Screen Tasmania
Application Form
4.4Business Travel
SECTION A : GENERAL INFORMATION
Applicants must make contact with a Screen Tasmania project officer prior to submitting applications. The allocation of project officers is subject to availability and workload.
This application form should be completed in compliance with Screen Tasmania’s 4.4 Business Travel Guidelines, General Guidelinesand Terms of Trade. Please refer to these guidelines for the specific requirements of your application.
Please provide the name of the Screen Tasmania Project Officer with whom you have discussed your application.
Applicant Details
Applicant 1 / Title: / First Name: / Surname:
Applicant 2 / Title: / First Name: / Surname:
Contact person / Applicant 1 Applicant 2
Contracting entity / Individual Company Other (please specify) ......
Company name (if applicable)
Contracting entity’s ABN
Is the contracting entity registered for GST / Yes No
Postal address
Street address
Contact phone / Mobile
Email / Website
Is your application related to a Screen Tasmania Initiative? / Yes No
If yes, which one?
SECTION B : EVENT INFORMATION
Name of Event
Location
Date(s)
Brief description of market event, film festival or market meetings that you wish to attend
Purpose of Travel
Market / Market Meetings / Festival or Awards Ceremony
Please go to Section C / Please go to Section C / Please go to Section D
Rationale for travel
Outcomes
Please describe the key outcomes you expect to achieve from travel
SECTION C : MARKETS AND MEETINGS
Project List
  1. Please list projects that you are pitching and selling in the table below. Please attach more detailed information on each project as per the checklist included at the end of this application form

Title / Type
Eg. Feature Film/ TV Drama Series/ Documentary / Purpose
Financing/Packaging/Selling/Completed / Key Cast / Key Crew / Proposed Budget
$AUD / ANZ Marketplace Attachment
Yes No
Yes No
Yes No
Yes No
  1. Please attach an itinerary and proposed list of meetings as per the checklist

SECTION D : FESTIVALS AND EVENTS
Festival Screenings
Has your project been nominated for an award? / Yes No
If yes, please provide details in the table below
Project Title / Type of Production / Screen Tasmania Investment / Award/Screening category / Screening date(s)
Have you been invited to attend the festival? / Yes No
If yes, is the festival contributing to costs? / Yes No
If so, please provide details
SECTION E : FINANCIAL INFORMATION
Budget Details
Category / Screen Tasmania Requested / Applicant contribution / Other funding
Airfare
Accommodation
Airport Transfers
Registration Fee
Travel insurance
Marketing/publicity expenses
Other – Please specify
Total
Amount sought from Screen Tasmania / $
Amount sought from 3rd party organisations / $
Total cost of Trip / $
Please include information of any other funding you have received from this fund during the past financial year
Date / Market Event/Festival attended / Amount Screen Tasmania funded
SECTION F : CHECKLIST
Please submit one electronic copy and two hard copies of the following:
a completed application form
a confirmed schedule of meetings
a travel itinerary
a statement detailing the projects the applicant will be promoting on the trip, including information regarding the development history of each project including the current stage of development and anticipated outcomes of meetings/market attendance
for each project the following must be provided:
  • a one page synopsis
  • a statement detailing the applicant’s plans for financing the project
  • evidence of market place interest in the project
  • copy of the option agreement and/or evidence of chain of title (as applicable)
  • a statement articulating the economic and cultural benefits of each project to Tasmania
letter of official selection and invitation for festivals (if relevant)
curriculum vitae of the applicant, detailing industry experience and training including a statement demonstrating a commitment to working in the Tasmanian film, television or digital media industry
copies of marketing materials/posters/pitch books intended for market
any other supporting material or documentation that may assist Screen Tasmania in considering the application, for example, audio, visual material. Screen Tasmania will accept material on DVD, CDROM and similar media using industry standard formats where appropriate
additional materials attached: (please specify)
SECTION G : DECLARATION & SIGNATURE
Publicity of Assistance
Unlike private sector financial organisations, the Department of Economic Development, Tourism and the Arts (the department) disburses public funds and is therefore accountable for the distribution of those funds. As part of the accountability process, the department may publicise the level of its financial assistance including the terms and conditions of the financial assistance as provided in the confidentiality requirements set out in the legal documentation entered into with you.
Right to Information
You should also be aware that information you provide to the department, and details of any financial assistance package, may be subject to requests for public disclosure under theRight to Information Act 2009 provided that information is not subject to the confidentiality requirements set out in the legal documentation entered into with you.
Personal Information Protection

Personal information will be collected from you for the purpose of undertaking the department’s activities. Your personal information will be used for the primary purpose for which it is collected and may be used for other purposes permitted by the Tasmanian Development Act 1983 and may be disclosed to contractors and agents of the department or affiliated bodies, and other organisations authorised to collect it.

Your basic personal information may be disclosed to other public sector bodies where necessary for the efficient storage and use of the information.

Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to the department’s personal information protection officer on (03) 6233 5888. You may be charged a fee for this service.

Have you read and understood the confidentiality regulations above? / Yes No
Screen Tasmania is required to identify all relevant financial or personal interests that may exist between board members or employees of Screen Tasmania and applicants. This is to ensure that measures can be introduced to prevent a conflict of interest arising between those persons assessing the application for Screen Tasmania and such applicant. For these purposes please select the relevant statement below:
I (the applicant and my colleagues on the project) do nothave a financial and/or close personal relationship with a board member or employee of Screen Tasmania
I (the applicant and my colleagues on the project) dohave a financial and/or close personal relationship with a board member or employee of Screen Tasmania. The nature of such relationship is:
I/we acknowledge this submission in no way inhibits or prejudices Screen Tasmania from becoming involved in or developing other projects which may or may not have various similarities with my project.
No agreement, arrangement or obligation shall be deemed to exist between Screen Tasmania and myself/us unless and until a formal contract is made between us.
SECTION G : DECLARATION & SIGNATURE cont’d
I/we are aware that in the event of this application being approved, no contracting will occur until Screen Tasmania has been provided with copies of executed documents giving the contracting party the right to exploit the material being the subject of the application either by way of assignment of copyright or an opinion.
I/we state the details provided in this application are true and correct.
Signature / Print name
Signature / Print name
Witness / Print name
Date / ……..…/……..…/……..…

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SECTION H : STATISTICAL DATA
Screen Tasmania is compiling statistics on applications for its funding programs. To assist us, we appreciate the completion of the form below and return it with your application.
This information is removed prior to processing of applications and is only used to generate aggregated statistics.
Date of application / ……..…/……..…/……..…
Gender / Female Male
Country of birth
If you are a Tasmanian resident, what area of the state do you reside in?
Are you of Aboriginal or Torres Strait Islander descent? / Yes No
Do you speak a language other than English at home? / Yes No
If yes, please specify language/s spoken at home.
How well do you speak English? / very well well not well not well at all
Do you identify as having a disability? / Yes No
If yes, please provide further details.