Application formThe Greater Circular Head Enterprise Grant Program

Please read the Guidelines available from the Department of State Growth website www.stategrowth.tas.gov.au or contact Business Tasmania on 1800440026 or ask@business.tas.gov.au.

Notes:

Failure to complete all relevant sections of this form may result in your project not being able to be fully assessed or approved due to insufficient information.

Closing date for final applications is 15 May 2018. Applications received after this date will not be accepted.

While new or start-up businesses that are spin offs of existing businesses are eligible to apply, applications must be made by the existing business.

Response areas are to be expanded to accommodate your response.

1. Project summary

Project Title - provide a short title for reference purposes

Request amount (excluding GST)

$

Brief summary of project - this information may be made public if application is successful

2. Business information

Legal entity:

Trading name:

ABN:

Physical location:

Suburb:

State:

P/C:

Postal address:

Suburb:

State:

P/C:

Phone:

B/H:

Mob:

Fax:

Email:

Website:

1.

2.

2.1 Contact person

This is the person responsible for all dealings with the department in relation to this EOI. The contact person must be authorised to provide further information and will receive all relevant notices.

Name:

Position:

Postal address:

Suburb:

State:

P/C:

Phone:

B/H:

Mob:

Fax:

Email:

3. Project details

Describe what you are requesting funding for (the project) and how it will benefit your business.

3.

3.1 What is the project?

3.2 What are the tasks, activities and resource requirements for the project?

In the table below, list the tasks and activities and estimate the level of resourcing required to complete the project.

All cost estimates are to be GST exclusive.

The total of column (B) must represent the total request amount.

Task/activity

Approximate completion date

Total project cost (A)

Grant contribution(B)

Applicant contribution(C)

Expected invoice date

TOTAL

$

$

$

Comments:

If the task/activity requires further explanation, provide details here.

1.

2.

3.

3.1

3.2

3.3 When is the earliest you can commence the project? / /

All projects are required to commence within one month of execution of the Grant Agreement and be completed within 12months from that date.

3.4 What will be the outcomes of the project?

Outcomes

Within 12 months

Cumulative within 24 months (include the first 12 months figures)

FTEs

Headcount

FTEs

Headcount

Jobs created

Jobs retained as a direct result of this project

Jobs created during construction phase

Job retention will be considered but not weighted as highly as job creation. An FTE is based on an average of 37.5 hours per week.

If the project creates new jobs, please explain how the project will create them. If the project aims to retain jobs, explain why these jobs are at risk and how the project will retain the positions.

If the project is for a feasibility study, please clearly demonstrate what significant investment has been generated to date and the Development Application status. If the project proceeds, what major outcomes are possible?

3.5 Market and total sales

In the table below, indicate the principal markets of the business and total sales. You must take into account this project.

Sales

At 30 June 2016

At 30 June 2017

Current year to date / /

Forecast for 2017-18

Forecast for 2018-19

Tasmania

$

$

$

$

$

Interstate

$

$

$

$

$

International

$

$

$

$

$

Import replacement

$

$

$

$

$

TOTAL

$

$

$

$

$

Import replacement - if the project will reduce the level of imported products or services into Tasmania, what is the estimated value of this reduction?

In responding to this item, the following should be addressed:

How will the project increase off-island trade of products or services?

How do you know that the project will achieve the levels of sales identified in the table above?

Have you identified new markets and product opportunities, undertaken/planning on greater promotion, product differentiation, branding, market positioning, pricing and distribution, collaborative initiatives?

3.6 What is the net economic benefit of the project to the greater Circular Head region?

The aim of the fund is to assist Tasmanian businesses in the greater Circular Head region to undertake projects that will significantly improve their growth, performance, productivity and sustainability, helping to generate new investment and employment that will diversify and strengthen the regions economy.

In responding to this item, tell us how this project will:

Create employment (job retention will be considered but not weighted as highly as job creation in the assessment)

Increase investment

Develop new off island or import replacement sales

Improve productivity, growth and sustainability to the business, and/or supply chain as a result of the assistance

Provide benefit to the regions economy beyond your business

Not negatively impact an existing Tasmanian business, or alternatively provide proof that there is unmet demand (statewide competitive neutrality)

3.7 Is there a strong business case for the project that is market driven?

In responding to this question, the following should be addressed:

What level of planning have you undertaken in relation to the project? Do you have a business case/business plan, if yes please attach.

What evidence can you provide that demonstrates the project is market driven?

What planning and other statutory approvals are required to undertake this project, and where are you at in the process of obtaining these?

3.8 What is your organisations capacity to undertake and complete the project within 12 months of being approved, and deliver sustainable outcomes thereafter?

In responding to this question, the following should be addressed:

How long your business has been operating.

What projects have you successfully undertaken in the past?

Who will be managing the project? What are their skills and experience?

What are the resources and skills (eg. staff, equipment, and financial management, business development skills) required to undertake the project and achieve outcomes? Do you currently have these within your business or will they be recruited or contracted in?

Demonstrate your business capacity and ability to commence the project within one month of execution of the Grant Agreement and complete the project within 12 months from that date.

3.9 What is your capacity to fund your share of the project costs?

In responding to this question, the following should be addressed:

How much will your business and/or others contribute to the project?

How will your business fund this contribution, eg. from existing reserves or bank borrowings? If it is bank borrowings please indicate if approval of funds has already been obtained and attach evidence of this approval.

What evidence can you provide to show your business is able to make this contribution?

3.10 Is your business part of a key growth sector as identified in the Sustainable Murchison Plan?

Please select all that apply:

food and agriculture

forestry and related products

information communication technology (ICT)

mining and mineral processing

renewable energy

specialist manufacturing

tourism

other areas of strategic economic interest* (please provide detail below)

* Areas of strategic economic interest are those that enhance Tasmanias recognised comparative strengths.

4. Business details4.1 Business structure

|_| Sole trader |_| Partnership |_| Company

|_| Trust - provide a copy of the trust deed

|_| Other, please specify

4.2 Business description

Provide a history of the business and describe how the business has developed, including products, services and markets.

4.3 Current Employment

In the table below, indicate the number of people your business employs.

At 30 June 2016

At 30 June 2017

At application date

Number of FTEs

Total number of employees (headcount)

An FTE is based on an average of 37.5 hours per week. You may employ people on a part-time basis and these people should be counted individually to determine the total number of employees. Contractors should not be included.

4.4 Financial details

In the table below, provide a summary of the financial performance and position of the business for both the previous two financial years and the current financial year. You must take into account this project.

Sales

At 30 June 2016

At 30 June 2017

Current year to date/