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Melbourne’s North Innovation and Investment Fund (MNIIF) Grant Application Form

Deadlines apply to this programRound 1 of MNIIF closes at 5:00pm Australian Eastern Standard Time (AEST) on Thursday, 26 September 2013. All applications must be submitted by the program closing time.

About the MNIIF Program The MNIIF Program gives effect to an announcement by the Australian and Victorian Governments on 23 May 2013 to provide funding support to those regions affected by Ford Australia’s announcement that it will cease its vehicle and engine manufacturing operations in Australia from October 2016.

The MNIIF competitive grants program will support investment by businesses leading directly to new sustainable jobs in the Melbourne’s North region to assist the region to diversify its economic base. Eligible projects will focus on encouraging new investment to create new or additional business capacity that results in sustainable jobs. The Melbourne’s North region is defined as the four Local Government Areas of Hume, Whittlesea, Moreland and Darebin.

Privacy and confidentialityApplications will be treated as ‘commercial-in-confidence’ but applicants should note that the application will be reviewed by both the Australian and Victorian governments.

Applicants should note that AusIndustry may disclose any information to Australian Government or State agencies for law enforcement or audit purposes. AusIndustry and the Victorian Government Department of State Development, Business and Innovation may also disclose information with the consent of the applicant.

Completing an applicationInformation on MNIIF is available in the MNIIF Guide for Applicants. Applicants should familiarise themselves with the Guide for Applicants prior to completing this application. An AusIndustry representative can help explain program requirements (contact the AusIndustry hotline on 13 28 46). When completing an application, applicants are advised to be factual and concise in all responses.

To be eligible for consideration under Round 1, completed MNIIF applications on the AusIndustry application form with attachments must be received electronically by 5:00pm AEST Thursday, 26 September 2013 either by e-mail to [email protected] or on a CD posted to the following address:

Melbourne’s North Region Innovation & Investment FundAusIndustry

MNIIF – Application Form July 2013 of 20

mailto:[email protected]

Commercial-in-confidenceGPO Box 85MELBOURNE Vic 3001

An unbound, signed hard copy of your application and attachments must also be received at the above address within 3 business days of the electronic submission.

Eligibility CheckPlease make sure you meet the following eligibility criteria.

Are you a non-tax exempt, Australian incorporated entity:

with an ABN;

that is registered for the Goods and Services Tax; and

able to issue tax invoices?

Yes No

Yes No

Yes No

Can you demonstrate that your project:

involves at least $100,000 in eligible expenditure (see MNIIF Guide for Applicants, Section 6.3 & 6.4);

will generate sustainable new jobs in the Melbourne’s North region and not involve the movement of business activity from other areas of Australia to the Melbourne’s North region; and

if there are any activities to be continued after the project completion date, these can be undertaken without any further grant funding.

Yes No

Yes No

Yes No

Can you demonstrate that you:

can fund the costs of your project which are additional to the government grant funding sought; and

have access to, or the beneficial use of, any intellectual property necessary to carry out and commercialise the project?

Yes No

Yes No

If your application is successful and a MNIIF funding agreement is executed with your eligible entity (being the company that is applying for the MNIIF grant), you understand that you must:

currently be, and continue to be for the life of the grant, engaged in trading or financial activities that form a substantial or significant proportion of the applicant company’s overall current activities; and

acquire and own any plant and equipment covered by the funding agreement and that these items must be capitalised in your own accounts.

Yes No

Yes No


Commercial-in-confidence

If you have not answered yes to all of the questions above, you are not eligible to apply for the MNIIF. For further details please consult the MNIIF Guide for Applicants or contact [email protected].




Part A - Applicant DetailsA1 Name of applicant

Note: For applicant eligibility requirements refer to Section 6 of the MNIIF Guide for Applicants. If your application is successful, this is whom the Government will execute the funding agreement.

Registered business name:

Trading name (if trading under a name

other than the registered business name):

Is the applicant applying as a trustee* on behalf of a trust? Yes No

If ‘Yes’, please also complete Section A4

* The trustee must be incorporated to be eligible to apply.

Is the applicant part of a group? Yes No

If ‘Yes’, please also complete group financial information in Section A8

Applicant business street address (Head Office):

Address

Suburb/town

State/Territory

Postcode

Is your mailing address the same as the Head Office address above? Yes No

If ‘No’, please provide the mailing address below:

Address

Suburb/town

State/Territory

Postcode

Is the project street address (where project activities will be undertaken) the same as the Head Office address? Yes No

If ‘No’, please provide the project street address below:

Address

Suburb/town

State Victoria

Postcode

Please check the box for the Local Government Area* where the proposed project activities will be undertaken:

Hume:

Whittlesea:

Moreland:

Darebin:

* Refer to MNIIF Guide for Applicants, Appendix 2 for a map of the Melbourne’s North Region

A2 Applicant business registrations

To be eligible to apply for funding, an applicant must be incorporated and registered for GST.

