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)

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Name / Type* / Share Class / % Shareholding / Amount Invested
Total

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o  Identify any connected companies and related parties and outline their relationships.
Type here ...(Max 1000 characters)

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)

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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)

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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
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

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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.

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10. Sources of Funding

Provider / Amount

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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)

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.

Submission of Applications / When the application has been completed, it, along with the additional information listed, should be emailed to:

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.

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