APPLICATION FORM PAYBACK START-UPS by xuyuzhu

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									                APPLICATION FORM: PAYBACK START-UPS ENTREPRENEURSHIP SCHEME

Guidelines to applicants: This scheme is designed for creative start-up entrepreneurs (i.e., 0-6 months of operations) who
would like to offer innovative, unique, exciting or new products/services/business models. The scheme is a payback one, not
a grant. You are advised to read carefully the relevant details on the MBGS website (mbgs.gov.mu).

A Call for Proposals will be launched and advertised widely in early January 2012. The deadline for submission of the
Application Form together with all annexed documents is 29 February 2012. Only a maximum of 30 projects will be selected
for an interview. Applications may be submitted by email or at the address mentioned at the end of this Form.

Please fill in all sections below as requested. If you find that the space provided below is too small, please include your
answers in an annex, with appropriate references. Your application needs to be supplemented by the relevant annexes (see
bottom of page 3) when you are requested to do so.
                                                          1.   General
1. Promoter’s name and coordinates:

a. Name: ____________________________               b. Residential address:_____________________________

c. Tel (Res):__________________                     d. Office:__________________ e. Mobile:_______________

f. Fax:______________________                       g. Email:__________________          h. Website:______________

2. Designation (or proposed designation):___________________________________________________

3. a. Current occupation and employer’s name:____________________                b. Employed since when?:________

4. Highest academic qualification:_____________________________                  5. Age:_______________________

6. What is the single achievement in your proposed field of activity that you consider to be most outstanding (if
any)?
______________________________________________________________________________________

______________________________________________________________________________________

_______________________________________________________________________________
                                         2.   On the Enterprise (Basic information)

7. a. Name of Enterprise (or proposed name):_________________________________                       b. BRN:_________

c. Business Address (or proposed business address):____________________________


8. a. Status: Operational? Yes/No:____________________                b. Since when?______________

c. If not, when do you propose to become fully operational?______________________________________

8. Sector and sub-sector of activity:
[Example 1: Manufacturing - Food Processing - Dairy products]
[Example 2: Services - ICT – Mobile applications]

____________________________________________________________________________________
                                                   3.   Project description
9. Did you prepare your Business Plan (BP) alone or with the help of various experts [Please specify and annex a copy of your
BP to this Application Form. A sample BP is available on our website ]:
_______________________________________________________________________________
_______________________________________________________________________________

10. Please describe your project plan or proposed activity [in less than 50 words]
_________________________________________________________________________________
_________________________________________________________________________________



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11. [Please annex a copy of your organisational structure for: (i) Year 1; and (ii) Year 5, highlighting the key positions,
departments, responsible persons and number of staff for each department]
a. Current number of staff (if any)______    b. No. of staff when fully operational_________

12. [Please elaborate further on your financials in the relevant chapter of the BP]

a. Investment to date (if any): Rs___________          b. Proposed total investment: Rs____________

c. Expected turnover for current year: Rs_________

d. Forecast Turnover and Net Profits for next 5 years [please fill in below]:
                 Turnover (Rs)                      Net Profit (Rs)
Year 1:         ______________                    _______________
Year 2:         ______________                    _______________
Year 3:         ______________                    _______________
Year 4:         ______________                    _______________
Year 5:         ______________                    _______________
13. What will be your key revenue drivers? [Please provide a breakdown of your key products/services in your BP, as well as
their percentage of total in years 1 and 5]
_______________________________________________________________________________
_______________________________________________________________________________

14. What are your credentials in the proposed or related field of activity [e.g., what specific expertise and/or qualification do
you possess that will enable you to succeed in this venture?]
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________




15. On a separate page, to be annexed with this Application From, or to be included in your BP, please present a detailed
timeline in tabular/Gantt-Chart form to show the following (as a minimum): List of activities and sub-activities that will be
conducted by you/your enterprise as from the time you are awarded the scheme by MBGS. Please include (among others)
the preliminary tasks to be undertaken and the expected timeframe; key milestones that need to be achieved and by when
(e.g., obtaining permits, licenses, EIA, etc); who will be involved in the team and who will conduct what?

Included on a separate page or in Business Plan? [Please specify]_____________________________

16. Please demonstrate how your business will not suffer from cash flow problems during the first 18 months of operations.
[Include in your BP detailed cash flows for the first 12 months and for the subsequent 4 years]
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

                                4.   Innovation, Creativity, Technology, and Business Model
[This new scheme is designed for innovators and game changers, those who want to do things in smart ways using the latest
technologies, and those who want to leverage the use of smart business tools to succeed globally. Your answers to Questions
17 to 20 will be critical in the assessment of your application.]
17. What are the innovative aspects of your business? In what way is it different from what your direct or indirect
competitors are doing? What are the new advancements being proposed?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

18. Demonstrate that you have the right brain stuff that smart companies are currently harnessing to generate top-line
growth.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________



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19. To what extent is use of the latest available technologies part of your business model?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

20. In what ways is your business model creating value for your customers (as compared to more traditional options?)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

                                                            5.   Other
21. What will be your personal involvement in the project during the next five years? [Please tick]
                                             Y1    Y2     Y3    Y4     Y5
                   Full-time:
                   Part-time :
                   Other [please specify]:______________________________________________
________________________________________________________________________________
22. Indicate how you plan to protect your intellectual assets/capital:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
23. Success in business requires not only technical and marketing skills but also leadership skills. Please provide two
examples which best demonstrate that you have the required leadership skills to succeed in business.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________



Summary of annexes to accompany this Application Form: (1) Copy of your ID; (ii) Copy of BRN; (iii) Copy of your BP (similar
to sample available on the MBGS website); (iv) Organigram (Y1 and Y5); (v) Timeline/Gantt Chart for project
implementation; (vi) Any other page you want to add to supplement your answers above, or in case space above is not
sufficient (please provide appropriate reference).




Declaration: I certify that the information provided in the Application Form and the annexes are correct to the best of my
knowledge.
Signature:                                                                             Enterprise seal:



Authorised enterprise signature:                                                        Date:
For official use:




                                   th
                MBGS Office: 4 Floor, DBM Building, Chaussée Street, Port Louis, Mauritius
                           Tel: +(230) 211-0641 / 212-9818; Fax: +(230) 213-3080
                    Email: mbgs@mail.gov.mu                Website: http://mbgs.gov.mu




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