Application Form

APPLICATION NOTES
ELIGIBILITY
2.3.1 Project Eligibility
The POC grant will be awarded through a competitive application process. Project Applications MUST
fall within the focal sectors (thematic areas) supported by the CCIC:
FOCAL SECTORS
TYPICAL PROJECT TYPES (not exhaustive)
Resource use
Efficiency
Waste-to-energy; materials recovery, reuse and recycling.
Water
Management:
Potable water; rainwater harvesting; efficient irrigation; waste water
treatment and recycling; water use efficiency; desalination.
Sustainable
Agribusiness
Water/energy efficient irrigation systems; waste management; high
value agribusiness; sustainable land use practices; waste to energy; wind
and solar energy for farms.
Solar Energy
Residential and commercial self-generation; residential and commercial
water heating; solar-powered air-conditioning.
Energy Efficiency
Lighting; household appliances; air-conditioning; commercial cooling and
ventilation systems; consumer behaviour; building energy management
systems; building design and materials.
Grants may not be made to activities or industries that are prohibited by the country in which the
applicant is based.
2.3.2 Applicant Eligibility
Grants are available to individuals and registered business entities nationals or registered in the
following countries: Antigua and Barbuda, Bahamas, Barbados, Belize, Dominica, Grenada, Guyana,
Jamaica, Montserrat, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname
and Trinidad and Tobago. Only one application will be considered from each applicant.
Staffs of the CCIC, CARIRI, SRC, the CCIC Management Committee, the Grant Evaluation Committee
and their immediate families are not eligible for award of POC grants.
2.4
Allowable costs
The POC grant activities may greatly vary across entrepreneurs. This will have bearing on what is
allowable under each circumstance. However, the critical rule will be that such costs are integral to
delivering the POC and reasonable. They may include:
a)
External fees and labour costs
b)
Prototype development including design, testing, and field trials.
c)
Market testing,
d)
Raw materials and consumables necessary to achieve proof of concept.
e)
Equipment/software necessary to achieve proof of concept.
f)
Costs in relation to applications for Intellectual Property Rights (IPR) in the Caribbean
g)
Travel, international and local, if the applicant can justify and demonstrate that these
costs are directly linked to the objectives of the project.
2.5
Specific exclusions
The following costs are not eligible for funding by POC grants:
a) Staff Salaries
b) Commercial marketing and selling costs
c) Costs incurred before the award of the grant
d) Costs of legal incorporation
e) Purchase/rental of non-critical assets (e.g. buildings, vehicles and furniture).
f) Construction of infrastructure except where inextricably linked to proof of concept.
g) Utilities
h) VAT/GCT (only if the beneficiary is registered for this tax)
The Management of the CCIC during the course of the POC grant administration may determine other
activities/costs to be ineligible for support.
2.6
Other financial considerations
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Funds will be disbursed in accordance with a signed Grant Agreement. In general, the amount
of grant awarded will be disbursed in 2-3 tranches except in circumstances where this
arrangement is not feasible.
The entrepreneur must set up a new bank account which will be used exclusively for POC
Grant funds
Procurement using POC grant funds shall adhere to the principles of “prudent shopping”;
Entrepreneurs must obtain three quotations for each purchase except where this is not
feasible.
Purchases should be made from the supplier offering best value; if this is not the least
expensive option the entrepreneur must justify the choice.
All expenditure must be approved by the CCIC before being made.
The CCIC takes no shares, options, warrants or debentures nor does it expect repayment
Application Form for Proof of Concept (PoC) Grant
SECTION A: GENERAL INFORMATION
Reference Number (issued by CCIC):
Applicant details
A1
Name of your innovation/business idea:
A2
Your name:
A3a
Fill in section A3a if you represent a company
1 Name of Company:
2 Your title/ position:
3 Year Registered & Reg. Number:
(a copy of the Certificate of Registration must be attached)
4 Country of Registration:
5 Technology area (e.g. solar, biogas, agriculture, water, sanitation):
6 Full-time employees:
(7) Part-time employees:
8 Last year’s sales (where applicable): USD
A3b
Fill in section A3b if you are applying as an individual or team
1 Country of citizenship:
2 National ID number or Passport Number:
(a copy of the photo page of the document must be attached)
All applicants must fill in the sections below
A4
Postal address :
A5
A6
A7
A8
A9
Physical address:
(if different from above)
Phone numbers (landline/mobile):
Email:
Website (optional):
Total Grant Amount Requested (from PoC budget, Section G5):
A10
Application Authorisation
I confirm that I am the Principal Applicant for this proposed Proof of Concept grant application and that
the information presented in this application form is accurate to the best of my knowledge.
