checklist for applicants - dpi.nsw.gov.au web view2 nsw department of primary industries, january...

INT17/238386

ABORIGINAL FISHING TRUST

FUND

Application for funding - LoansUse this form to apply for a LOAN up to $1 million. For further information about applying for funding under the Aboriginal Fishing Trust Fund (AFTF) funding, please refer to the Aboriginal Fishing Trust Fund -Guidelines for Applicants available for download at www.dpi.nsw.gov.au/fishing/aboriginal-fishing/AFTF.

This form is divided into two sections – Part A and Part B. Part A relates to eligibility and merit particulars of the application whilst Part B relates to the financial information needed for the NSW Rural Assistance Authority (RAA) to assess the capacity of the applicant to service a loan.

You should seek assistance from your financial counsellor, business advisor, accountant or a trusted family member or friend if you have difficulty understanding and completing PART B of this form. The RAA is also available to assist with queries relating to PART B of this form by calling 1800 678 593.

For any further assistance, contact the AFTF management team on (02) 4424 7421 or email [email protected].

Checklist for Applicants

Yes No Not Applicable

Have you answered all applicable questions? ☐ ☐ ☐If your project is supported by an Aboriginal organisation or entity that has cultural authority to speak for Country, have you provided evidence of that support?

☐ ☐ ☐

Have you attached your Project Plan? ☐ ☐ ☐If you are applying as an Aboriginal community organisation, have you provided evidence of being incorporated, or evidence of being sponsored by an incorporated organisation?

☐ ☐ ☐

If you are applying as an Aboriginal owned and run business, have you provided evidence that your business is majority Aboriginal owned, managed and operated? (E.g. A copy of the business’ constitution, a Statutory Declaration or evidence of being a certified supplier with Supply Nation)

☐ ☐ ☐

If you are applying as an existing business, have you provided evidence that the business has been operating (not just established) for at least 12 months, and evidence of operating expenses of at least $15000 (e.g. balance sheets, profit and loss statements, stock trading account & depreciation schedules)?

☐ ☐ ☐

Have you attached your Business Plan? ☐ ☐ ☐If you are applying for funds to purchase an existing business, have you attached financial statements for the business you are purchasing (e.g. balance sheets, profit and loss statements, stock trading account & depreciation schedules).

☐ ☐ ☐

The last 3 years individual Taxation Returns and a current listing of all Assets & Liabilities held by each:

Individual Director(s)/Shareholder(s) of all companies associated with your business.

Individual members of partnerships/Firm & Family Trusts associated with your business.

(Note: In each of the above, each Director/Shareholder is to provide details including

☐ ☐ ☐

Aboriginal Fishing Trust Fund – Application for Large Grant or Loan

Yes No Not Applicable

source of income, if they are not primarily dependent on the business for their livelihood).

(Taxation Assessment Notices are not acceptable)

Monthly Cash Flow Budgets ☐ ☐ ☐

Copy of existing Fishing Business Determination Certificate/s ☐ ☐ ☐

Details of proposed assets (including commercial fishing shares) to be purchased ☐ ☐ ☐

Have you signed all relevant sections of the application form? ☐ ☐ ☐

☐ ☒ ☐

2 NSW Department of Primary Industries, May 2023

Aboriginal Fishing Trust Fund – Loan Application

PART A1. Applicant

Are you applying as: ☐An Aboriginal person,☐An Aboriginal entity, which includes a family/clan or community organisation, or an Aboriginal owned and run business☐A person acting on behalf of an Aboriginal entity.

Name(s) of borrower(s)Please provide the name(s) of all person(s) or the entity making this application. Consultants assisting with an application are to provide their details in Section 7 Partnerships.

Click here to enter text.

Date of birthPlease provide the date of birth of each person making this application.


Address Click here to enter text.

Email Click here to enter text.

Telephone Click here to enter text.

BusinessesComplete this section if you are applying as a business

Business name Click here to enter text.

Full name(s) of owners and their positions (Director, Trustee, Partner etc)


ABN/ACN Click here to enter text.

OrganisationsComplete this section if you are applying as an organisation or as an individual or entity sponsored by an organisation through an auspice arrangement.

Are you applying as:

☐ An unincorporated organisation

☐ An incorporated organisation

☐ An Individual or entity ‘sponsored’ by an incorporated organisation?

Organisation name Click here to enter text.

ABN/ACN Click here to enter text.

GST registered?If registered for GST provide the date of registration.

☐ Yes ☐ No Date: Click here to enter text.

How would you like to receive correspondence from the RAA?

Mail ☐ E-mail ☐



2. Project manager

NameProvide the name of the person managing the project - this will be the main contact for the project.


Postal address Click here to enter text.

Email address Click here to enter text.

Telephone Click here to enter text. Mobile Click here to enter text.

Position title Click here to enter text.

3. Administration officer (if applicable)

NameProvide contact details for the person in the organisation responsible for financial management and administration


Postal address Click here to enter text.


Telephone Click here to enter text. Mobile Click here to enter text.