Note: ABN and ACN must both belong to the same entity.



Australian Business Number(ABN)

Australian Company Number(ACN)

Date of Incorporation(dd/mm/yyyy)

A3 Related bodies corporate

Do you, or will you, have any related bodies corporate? Yes No

If yes, provide details of your ultimate holding company:

Legal name:

Country of Incorporation:

Please attach a diagram of your company group to the application. This diagram must show the name and country of incorporation of each body, the relationships and the relative shareholdings within the group.

A4 Trustee applying on behalf of a trust (where applicable)

Name of trust:

ABN used by the applicant in its role as trustee* for the trust:

ACN of the trustee for the trust:

* The trustee must be incorporated to be eligible to apply.

* A copy of the Deed of Trust must be provided.

A5 Primary contact details for this application

Title:

Full Name:

Mailing Address (if different from company):

Suburb/town:

State/territory: Postcode:

Telephone number:

Mobile telephone number:

E-mail address:

Company web address:

Is the applicant the contact’s employer? Yes No

If ‘No’, please describe the contact's relationship to the applicant

If ‘Yes’, please provide the position in applicant company:



A6 Applicant organisation background

What is the core business of your organisation?

Describe your product or service?

Who are your major customers?

Do you have a business plan? Yes NoIf ‘Yes’, please attach the business plan to the application.

ANZSIC Code* for the applicant company’s core business:

ANZSIC Code for the proposed project activities:

* Refer ANZSIC Class Codes 2006 listing on the AusIndustry website (http://www.ausindustry.gov.au/programs/Pages/ANZSIC-ClassCodes2006.aspx)

A7 Applicant financial information

Please complete the following table.

Note: The information provided must agree with the financial statements provided by the applicant.

Recent Trading Performance FY 2010/11 FY 2011/12 FY 2012/13

Sales Revenue $ $ $

Export Revenue $ $ $

Taxable Income $ $ $

Current Assets $ $ $

Total Assets $ $ $

Current Liabilities $ $ $

Total Liabilities $ $ $

Net Assets $ $ $

Number of Employees (including working proprietors and salaried directors)

Number of Independent Contractors

Full Time Equivalent Staff (FTE) *

Salaries $ $ $

R&D Expenditure $ $ $


http://www.ausindustry.gov.au/programs/Pages/ANZSIC-ClassCodes2006.aspx


What is the end date for the applicant’s 2012/13 financial year? (dd/mm/yyyy)

Company Group financial information

If you are part of a group, please complete the following table for the group and provide a diagram of the group structure (see Part D for list of attachments required).

Note: The information provided must agree with the group financial statements provided.

Recent Trading Performance FY 2010/11 FY 2011/12 FY 2012/13

Sales Revenue $ $ $

Export Revenue $ $ $

Taxable Income $ $ $

Current Assets $ $ $

Total Assets $ $ $

Current Liabilities $ $ $

Total Liabilities $ $ $

Net Assets $ $ $

FTEs*

Salaries $ $ $

* Note: FTE is measure of the total level of staff resources used. The FTE of a full-time staff member (e.g. 37.5 hours per week) is equal to 1.0. The calculation of FTE for part-time staff is based on the proportion of time worked compared to that worked by full-time staff. For example, a staff member working 2 days per week, at 7.5 hours per day, is equivalent to 0.4 FTE.


Part B - Project DetailsB1 Project Title (maximum 10 words)

Note: Please provide a straightforward concise project title, not a descriptive sentence, suitable for publicity purposes. If the application is successful, this title may be used by the Australian and Victorian Governments in published material.

Project Summary (maximum 50 words)

Note: Please include what the project ultimately intends to achieve. If the application is successful, this summary may be used by the Australian and Victorian governments in published material.

B2 Overview of the Investment Proposal

Provide a description of the investment proposal you wish to undertake with the assistance of MNIIF grant funding. Include:

Key activities (eg a new product/process/service, purchase of new equipment etc).

Expected outcomes (eg expanded business, new product/service, increased employment etc).

What is the demand for your proposed project (product/service) from the target market?

Outline any identified risks associated with your project.

Outline the research that has been undertaken to support your claims of projected demand.