Signed: _____________________________
Principal Applicant
Please sign and scan this page and attach it to your electronic application
Date: ________________
SECTION B: BUSINESS IDEA DETAILS
B1
Fundamental Concept &Business idea Summary: Please clearly state the nature of the innovation
and the concept that is to be proved. Briefly describe the background to this concept,what basic need
it addresses and its relevance to the purpose and focal sectors of the CCIC – (see Eligibility- Section
2.3.1 of the Application Form notes). (500 words max)
B2
What is the end product, process or service resulting from this concept and how is it new or
innovative? (Please ensure that this is understandable by, and compelling to, a non-technical
person). (300 words max)
B3
Commercial Objectives: How will this concept be commercialised? (Please select from the following,
by deleting or adding as appropriate. If not known at this stage, please describe any other
commercial objectives) (100 words max)
1) To create a profitable company which provides products or fee-based services
2) To license or sell intellectual property
3) <Insert Other>
B4
Commercial Potential and Revenue Model: What is the commercial potential of this concept,how are
you going to make money through the business/innovation? (250 words max)
SECTION C: RELEVANT EXPERIENCE
C1
Key Individuals (list below and attach CVs)
#
Name
Role/Position
1
2
3
4
5
C2
What level of expertise do you and/or your team have in commercialisation management, project
management and/or business management? If the team lacks commercial or management
expertise, how will this be addressed? (300 words max)
C3
What relevant technology experience and qualifications do you and/ or your team have?(max 400
words)
SECTION D: INTELLECTUAL PROPERTY, LICENSES AND PERMITS
Fill in Section D only if licences/permits and/or intellectual property (IP) rights are necessary for
your business model or innovation.
D1
What licenses/ permits do you require? Which of these have you applied for/ obtained? (max 200
words)
D2
Have you secured any intellectual property (IP) rights for your business/ innovation? If yes, please
describe the status (max 200 words)
D3
Will some of the PoC grant be allocated towards IP protection? If yes, please provide details.
(Funding is available only for IP Protection in Caribbean countries) (max 250 words)
SECTION E: MARKET
E1
Market Demand: Please describe the customer problem your business idea or innovation proposes
to solve and/or what market demand your concept satisfies. (400 words max)
E2
Target Market and Value Proposition: Please describe the target market/ intended
customers,estimate this in terms of size and value. What evidence is there that customers will pay
for this technology, product or service over what is already available in the marketplace? Describe
any existing interest from customers. (500 words max)
E3
Competition: Please identify and describe potential and existing competitors in the market place.
What are their strengths and weaknesses? (400 words max)
E4
Competitive Advantage: What is your unique selling point? What makes your proposition more
compelling than existing alternatives or alternatives currently in development? (200 words max)
E5
Route to Market: What is the expected route to market and what channels will be used to reach
customers? Identify any potential customers/licensees that have been contacted. Are there any
relevant partnerships and connections that exist or need to be made? (300 words max)
E6
Market Information Requirements: If market analysis is a key activity for this business idea, then
please outline the information you require. (300 words max)
SECTION F: IMPACTS
ENVIRONMENTAL IMPACTS
F1
How will your business/ innovation benefit the environment? How will these impacts be quantified
and measured? (max 300 words)
F2
Please describe any negative impact your business/ innovation may have on the environment. How
will these potential negative impacts be mitigated? (max 200 words)
SOCIAL IMPACTS
F3
How will your business/ innovation benefit the community? How will these impacts be quantified
and measured? (max 300 words)
F4
How will your business/ innovation benefit women? How will these impacts be quantified and
measured? (max 300 words)
F5
Where the information is available please estimate the following as a result of your
business/innovation:
Indicator
Materials recovered, reused, recycled
Water harvested, recycled, saved, treated, made potable
Energy saved, waste reduced
Renewable Energy capacity created
Number of new electricity connections
Number of people who gain access to clean water
Number of households who gain access to better/ cheaper food
Number of direct jobs created (total)
Number of direct jobs created for women
Number of indirect jobs created (total)
Number of indirect jobs created for women
Other (specify according to your business idea)
Value
Units
Number
Number
Number
Number
Number
Number
Number
SECTION G: CASE FOR PoC FINANCING, BUDGET AND RISKS
G1
Explain why PoC grant financing is necessary for your business/ innovation to succeed. What will a
PoC grant enable you to achieve? (max 500 words)
G2
Please provide details of any funds and/ or in-kind support that you will put towards your business/
innovation, or any funds/in-kind support that you have put towards your business/ innovation to
date. (200 words max)
G3
Time Commitment: What personal time commitment is going to be allocated to this venture? (200
words max)
G4
Please provide details of any funds and/or in-kind support that have been committed by donors/
investors/ other parties in the last 5 years (include the name of the organisation, the amount
received in USD, and the year received) (200 words max)
G5 PoC Budget and Work plan (Please complete and attach the Budget and Work plan template that is
provided.)
Risks: Please complete the table below by identifying the main risks that may impact upon the
successful completion of the business idea, the likelihood of occurrence of each risk and an outline
of a strategy for mitigating each risk. (Note that risks & uncertainties that could affect the business idea
G6
include technical risks and commercial risks as well as external factors such as market, legal, regulatory or
environmental.)
Risks
Likelihood
Risk Mitigation Strategy
(Low, Med, High)
Supporting Documents Checklist:
I have attached the following supporting documents:

Copy of company registration document (for Company) or ID card/passport photo page (for
individual)
 Signed and scanned Application Authorisation (Section A of this application)
 CVs of all key individuals
 Proof of Concept
Budget and Work Plan (Excel Spreadsheet)