Regional Enterprise Development Fund Feasibility Grant: Application Form Enterprise Ireland will not release any information received as part of this application except as may be required by law, including the Freedom of Information Act 2014. In the event of a Freedom of Information request, the client will be given reasonable advance notice in order to contest such disclosure To ensure consistency, this document uses protected form fields which are limited in length and which only allow use of plain text (ie. no bolding, underlining, bulleting, etc). 1. Applicant Details Applicant Name .... Company Registration Number (if applicable) .... PPS No. (if an individual) Business Address .... Web Address .... Telephone Number .... Contact Name .... Contact’s Job Title .... Contact’s Email Address .... EI Development Adviser (if known) .... Project Summary - …. 2. Company Ownership (if applicable) Type* Share Class % Shareholding Amount Invested Name Total o Identify any connected companies and related parties and outline their relationships. Type here ...(Max 1000 characters) Regional Enterprise Development Fund Feasibility Study Page 1 of 5 3. Management o Outline the current management structure. o What are the key skills and track record of the current management team and advisers? Type here ...(Max 1500 characters) 4. Project Description Start Date of Project .... End Date of Project .... 5. Project Team Proposed partners and collaborators on the Project: Type here ...(Max 3000 characters) Target benefits of the initiative planned Type here ...(Max 3000 characters) Existing infrastructure and supports in this area Additionality to be delivered by planned project, plans to leverage existing resources 6. Value for Money/Economic Impact Scale of the proposed project including proposed costs Type here ...(Max 3000 characters) Regional Enterprise Development Fund Feasibility Study Page 2 of 5 Geographical/sectoral scope of the project proposed Type here ...(Max 3000 characters) Planned economic/enterprise impacts Type here ...(Max 3000 characters) Target metrics to be achieved Type here ...(Max 3000 characters) 7. Need for support Existing infrastructure and supports in this area Type here ...(Max 3000 characters) Additionality to be delivered by planned project, plans to leverage resources Type here ...(Max 3000 characters) Evidence of need for project Type here ...(Max 3000 characters) Business case for fund support Regional Enterprise Development Fund Feasibility Study Page 3 of 5 Type here ...(Max 3000 characters) 8. Project Costs Consultancy Fees Costs of hiring a specialist consultant(s)/consultancy firm to input or undertake the proposed project are set at a maximum of €900 per day for a maximum of 25 days. Where more than one consultant is being used from the same firm, daily rates will apply to the firm. The daily rate is to be inclusive of consultant’s time and all associated travel, subsistence and out of pocket expenses. The grant will be offered up to 50% of the eligible expenditure up to a maximum of €22,500 grant. Name Function Cost per day No of days Total EI use Sub-Total Total Expenditure 9. Amount of Aid Sought from EI Please provide detail on the requested amount of aid sought (amounts in €’000) Grant Type Total Expenditure (refer to Project Costs Above) Percentage Support Sought (Max is 50%) Grant Sought € Feasibility Please indicate if you are applying for Stream 1 or 2 approx. 10. Sources of Funding Provider Amount 11. Benefits of and need for EI support o Outline the reasons why EI should support your application? o If successful, what would be the likely impact of the initiative? o What would be the impact of not receiving financial support from Enterprise Ireland? o Include information on any additional economic benefits to Ireland (local suppliers, etc). Type here ...(Max 1500 characters) Regional Enterprise Development Fund Feasibility Study Page 4 of 5 12. Declaration by Authorised Officer of the Applicant (Note: All questions must be answered, declaration signed and dated otherwise the application will be deemed incomplete). DECLARATION BY APPLICANT An applicant is required to declare if they have or will receive funding from another source for this project. Other sources of funding Amount € Restrictive Measures in Force The Company represents and warrants that it is not directly or indirectly, by way of funding or shareholding, covered by the European Council decisions, (2014/386/CFSP) and (2014/512/CFSP), (extended to 31 January 2016 and 23 June 2016 respectively) concerning restrictive measures in respect of actions undermining or threatening the territorial integrity, sovereignty and independence of Ukraine. For further information see: http://eeas.europa.eu/cfsp/sanctions/docs/measures_en.pdf Name of Company’s Authorised Officer/ Applicant: .... Date: .... Checklist of Information Needed by EI Document Note Application Form. Formal Enterprise Ireland Application Form (this document). Please provide all information in soft copy, where available The application form must NOT be a pdf document. When the application has been completed, it, along with the additional information listed, should be emailed to: Submission of Applications [email protected] Please note, for successful applicants, only eligible expenditure incurred after the call close date of 9th June 2017 will be considered for funding by the approval Committee. Regional Enterprise Development Fund Feasibility Study Page 5 of 5
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