Approvals

Does your project require any approvals? Yes No

If ‘Yes’, please advise of the required approvals and their status (eg planning, LGA):

B3 Number of ongoing FTE jobs expected to be created by your project

Note: If the application is successful, this summary may be used by the Australian and Victorian governments in published material.

Expected increase in ongoing FTEs at project conclusion:

B4 Project Timeline

Please provide the proposed start and end dates for your project.

Note: Grant funding is available for project activities up to 30 June 2016. No project activities will be funded prior to the execution of a funding agreement with the Government.

Start date (mm/yy): End date (mm/yy):

B5 Project Milestones and Major Activities

Please outline the applicant’s key milestones and describe the major activities to be undertaken to achieve each milestone. Please ensure that the start date of Milestone 1 and the end date of the last Milestone match the start and end date as stated in B4 of the application.

Note: Additional rows automatically appear when you hit 'Tab' at the end of that last row of table

Key Milestones and Related Major ActivitiesStart Date

(mm/yy)

End Date

(mm/yy)

Estimated expenditure

(GST Exclusive)

Milestone 1:

Outcomes: $

Milestone 2:

Outcomes: $

Milestone 3:

Outcomes: $

Milestone 4:

Outcomes: $

Total expenditure for project $

B6 Other government assistance

Has the applicant received or applied for any Commonwealth/State government assistance (including the R&D Tax Incentive/Concession) in the last 5 financial years?

Yes No

If ‘Yes’, provide details of the source, timing and amount of other government assistance (include current applications, grants received and unsuccessful applications):


Assistance source (program and agency)

From

(mm/yy)

To

(mm/yy)Amount

P (pending)

S (successful)

U (unsuccessful)

$

$

$


B7 Grant amount sought

Please note that the minimum grant size is $50,000 GST Exclusive and the applicant’s contribution must be at least equal to the grant amount sought.

Note: Applicants must attach evidence of ability to fund applicant’s share of project cost (refer to instructions in Appendix A).

A. Applicant’s contribution (GST Exclusive) $

B. Grant amount sought (GST Exclusive) $

C. Other funding (if relevant) * (GST Exclusive) $

D. Total expenditure for project (A+B+C) (GST Exclusive) $0

Whilst grants will be up to 50% of eligible expenditure, applicant projects that demonstrate a higher level of investment in relation to the grant sought will be favoured.

*C. Other funding

Please provide a breakdown of other funding sources (GST Exclusive)


$

$

$

Total other funding $

B8 Project budget

a) Please complete the table below detailing the total costs and key activities of the project across the relevant financial years.

Refer to MNIIF Guide for Applicants , Section 6.3 and 6.4 for detailed information on eligible expenditure.

Expenditure type

(GST Exclusive)FY 2013/14 FY 2014/15 FY 2015/16

Total Project Costs

Eligible expenditure $ $ $ $0

Ineligible expenditure $ $ $ $0

Total FY expenditure for project $0 $0 $0 $0


b) Provide a breakdown of eligible new machinery and/or equipment costs:

Note: Additional rows automatically appear when you hit 'Tab' at end of last row of table

Plant item What will it be used for in the project?

Estimated Cost ($)

(GST Exclusive)

Expected procurement date

(mm/yy)

$

$

c) Provide a breakdown of construction or fit-out of a new building or extension to premises cost:

Note: Additional rows automatically appear when you hit 'Tab' at end of last row of table

Building item What will it be used for in the project?

Estimated Cost ($)

(GST Exclusive)

Expected procurement date

(mm/yy)

$

$

d) Provide a breakdown of project management and direct labour costs:

Note:

Generally these expenses would be no more than 5% of a project’s total value. Please refer to the MNIIF Guide for Applicants, Section 6.3 for further explanation

Additional rows automatically appear when you hit 'Tab' at end of last row of table

Position title Role in project Anticipated annual salary

Anticipated Start date

(mm/yy)

Anticipated End date

(mm/yy)

Estimated eligible

salary cost

$ $

$ $


e) Provide a breakdown of ineligible other costs:

Expenditure item What will it be used for in the project? Estimated project cost (GST Exclusive)

$

$

B9 Project Forecasts

Note: these forecasts should reflect the project outcomes only and not the wider entity.

Financial Year 2013/2014 2014/2015 2015/2016 2016/2017 2017/18

Estimated Sales Revenue $ $ $ $ $

Estimated Export Revenue $ $ $ $ $

Estimated project Taxable Income $ $ $ $ $

Depreciation of the project’s assets $ $ $ $ $

Full Time Equivalent Staff (FTE)*

Salaries $ $ $ $ $

Outline key assumptions behind the project forecasts.