Position title Click here to enter text.

4. Project team – expertise and experience

Team membersWho will be involved in delivering your proposal’s objectives (what is their role and area of expertise?

Name Role / expertise Phone Email

Click here to enter text. Click here to enter text.






5. Project information

Briefly describe the purpose of the loan. Include details of the key outcomes and deliverables that will be achieved from undertaking the project.


Aboriginal Fishing Trust Fund program objectivesExplain how your proposal meets the objectives of the funding program (as described in the ‘Aboriginal Fishing Trust Fund - Guidelines for Applicants’).


Benefits



Describe how your proposal will deliver social, cultural and/ or environmental benefits to the Aboriginal community and/or broader community.


Cost effectiveness, value for money and sound budgetingExplain the outputs of your project, how it provides value for money and the financial management arrangements that will be implemented. Refer to any profit and loss statement, business plan, or cash flow statement you are attaching to the application


The capacity and commitment to undertake and complete the projectExplain how you have the capacity and commitment to complete the project, including any expertise in your project team, or any previous experience with similar projects


6. Project support and references

Do you have support from Aboriginal organisations or entities that have cultural authority to speak for Country? Please attach letters or emails if you have them to explain the support you have, or provide references.


7. Partnerships

Is this project partnered/collaborated with any other individuals or organisations to apply for this funding and/or to undertake the project?If yes, provide the following details for each organisation or person in the partnership/group.

Partner 1 Name of organisation or person Click here to enter text.

Contact person Click here to enter text.



Role in partnership Click here to enter text.

Partner 2 Name of organisation or person Click here to enter text.

Contact person Click here to enter text.



Role in partnership Click here to enter text.



8. Project plan

How do you propose to carry out the project? Provide details of the activities to be undertaken, timeframes, roles/responsibilities, and how you will measure your project’s performance. A Project Plan template is available at http://www.dpi.nsw.gov.au/fishing/aboriginal-fishing/AFTF/apply-for-funds


9. Project approvals

Are you aware of any impediments, legal or otherwise, that may hinder, delay or otherwise adversely affect the timely and successful implementation of the proposal? Please provide details.


10. Communication and extension plan

How will the project activities and outcomes be promoted to the wider community? Note: Project promotion and communication is encouraged.



PART B – NSW Rural Assistance Authority1. Details of assistance required

What is the amount you are applying for? $Click here to enter text.

Total purchase price

AFTF Loan

Other

Total required

$Click here to enter text.




Repayment Term Requested

Note: Maximum available repayment term is 20 years, dependent on the amount being borrowed and ability to repay.

Click here to enter text. years

2. Details of security offered (attach list if insufficient space)Note: Applications seeking loans under $10,000 do not need to offer security with their application.

Type Details Owner Name(s)

Click here to enter text. Click here to enter text. Click here to enter text.



Additional security such as a mortgage over property may be required. Please advise details of property available to secure your loan.

Property Address Click here to enter text.

Registered Proprietor/s Click here to enter text.

Date Purchased Click here to enter text.

Current Market Value

$ Click here to enter text.

Amount owing $ Click here to enter text.

Title Reference (DP No.) Portion/Lot No. Parish County
















Deeds Held By Click here to enter text.

3. Monthly Cash Flow

Please provide monthly cash flow for: 1) the next 12 months, and

2) the following 12 months.

A computerised cash flow forecast is preferred. An electronic template is available at https://www.dpi.nsw.gov.au/fishing/aboriginal-fishing/AFTF/apply-for-funds

Your accountant/business adviser should be able to assist with the preparation of cash flows.

4. Commitment Statement

Details of all approved loans obtained to assist with this proposal are also to be included in this section.

a. Enter information on Overdraft, Commercial Bills, Credit Card facilities, Private or Family loans at call

Lender or credit provider Type Term Interest Rate Limit Balance Owing Review

Date























TOTAL Click here to enter text.

b. Enter information on Term Loans, Fixed Rate Loans, Investment, Private or Family loans

NOTE: Indicate if (1) interest is a variable (V) or fixed (F) rate and (2) if instalments are monthly (M), half yearly (H) or annually (A)

Lender or credit provider

Term in years

Type of Advance

Interest Rate V or F Install

periodInstalment Amount Balance Owing Expiry

Date





























c. Hire Purchase and Lease Arrangements

Company Term in years

Interest Rate

Install period

Instalment Amount

Contract Amount Balance Owing Expiry

Date



























SUMMARY OF BORROWINGS

Balance OwingAnnual Instalments

PART A Total Click here to enter text.


PART B Total Click here to enter text.


PART C Total Click here to enter text.



5. Statement of Financial Position of all Applicants

(If individual partners or directors hold assets or liabilities that are not shown below please provide a separate statement)

Liabilities(Show present debts) $ Assets

(Show at present fair market value) $

Property Held

Total Borrowings Click here to enter text.

Address: Click here to enter text. Click here to enter text.

Other Real Estate (Details)Click here to enter text.


Income / Land Tax Click here to enter text.

