Fillable Trpsi Fillable Application Form

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Trpsi Fillable Application Form

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1
Department of Agricultural Environment and Rural Affairs
GUIDANCE NOTES ARE PROVIDED FOR EACH QUESTION. YOU SHOULD READ THESE
CAREFULLY BEFORE ANSWERING THE QUESTIONS
General Data Protection Regulations (GDPR) - When you apply for Rural Business
Development Capital Grant Pilot Scheme we will ask for some personal information because,
for example, your personal email address or telephone number is used on the applicant
organisation’s behalf. When you provide this information it is processed in adherence with
the GDPR, Data Protection Act 2018 as well as the scheme’s Terms and Conditions to enable
us to communicate with you about the application.
Only fully completed application forms submitted with the required documentation (as
per checklist at end of application) will be considered. Any application submitted with
missing information or incomplete questions will be deemed incomplete and subsequently
rejected.
The closing date for receipt of applications is 12noon on Wednesday 18
th
December 2019.
Applications should be submitted to their local Council via the method listed in the guidance
notes. Applications submitted after this date/time will not be accepted.
For Official Use Only: To Be Date Stamped on Receipt
Date / Time
Received:
Application
Ref:
RBDS -
Acknowledged
by:
Method of
Delivery
Email
Hand/Post
Tackling Rural Poverty and Social Isolation (TRPSI) Programme
Rural Business Development Grant Pilot Scheme
APPLICATION FORM
2
Applicant Details
(a) Name of Organisation: ______________________________________
(b) Organisation/Individual Contact Details:
Contact name
Address
County
Post Code
Tel Number
Mobile Number
E Mail Address ________________________________________
Website ______________________________________
(c) What term best describes your organisation (select 1 option)
Sole Trader HMRC Self-Assessment Number ________________________
Limited Company Company Number ___________________________________
Business Partnership HMRC Self- Assessment Number for each partner:
__________________________________________________
__________________________________________________
__________________________________________________
Other Describe status and provide detail of business registration:
_________________________________________________________________________
Q2 Business Overview
(a) What date was your business established? ____________________
(b) If your business is located at a different address to Q1b, please provide your
business address:
______________________________________________________________________
3
(c) Provide an overview of your current business activities (Products / services offered,
types of customers, any export)
(d) Please provide the number of employees involved in your business, including
yourself:
* Full-time employee must work at least 30 hours per week
(e) What was your sales turnover last year?
Last financial year: £_________________
If you have been trading for less than 1 year, provide your sales to date: £______________
Male
Female
Male
Female
Permanent
full-time*
Permanent
part-time
Temporary
full-time
Temporary
part-time
Maximum 500 words
4
Q3 Project Details
(a) Project Title: ___________________________________
(b) Project Description: Please describe your project and detail any new business
activities, customers or markets that you intend to target.
(c) Please describe the need for your project:
Maximum 500 words
Maximum 500 words
5
(d) The focus of this grant scheme is to sustain existing rural businesses, and support
business growth, improve business efficiency and promote innovation in businesses.
Please tell us what the anticipated outcomes of implementing the project will be over
the next 12months. Please complete all boxes that apply to your business/project:
Please tick if
appropriate
Please provide specific detail on the impact this grant will
have on your business in the relevant sections below
Existing jobs will
be sustained
New jobs will be
created
Sales turnover
will increase
Business will be
more efficient
Increased
innovation in the
market place
Increased
innovation in my
business
Export sales
outside of NI will
commence/
increase
6
(e) What skills and experience do you have which are relevant to your project or
business? Please include details of any other external support you have received to
set up or develop your business (eg Go for It Programme, business mentoring etc)
Q4 Project Costs
(a) Is your business VAT registered? YES / NO
If yes, please provide the VAT registration number:
*If you are VAT registered, TRPSI funding should be applied for against the Net cost. You do not need to
complete the VAT and gross cost column. If you are not VAT registered, you should complete all columns and
you may apply for funding against the gross cost. Maximum grant request is 50% grant rate up to £4,999.