Group Sales / Profit Projections (if applicable)

Note: these forecasts should reflect the entire group as consolidated amounts and not just theapplicant entity.

Financial Year 2013/2014 2014/2015 2015/2016 2016/2017 2017/18

Estimated Sales Revenue $ $ $ $ $

Estimated Export Revenue $ $ $ $ $

Estimated project Taxable Income $ $ $ $ $

Depreciation of the $ $ $ $ $


project’s assets

Full Time Equivalent Staff (FTE)*

Salaries $ $ $ $ $

B10 Project impacts

a) How will the project contribute to the company’s growth?

b) How will the project contribute to the company’s competitiveness?


Part C - Assessment CriteriaProvide information detailing how your project meets each of the assessment criteria.

Note: For each criterion you must address each of the points under the criterion description. Your response to Part C should be no more than 15 pages in total.

C1 The level of net economic benefit that your proposed project will bring to the Melbourne’s North Region including:

Number of sustainable, new FTE jobs created through the project.

The number, type and timeline for the creation of the new jobs. Include estimated or average salaries for new positions (refer to data provided in B1).

Where will the workforce for the project be sourced?

Does there exist potential for your project to provide new job opportunities for ex Ford / automotive supply chain workers?

The employment impact on other businesses.

Estimate of indirect ongoing FTE jobs resulting from the project benefit.

Estimate of expected FTE jobs during construction/preparation phase.

The contribution of the project towards the diversification of the region’s economy and the extent of new innovation, including new technology.

A new economic activity, an expansion of an existing activity or diversification of existing businesses.

Describe the input and output impacts on your supply chain, including where the inputs for the investment proposal will be sourced.

The generation of further investment.

Trade impacts on other businesses in the Melbourne’s North Region (including competitors).

The extent to which the project will service market inside/outside Melbourne’s North.

C2 The demonstrated capacity of the applicant(s) to successfully undertake the project outlining the skills, experience and resources to which you will have access.

Details of management experience required for the project, including the applicant’s track record, or if outside prior business activities, outline the expertise and capabilities to successfully implement the new project.

Details of the technologies involved in the investment proposal should be provided. Was the applicant involved in the development of these technologies?

Has the applicant accessed customers and sourced distributors or relevant supply chains relating to the investment proposal?

C3 The demonstrated capacity of the applicant to provide matching funding for the project.

An explanation of how the investment proposal will be funded.

The level of funds likely to be generated from each source.


The type of funding (e.g. debt and/or equity) must be provided.

Has private sector funding for the investment proposal been secured or evidence of significant progress in negotiations for funding should be provided, including details of any special conditions applying to the provision of funding

Note: Applicants must attach evidence of ability to fund applicant’s share of project cost (refer to instructions in Appendix A).

Recommended additional evidence may include:

for internal funding sources - cash flow forecasts, evidence of existing sales pipelines and/or sales contracts; and

for external funding sources such as equity investments or loans - evidence of the commitment and capacity from the investor or finance provider.

C4 Sustainability of the project to continue after its completion date over the longer-term without the need for ongoing Government support.

Please discuss the anticipated longer term outcomes from implementation of this project and the rationale as to the ongoing sustainability of those outcomes once government assistance is exhausted. Consider industry trends, market size and competitors in the medium to long-term as well as the likelihood of further funding from the private sector to support claims made.

C5 The value for public money offered by the project as measured by the extent to which the project would be unlikely to proceed without funding support.

Why would the investment proposal not proceed without the grant?

How would the incentive of the grant impact favourably on the scale or timing of the investment proposal?

What other funding options has the applicant pursued to bring this investment proposal to fruition?


Part D - AttachmentsMandatory attachments

Note: Applications that do not include mandatory attachments will be deemed incomplete and may not be assessed.

The following documents, unless they are not applicable, must be attached to your application (mark box to show that documents are attached):

Group organisational chart (if applicable)

Copy of Deed of Trust (if applicable);

For existing entities, the applicant's three most recent (preferably audited) financial

statements (highly recommended for the FY2010/11, FY2011/12 and FY2012/13) and any

interims;

Consolidated group’s three most recent audited financial statements (if applicable);

Where parent entity is providing funding, written undertaking to this effect and evidence of

ability to provide funding (eg financial statements);

Evidence of loan approval (if applicable); and

Funding declaration from external accountant confirming ability to fund applicant’s share of

project cost and solvency (See Appendix A for template);

Applicants seeking a grant in excess of $500,000, the following additional documents must be attached to your application (mark box to show that documents are attached):

Detailed assumptions regarding the Project’s forecasted revenues and profits;

Depreciation rates and schedules of capitalised assets; and

The Project’s assets salvage value after five years, including assumptions.