Plant and Equipment Click here to enter text.

Crown Land Debt Click here to enter text.

Motor Vehicles/Boats Click here to enter text.

Cash at Bank Click here to enter text.

Sundry Creditors Click here to enter text.

Share Portfolio Held Click here to enter text.

Co-Operative Shares Click here to enter text.


Superannuation Click here to enter text.

Produce on Hand (Saleable) Click here to enter text.



Have you ever been bankrupt, assigned a liquidator, or are there any unsatisfactory judgements against you in any court? ☐ Yes ☐ No

If YES give details:


6. Contact Details

Accountant

Firm Name Click here to enter text.

Contact Name Click here to enter text.


Contact Telephone Click here to enter text. Mobile Click here to enter text. Fax Click here to enter text.

Main Lender

Bank or Company Name


Contact Name Click here to enter text.


Contact Telephone Click here to enter text. Mobile Click here to enter text. Fax Click here to enter text.


7. Consent for release of information

I/We have lodged an application with the NSW Department of Primary Industries for an Aboriginal Fishing Trust Fund loan.

To allow this application to be assessed, I/we authorise the release of information by relevant authorities, including Commonwealth, state/territory or local authorities to the NSW Rural Assistance Authority relating to my/our application for an Aboriginal Fishing Trust Fund loan.

Applicant name: Click here to enter text.

Signed Date Click here to enter text.

Applicant name Click here to enter text.




Note: Click the image icon to insert a digital signature or print off completed form and sign

8. Declaration

I/We have read and understood the Aboriginal Fishing Trust Fund - Guidelines for Applicants and have sought appropriate advice.I/We have read the Privacy statement below about how information provided in my/our application may be used.I/We understand that completed applications will be assessed against set criteria and loan offers will be based on the availability of funds.I/We hereby give approval to the NSW Department of Primary Industries and the NSW Rural Assistance Authority to obtain and provide information relevant to this application from my/our lender(s), accountant, or any other person nominated by me/us.I/We give ongoing approval for the NSW Rural Assistance Authority to obtain and provide information as required from my/our lender regarding any review (annual or otherwise) of my facilities with that lender and/or this loan if approved.

I/We solemnly declare that this is a true and correct statement of all my/our affairs and I/We make this solemn declaration subject to punishment by law provided for any wilful false statement.

Applicant name: Click here to enter text.







Note: Click the image icon to insert a digital signature or print off completed form and sign

Submitting the form Email to [email protected] or Mail to:

Aboriginal Fishing Trust Fund NSW DPILMB 3020Nowra NSW 2541

NOTE: Email is the preferred method of receiving application forms

General Statement

Any person who knowingly and with intent to defraud the NSW Rural Assistance Authority, NSW Department of Primary Industries or another person, files an application for assistance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent act, which is a crime under the Crimes Act 1900 and subjects the person to criminal penalties.

Privacy Statement

The information is being collected by NSW Department of Primary Industries and the NSW Rural Assistance Authority for purposes of assessing eligibility for a loan and for the purposes related to the administration of the scheme of assistance under which you have applied, including the assessment of the effectiveness of the scheme.

The information in this application is provided voluntarily. However, we will not be able to assess your application if you choose not to provide the information.

This information may be disclosed to staff administering the program, the Aboriginal Fishing Trust Expenditure Committee, the Aboriginal Fishing Advisory Council and to a credit assessment agency in order to assess and administer the application. This information may also be disclosed to staff and other persons engaged by the NSW Department of Primary Industries or the NSW Rural Assistance Authority or to either State or Commonwealth government agencies. We will supply you with details of those that we have disclosed information to, if you apply to us in writing. Information regarding your application may also be discussed and exchanged with the nominated contact persons listed by you in your application.

Not providing the information requested in this application or providing false or misleading or incomplete information may impact on the ability of NSW Department of Primary Industries and the NSW Rural Assistance Authority to accurately assess your application.

The information will be held by the NSW Department of Primary Industries and the NSW Rural Assistance Authority and all reasonable measures will be taken to ensure that the personal information collected is stored securely.

You may access or correct your personal information by contacting the NSW Rural Assistance Authority by telephone on 1800 678 593 (toll free) (calls to “1800” numbers from your home phone are free. Calls from a public phone and mobiles may be timed and attract charges) or by writing to: Manager Financial Administration, NSW Rural Assistance Authority, Locked Bag 23, ORANGE, NSW, 2800. Alternatively you can contact the NSW Department of Primary Industries on (02) 4424 7421 or by writing to the Aboriginal Fishing Trust Fund, NSW Department of Primary Industries, LMB 3020, NOWRA NSW 2541.

Lastly, documents held by the NSW Department of Primary Industries and the NSW Rural Assistance Authority are subject to the Government Information (Public Access) Act 2009 (‘GIPA Act’). This means that the information contained in application forms and other relevant information an applicant provides may be released in response to a request lodged under the GIPA Act.


checklist for applicants - dpi.nsw.gov.au web view2 nsw department of primary industries, january...

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