(c) Please provide details of all sources of funding for the project:
(b) Breakdown of costs:
Item
Net Cost (£)
VAT Amount
(£)
Gross cost (£)
TRPSI Funding
Applied for (£)*
Total Cost
£
£
£
£
Source of funding
Name of Funder
Current status of
application
Total Amount
applied for £
TRPSI Scheme (this
application)
DAERA
Submitted
Own resources –
cash
Self
Maximum 500 words
7
(d) Please confirm that you can purchase the item(s) in full before claiming funding
back against the item: Yes No
Q5 Previous Funding
(a) Have you / your business been awarded any other grant assistance within
the last four years, eg NI Rural Development Programme or Invest NI?
YES NO
If YES, please provide the following information:
Name of Funding
Programme
Date of Letter of
Offer
Date of Receipt of
Grant
Amount of Grant
Received
Please note that you must also complete the De-Minims Aid Declaration at the end of this
application form.
Q6 Project Timescales
To be eligible for grant aid, you must be able to complete your project in a short timeframe,
between Letter of Offer issue (anticipated mid-February 2020) and 31
st
March 2020. By 31
st
March, all works must be completed and onsite and must be fully paid and cleared the bank.
Your claim for payment must be submitted to your local Council by 28
th
April 2020.
Please confirm if you can complete your project as described by 31
st
March 2020 and
submit your claim by 28
th
April 2020:
Yes No
Own resources –
loans
Other – please state
TOTAL (this should match the total cost listed above)
£
8
Q 7 (a) Does you project involve any building works to your premises?
Yes No
If no, please proceed to question 8.
(b) Is planning permission required for your project? Yes
No
If required, this must be in place at the time of submitting your application for funding and a
copy must be provided with your application form. The onus to ensure necessary statutory
approvals are obtained and in place lies with the applicant.
(c) Is building control applicable? N/A / GRANTED / APPLIED FOR / STILL TO APPLY
(d) Do you own or lease the land /building in which the works are to be carried out?
Own land/building
Lease, for minimum period of 5 years
Please note, that a 5 year lease is the minimum requirement for this project. Shorter lease
periods cannot be considered for projects applying for building works to alter premises.
Q8 Would you like to be registered onto your local Councils Economic Development
Database to be kept up to date with other relevant programmes and initiatives?
Yes
No
CHECKLIST
Please ensure you have:
Filled in all parts of the form, including Annex A
Provided copies of all quotations as detailed at Annex A
A copy of most recent Bank / Building Society Statement for account used by the
business
Provided a copy of your 5 year (minimum) lease/ proof of ownership
(only for projects involving work to buildings / land)
Provided a copy of your full planning permission
(only for projects involving work to buildings / land and if required)
Provided additional pages, where appropriate.
9
DECLARATION
(a) Application
I declare that all of the information provided in this application and
accompanying documents is true and correct.
I confirm that I am age 18 or above.
I confirm that the project detailed in the application has not commenced.
I confirm that I can complete this project by 31
st
March 2020 and it will be
paid and cleared through the bank account used by my business by 31
st
March 2020.
Signed by Applicant: ___________________________
Print name: ___________________________
Date: ___ / ___ / ___
Position held: ___________________________
10
(b) De Minimis Aid Declaration
Financial Assistance awarded under the Rural Business Development Grant Pilot Scheme is
classified as De Minimis Aid as set out in European Commission Regulation (EU) No 1407/2013 of
18 December 2013 on the application of Articles 107 and 108 of the Treaty on the Functioning of
the European Union to de minimis aid. If you have received other de minimis aid from
Government Departments, Intertrade Ireland or Local Councils over the last 3 years this might
impact on your eligibility to receive mentoring support.
The maximum amount of de minimis aid that an undertaking can receive within a 3 year fiscal
period in the UK is €200,000. Where an undertaking is part of a group, linked either though
limited companies or individual shareholders, the de minimis limit may apply to some or all of the
combined group and not just individual undertakings.
To allow us to determine whether awarding this grant will breach this limit, please complete the
table below that details the date and value of any de minimis aid the company has received
during your last 3 fiscal (accounting) years. Where the Company is part of a group, please
complete the table for all group companies.
Please note that it is your responsibility to check whether the support you have received was
classed as ‘de minimis’ aid. If in doubt, please check with whoever provided you with the
support.
