support your application.
6.1 Please include a copy of your Environmental Statement/Environmental Policy and details of your Environmental Management System.
Environmental Policy / Statement
Environmental Management System(s)
6.2 Does your organisation have any of the following in place that is required to cover your current activities
Waste Carriers licence
Waste Exemption or Permit
Planning
Other (Please specify below) Not Required for current activities
6.3 Will you need to apply for any of the above or any other legal document(s)in order to deliver the proposed project, if so what please advise the timescale for obtaining these?
6.4 Please provide a current H&S policy /statement in the appendices together with the names, titles and qualifications of the person or persons who act as your organisation’s competent Health and Safety advisor. Give details of any site accidents for the last 5 years and provide details of any prosecution(s) or caution(s) in respect of violations of Health and Safety legislation and regulations that your organisation has received in the last five years.
7.1 Please provide any additionalinformation that you feel will support or influence this application.
7. 2 Please note any added value/community benefits that may arise from the proposed activity.
Please set out below any potential conflicts of interest that might arise if selected to receive funding and give an indication of how this conflict(s) would be addressed.
Does your business have any material litigation, pending or threatened, or other legal proceedings against you or your business?
WRAP Cymru’s Business Support Service is delivered through the provision of expert assistance under EC Regulation 407/2013 which is deemed de minimis aid. Before we can offer support, you are required to declare any previous De minimis aid you have received in the last 3 years. Please see the guidance document for further information. Please attach separate sheet if necessary.
Date support awarded / Name of organisation who awarded the support / Value of aid received
TOTAL:
The following documents mustbe submitted with your application form. Please use this checklist to ensure your application is complete.
Full audited accounts for the last two yearsand recent management accounts for a month end period not later than two months prior to date of applicationOR where your organisation is new, a copy of yourBusiness Plan, including financial projections for at least the first 12 months of operation.
A copy of your organisation’s Health & Safety Policy.
A copy of your organisation’s Environment Policy.
A copy of all necessary waste management permits or exemptions required operating the service (where already in place) or a signed statement to confirm that these will be in place before the proposed support is completed.
A copy of your last 12 months EA (NRW) returns(if applicable)
Please list any additional documents that you are providing in support of your application hereWe will use the information you give us during assessment and during the life of your grant (if awarded) to administer and analyse grants and for our own research purposes. We may give copies of all or some of this information to individuals and organisations we consult when assessing applications, administering the programme, monitoring grants and evaluating funding processes and impacts. These organisations may include accountants, external evaluators and other organisations or groups involved in delivering the project. We may share information with organisations and individuals with a legitimate interest in WRAP applications and grants or specific funding programmes.
We have a duty to protect public funds and for that reason we may also share information with other government departments, organisations providing matched funding or for the prevention and detection of crime.
We might use personal information provided by you in order to conduct appropriate identity checks. Personal information that you provide may be disclosed to a credit reference or fraud prevention agency, which may keep a record of that information.
If you provide false or inaccurate information in your application or at any point in the life of any funding we award to you and fraud is identified, we will provide details to fraud prevention agencies, to prevent fraud and money laundering.
We might use the data you provide for research purposes. We recognise the need to maintain confidentiality details and these will not be made public in any way, except as required by law.
On signing this application I authorise WRAP Cymru to make any enquiries necessary to verify the information provided. I understand that information provided in this application may also be shared with the Welsh Assembly Government as project funders, and that the information given will be aggregated for reporting purposes
WRAP agrees that, except as otherwise agreed in any grant agreement between WRAP and the Applicant; the Confidential Information contained is and shall remain the exclusive property of the Applicant, which retains all intellectual property and proprietary rights in the Confidential Information and in all physical manifestations of it.
The decision whether or not to offer funding support to any potential recipient rests solely with WRAP and WRAP disclaims all liability arising from the failure of any applicant to secure funding. WRAP Cymru shall not be required to provide reasons for any decision to refuse to award funding to any particular applicant. Furthermore WRAP disclaims all responsibility for consequences arising from advice given or equipment procured. This provision shall apply whether the advice or equipment is given by WRAP Cymru directly or by contractors appointed by the recipients using funding supplied by WRAP Cymru. Successful applicants will be required to share information regarding the provision of funding with WRAP Cymru. Applicants applying for grants from WRAP Cymru are asked to note the information contained within this disclaimer before deciding whether or not to apply for funding.
I declare that the information given on this form and in any other documentation that supports this application is accurate and true. I understand that, where any materially misleading statements (whether deliberate or accidental) are given at any stage during the application process, or where any material information is knowingly withheld, this could (at the discretion of WRAP) render my application invalid and any funds received as a result of a misleading application will be liable for repayment.I have read and accept all terms and conditions proposed under this funding programme.
FIRST NAME
SURNAME
POSITION
SIGNATURE
DATE
The above has full authorisation to sign on behalf of the applicant organisation named above in section 1.
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