Applicants seeking grants greater than $2 million, may be asked to provide additional supporting documents.

Recommended additional attachments

Where relevant, you may also wish to provide the following information to further support your application (tick box if

attached):

Business plan &/or Gantt chart &/or project schedule.

Sales contracts or orders.

CVs or resumes of key personnel.

Copy of statutory approvals received for planning or building (if applicable).

Letters of support from customers or suppliers.

Part E - DeclarationAuthorised person declaration

I declare that I am authorised by the applicant to complete this form on behalf of the applicant and to

sign and submit this declaration on behalf of the applicant.

I understand that I may be requested to provide further clarification or documents to verify the

information supplied in this form and the Commonwealth may during the application process consult

with other agencies about the applicant’s claims and may also enlist external technical or financial

advisers to advise on information provided in the application.

I declare that the information contained in this application is to the best of my knowledge true,

accurate and complete.

I declare that the below signature on this application is by:

- an employee who has authority to commit the applicant company to this project; or

- a Director of the applicant company.

Applicant’s signature Name of signatory

Date (dd/mm/yyyy)


Getting HelpIf you wish to obtain advice on your application please contact the AusIndustry hotline on 13 28 46. We will either provide advice via the phone or e-mail or arrange a suitable time to meet with you. Additional information concerning MNIIF can be obtained from the AusIndustry website.

Submitting your MNIIF – Round 1 applicationTo be eligible for consideration under Round 1, completed MNIIF applications on the AusIndustry application form with attachments must be received electronically by 5:00pm AEST Thursday, 26 September 2013 either by e-mail to [email protected] or on a CD posted to the following address:

Melbourne’s North Region Innovation & Investment FundAusIndustryGPO Box 85MELBOURNE Vic 3001

An unbound, signed hard copy of your application and attachments must also be received at the above address within 3 business days of the electronic submission.

Applicant feedbackAusIndustry values your input to the service provided to our customers. Please complete this voluntary

questionnaire. Note that this questionnaire is not part of the application or assessment process.

How did you find out about the MNIIF?

(Select one or more of the following.)

Newspaper/magazine article

Advertisement

Internet

Direct mail/e-mail

Industry group

Word of mouth

AusIndustry staff

AusIndustry hotline

VIC Trade & Investment

Other

If ‘Other’, please specify

Please tick this box if information about AusIndustry’s product and services is not required in future



http://ausindustry.gov.au/programs/regional-innovation/Pages/default.aspx

APPENDIX AMelbourne’s North Innovation and Investment Fund (MNIIF) –

Funding Declaration

Role of person making declaration

[Accountant or Chief Financial Officer(CFO)]

Name

Signee’s relationship to applicant:

Qualification Chartered Accountant

Certified Practicing Accountant

Association of Certified Practicing Accountants

Institute of Chartered Accountants in Australia

Institute of Public Accountants

Membership Number:

Applicant’s Name:

Applicant’s ABN:

I declare that:

On the basis of the evidence [Applicant Name] has supplied to me, I consider that [Applicant Name] is solvent and able to fund its share of the cost of the proposed project from the following source of funding [insert source of funding].

This opinion is based on the applicants share being [insert amount] out of total project expenditure of [insert amount].

The applicant is part of a consolidated group for tax purposes Yes No

Signature.....................................................................................

Signed on this.................day........................of 20......................

The letter must be prepared and signed by a person who:

is not a director, other office holder, or employee of the applicant or related body corporate of the applicant;

has not been engaged by the applicant for the purpose of preparing the MNIIF application;

has no financial interest in the applicant; and is a current member of the Institute of Chartered Accountants in Australia; or the Society of Certified

Practising Accountants; or the National Institute of Accountants as a Public Practice Certified Member.

The letter must include each of the following:

the statement: ‘On the basis of the financial statements [Applicant Name] has supplied to me, I consider [Applicant Name] is solvent.’

the statement: ‘On the basis of the evidence [Applicant Name] has supplied to me, I consider that [Applicant Name] is able to fund its share of the cost of the proposed Melbourne’s North Innovation

Melbourne’s North Innovation and Investment Fund (MNIIF) Grant Application Form of 20

and Investment Fund project. This opinion is based on total project expenditure of [$ project expenditure].’

Melbourne’s North Innovation and Investment Fund (MNIIF) Grant Application Form of 20

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