Has the company (or any company within the Group if applicable) received
any form of public support or grant that was classed as de minimis in the last 3
years?
If ‘Yes’, please provide detail in the table below:-
Yes
No
Date support/grant funding
awarded
Funding body
Purpose / Scheme
Amount
Total
What is the date of the end of your accounting (fiscal) year (dd/mm)?
Declaration
I confirm that:
The details provided on this form are current and accurate to the best of my knowledge.
The company is solvent and no distress or execution has been levied against it.
I understand that completion of this form neither entitles nor requires me to take part in any
business support scheme in the future.
Signed on behalf of
applicant
Print Name
Position
Date
11
The closing date for receipt of applications is 12noon on Wednesday 18
th
December 2019. Applications submitted after this date/time will not be
accepted.
WARNING
To knowingly or recklessly make a false statement to obtain aid for yourself or anyone else, will
lead to disqualification, liability to refund of any aid already paid and possible prosecution.
The information provided on this form may be made available to other Departments/Agencies
for the purposes of preventing and detecting crime.
DAERA FRAUD HOTLINE 0808 1002716
Data Protection and Freedom of Information Issues
DAERA and our delivery agents take data protection and freedom of information issues
seriously. We take care to ensure that any personal information supplied is dealt with in a way
which complies with the requirements of the Data Protection Act 2018 and the General Data
Protection Regulation. This means that any personal information you supply will be processed
principally for the purpose for which it has been provided. However, DAERA may also use it for
other legitimate purposes in line with the Data Protection Act 2018 and Freedom of Information
legislation. These include:
•
Occupational health and welfare;
•
Compilation of statistics;
•
Disclosure to other organisations when required by law to do so;
•
Disclosure under the Freedom of Information Act 2000 or the Environmental
Information Regulations 2004 where such disclosure is in the public interest;
•
The prevention and detection of fraud or maladministration (e.g. The Comptroller &
Auditor General and HM Revenue & Customs).
For further details on your privacy see the DAERA Privacy Statement (www.daera-ni.gov.uk/daera-
privacy-statement)
The Rural Business Development Grant Pilot Scheme is funded by the
Department of Agriculture, Environment and Rural Affairs (DAERA) as part of
the Tackling Rural Poverty and Social Isolation (TRPSI) Programme.
12
The Rural Business Development Grant Pilot Scheme is funded by
the Department of Agriculture, Environment and Rural Affairs
(DAERA) as part of the Tackling Rural Poverty and Social Isolation
(TRPSI) Programme.
The Scheme is being administered by local Councils.
13
Evidence of Value Annex A
Please use this form to provide detail of the quotes that you have obtained in respect of the individual items you wish to purchase. You must also
submit the actual quotes with your application. An example has been provided in the first line. Continue on a separate sheet if necessary.
Please note:
At least 2 quotes from 2 separate suppliers should be sought for each item. You or a business that you are an owner/partner/director of, are excluded from
quoting for the supply of goods, services or works to a project that you may be offered funding for.
If quotations are being sought, or provided from any member of your family or extended family then the relationship must be advised to the Council prior
to any procurement activity and declared in writing on the procurement documentation. In these cases you are required to provide 3 quotes i.e. two
independent quotes in addition to the family member quote to provide sufficient comparison of costs under the reasonableness of costs rules within the
programme.
Quotes should be ‘like-for-like’; particularly where items are specific e.g. laptop / IT / machinery etc. Quotations for the same make and model of products
must be provided. Email quotes are acceptable and should include any covering email.
Quotes must be dated prior to close of call and contain the supplier’s name.
Internet searches should be printed off and sent with your application – we will not accept website addresses / links to websites.
The lowest quotation should be selected with corresponding costs detailed on the application form.
Please note that DAERA will reimburse at the cost of the lowest quotation.
ITEM
ESTIMATED COSTS – QUOTES RECEIVED
PREFERRED SUPPLIER
COST
Supplier 1
Quote
Supplier 2
Quote
Example:
Printer, Model XYZ Windows 10
ABC Printers Ltd
£205.12
Printers R Us
£210
ABC Printers Ltd
£205.12
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Trpsi Fillable Application Form

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Completed 19 July 2020

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