(Lag Name) Leader

Project Reference: Date Received: Date Approved:

Please consult the additional LEADER Grant Application Note when completing this form.

1.1 / Project Title
1.2 / ProjectType / Standard Project / *tick if applicable
1.3 / Standard Project Sub Type
(Tick ONE as appropriate) / Community / *tick if applicable / Enterprise / *tick if applicable
Farm Diversification
(Please complete section 3.4 for Farm Diversification.) / *tick if applicable

Part 1: Project Overview

1.4 / Estimated Project Start Date(dd/mm/yyyy)
1.5 / Estimated Project End Date(dd/mm/yyyy)
1.6 / Estimated Project Financial End Date (dd/mm/yyyy)
(Final project payment date no later than 31stDecember 2020)
1.7 / Total Cost Of Project / £
1.8 / Eligible Costs / £
1.9 / Grant Requested From LEADER / £

Part 2: ApplicantDetails

2.1 / Senior ApplicantName
Position/Title
Applicant Address
Postcode
Contact Telephone Number
Alternative Contact Telephone Number
Email Address
Main Contact Delete as applicable* / Yes / No*
2.2 / Additional Applicant/Agent name
Position/Title*
Applicant Address
Postcode
Contact Telephone Number
Alternative Contact Telephone Number
Email Address
Main Contact Delete as applicable* / Yes / No*

N.B.If you are an Agent complete form PF/05and attachBusiness Mandate Form

Part 3: Organisation details- (For Organisations only)

3.1 / Organisation Business Name
Website Address (If applicable)
Company Registration Number
Business Reference Number (BRN) (Used for payment purposes) / BRN:
Date Formed (dd/mm/yyyy)
Main Activities
Trading? Delete as applicable* / Yes/No*
Organisation VAT Registered? Delete as applicable* / Yes / No*
VAT Registration Number
VAT Notes
3.2 / Organisation Type (Tick only ONE that applies) (x) / Organisation number
Company limited by guarantee
Constituted group
Public body
Private business
Sole Trader
Charity
Scottish Charitable Incorporated Organisation (SCIO)
Other (please specify)
3.3 / Organisation Sub-Type(main area of activity) (x)
Religious
Education
Cultural/Historical
Training
Health
Scientific
Agricultural
Sporting/Recreational
Youth/Community/Voluntary
Other (please specify)

Please complete section 3.4 for Farm Diversification.

3.4 / Farm Diversification Project? (delete as appropriate*) / Yes/No*
If yes please provide the Main Location Code of the activity (Use part11 for additional sub-codes)
If yes please provide the Land Parcel Identification (LPID) (Use part11 for additional LPID(s))
3.5 / Delivery Staff – please list personnel involved in this project detailing relevant skills
Name / Job Title / Job Description / Skills

Part 4: Partnership details

4.1 / Do You Have A Partnership Agreement?
(Delete as Appropriate*) / Yes/No*
4.2 / Other PartnershipsInvolved In Managing Or Delivering This Project?
Please give details below
Name / Address / Post Code
Partnership Type / Organisation Type
Partnership Type / Organisation Type
Partnership Type / Organisation Type
4.3 / Partnership Details
Details of main activities :–
Details of partnership involvement :–
Partnership Formed (dd/mm/yyyy)

Part5: Project details

5.1 / Where Will The Project Be Happening?
Please supply any Locale, District, Postal or Datazone information.*
5.2 / Project Summary. (Summarise your project as concisely as possible, including fit with Local Action Groups LDS and any background information)
(a)Project Summary (Max 2000 characters)
(b)Fit with Local Development Strategy (Max 2000 characters)
(c)Project Aims and Objectives (Max 2000 characters)
(d)Project Activities (Max 2000 characters)
5.3 / Does Your Project Require Planning Permission Or Any Other Statutory Consent? (delete as appropriate*) / Yes/No*
If YES, please detail below
Description / Reference Number / Date Expected / Date Received

Part 6: Project Results, Outputs and Outcomes

ListOf Project Results, Outputs And Outcomes
RESULT
e.g. 50 new trainees / OUTPUT
e.g. Number of Recruitment events / OUTCOME
e.g. Improved job prospects

Part 7: Project Milestones

7.1 / Summary of Milestones from ‘Milestone/Cash flow spread sheet’
Milestones / Date to be Achieved (dd/mm/yyyy) / Total Value £
TotalMilestoneCosts £

Part 8:State Aid

8.1 / State Aid Rules Apply(delete as appropriate*) / Yes/No*

*Pleasesee Section 8 of the guidance notes regarding state aid.

Previous Funding and State Aid

Has your organisation received any previous LEADER, European or public funding from any source over the last three years? If so, was it awarded under de minimis?

Please give details in Table 8.2.

8.2 / Details of ANY previous State Aid received
Awarding body / Funding Type / Year of award / Funding Value (£) / Project Name/Brief Description / De-minimis
Y/N

Part 9: Project Finances

9.1 / Details of Matched Funding
Source/Organisation / Confirmed Yes/No(Delete as Appropriate*) / Date Due
(dd/mm/yyyy) / Date Received(dd/mm/yyyy) / Amount Due
£ / Total Received £ / Type
Public/Private
Yes/No*
Yes/No*
Yes/No*
Yes/No*
Yes/No*
Yes/No*
Yes/No*
Total £
LEADER grant requested £
Total £
(This should be the same as to Total Milestone Costs in Part 7.1)
9.2 / Is Your Project Likely To Generate Any Revenue/Income?
(delete as appropriate*) / Yes/No*
If yes, please give details of anticipated net amounts, dates and sources
Description / Date / Net Amount £
Description (…continued) / Date / Net Amount £
9.3 / Please complete the ‘Financial cashflow projection / Milestonesspreadsheet’ / See separate sheet.

Part 10:Signature and Checklist

10.1 / Checklist.Please make sure you enclose copies of the following: / Please indicate (x)
1 / Constitution or articles and memorandum
2 / Committee members or list of directors
3 / Permissions – planning etc
4 / Policies – child, risk, equal opportunities etc
5 / Bank statement
6 / Photo Identification (Passport / Driving Licence or official source)
7 / Organisation – Company Registration Certificate
8 / Project plan
9 / Insurance
10 / Research / evidence of need and demand
11 / PF05 Form (Business Mandate form)
12 / If VAT Registered; VAT Certificate
13 / If not VAT Registered; proof not registered, e.g. Letter from Organisation's accountants
14 / Milestones spread sheet
15 / Financial cash flow forecast spread sheet
16 / Financial Accounts (contact your local LEADER office for guidance)
17 / Confirmation of match funding if available
18 / Partnership Agreement
10.2 / Declaration
I declare that the information I have given on this form is, to the best of my knowledge and belief, accurate and correct and I hereby authorise theLocal Action Group accountable body or any person authorised for that purpose by the accountable body to make any enquiries necessary to verify the facts.
I understand that if I knowingly or recklessly provide information that is false or misleading in any material particular, I may be prosecuted.
I also understand that if I provide false or misleading information, that may disqualify me from LEADER funding or result in the recovery of any funding already paid and other financial penalties.
I undertake to notify any material changes in the information I have given above to the Local Action Group who has provided the LEADER funding.
10.3 / Senior ApplicantAuthorised Signatory
Signature: / Print Name / Date
10.4 / Chairperson or Organisation Equivalent (If different from above)
Signature: / Print Name / Date

Part 11: Any Other Information?

11.1 / Use this section to provide us with any relevant and supporting information.

Privacy notice

The information that you provide to LEADER will be used to process your application and administer funding appropriate to meeting the aims of the Local Development Strategies. We will store your information as long as that information is required to fulfil the requirement of the LEADER programme.

Your information will be shared with:

Accountable bodies who have delegated responsibilities from Scottish Ministers for administering LEADER – these will be local authorities and National Parks.
Local Action Groups who are responsible for managing the Local Development Strategies and monitoring progress of LEADER in their areas – these will be made up of public sector organisations, businesses, third sector organisations and community groups.

You can find out more about LEADER at

We will use your contact details to provide you with information about the progress of any application you make or for other purposes to do with the administration of LEADER.

We would like to contact you about other opportunities that LEADER may provide to you and/or your community by post, telephone or email. If you agree to being contacted in this way, please
tick the relevant boxes below.

Telephone Email Post

If you need further information please contact your Local Action Group.

Please also refer to the Scottish Government Privacy Policy on how personal information is used and looked after when administering rural grant and subsidy schemes. This can be found at

You have the right to request a copy of the information that we hold about you.

If you would like a copy of some or all of your personal information please email or write to your Local Action Group.

Find your Local Action Group address at

We want to make sure your personal data is accurate and up to date. You may ask us to correct or remove information you think is inaccurate.

For LAG Office use only.

Project reference number / Date received
Local Development Strategy target thematic objective
Focus Area
Project approved
(delete as appropriate*) / Yes/No* / Comments
Project Area
(delete as appropriate*) / OTHER* / TRANSITION*
Project Sub Measure
Intervention Rate / %
Actual Start Date / Actual End Date
Actual Financial Start Date / Actual FinancialEnd Date
Economic Activity*(delete as appropriate) / *Yes/No / Investment Priority
*(delete as appropriate) / *Yes/No
State Aid Information
State Aid Rules Apply
*(delete as appropriate) / *Yes/No / Intervention Rate applied / %
Aid Amount / £
Public Contribution / £
State Aid Details
Type of State Aid
LAG Project Activity
Rejected by
Date Rejected
Reason for Rejection
Details
Approved by
Date Approved
Withdrawn by
Date Withdrawn
Reason for Withdrawal
Details

LEADER Grant Application Form 2014-2020 v1.1 – 16 February 2016Page 1