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					Instruction for completing the Department of Employment and Workplace Relations Financial Viability Assessment Forms
MUST BE COMPLETED BY:  All organisations that did not receive CDEP funding in 2004-05. Note: if your organisation received CDEP funding in 2004-05 you do not have to complete this form as the financial viability assessment will be made on information already submitted to DEWR. However, you will need to sign and complete a Financial Declaration Form. Financial Viability Assessment If you are lodging an application for Community Development Employment Projects (CDEP) programme funding with the Department of Employment and Workplace Relations (DEWR), then, as part of the risk assessment process and consistent with Commonwealth procurement guidelines, DEWR will need to conduct an assessment of your organisation’s financial viability. The objective of the financial viability process is to determine, on the basis of information provided, if:   the applicant is financially viable; and there are any circumstances which may adversely affect the applicant’s ability to meet its contractual obligations to supply services for at least the period of the contract.

This process is used to minimise risk to the Commonwealth. This process is not used to measure the profitability of an organisation nor its potential for success.

1.

Information required from all organisations

Before DEWR’s Financial Viability Team can commence a financial viability assessment you need to:   complete the Financial Viability Assessment Information Sheet (Attachment ‘A’); complete and sign the Authorisation to undertake a Financial Viability Assessment (Attachment ‘B’); and  attach the completed Financial Viability Assessment Information Sheet and Authorisation to undertake a Financial Viability Assessment to your application along with any supporting or supplementary information. Other information to be provided    If the financial statements you provide are in a name other than that of the applicant or the accounting period has changed, an explanation must be provided; Financial statements which are audited and prepared on an accrual basis are preferred; If your organisation has recently merged with another organisation, the terms of the merger and details of ownership of assets and responsibility for liabilities must also be provided; and

1.1



If assets are recorded in the Statement of Financial Position (Balance Sheet) which are not wholly owned by your organisation, the extent of that ownership and the values are to be recorded in the notes to the accounts.

If you have access to additional funds, documentary evidence must be included. The type of information sought is documentary evidence which substantiates:    a bank loan; a line of credit; or access to financial support.

Assets should be substantiated by independent valuations, while access to a line of credit must be substantiated by an original letter from the lending institution. If a guarantee is not from a lending institution, the guarantor must provide financial statements or evidence of capacity to honour the guarantee. A copy of your Certificate of Incorporation and/or Business Name Certificate of registration must also be provided. You should note the following: Financial statements must be:    for the entity as a whole; for the entity which, if successful, will undertake the project and be contracted to DEWR; and recorded in Australian dollars.

Pages containing information of a confidential nature should be marked prominently ‘Commercial in Confidence’ at both the head and foot of the page. You should decide on the most relevant and current information to prove your organisation’s financial viability. If you are unsure of how much information to provide, it is better to provide more than necessary, rather than too little.

2.

Information required based on entity type

In addition to information required in the above paragraphs, you should also provide the following information, as relevant, based on the type of organisation you are.

2.1

Organisations that have been in operation for less than 12 months.

If the organisation has been in operation for less than 12 months, DEWR requires independent evidence supporting the financial capacity and start-up capital of the organisation. For example, this evidence may be in the form of:       a line of credit; bank or other guarantees; evidence of assets (including valuations and amounts of any prior encumbrances) the business may use as collateral; funding available from personal or associated business sources; a business (work) plan including financial projections; and other documentation which independently verify the financial resources available to the organisation.

2.2 Information required from Trusts
DEWR requires the following types of documents to assess the financial viability of Trusts:    financial statements for the Trust and related organisations (including the trustee); an explanation of loans and borrowings between the Trust, and its related organisations, (including related Trusts); and any other documentation that is considered to be of assistance to DEWR in accessing financial viability.

DEWR will also require a copy of the Trust Deed.

3.

Checks of Applicants

As part of the risk assessment process, further checks of the applicant may be undertaken. Checks are made to identify whether there is any information on public records and internal databases which may adversely affect the applicant’s ability to meet its contractual obligations. Checks are also made for non-disclosure of adverse information. You may be contacted to clarify uncertainties or to seek financial statements where your organisation’s financial year ends shortly before or during the assessment process. If your financial statements are more than 12 months old or are not audited, you may be required to provide audited financial statements or updated financial statements before a final determination is made.

Attachment A
FINANCIAL VIABILITY ASSESSMENT INFORMATION SHEET
This information will only be used to conduct a financial assessment

APPLICANT DETAILS (1) Legal name of Applicant organisation (for example organisation, trust or full
name of individual(s)).

(2)

Registered business or trading name (if any).

(3) If you have more than one business/trading name, list these other business/trading
names.

(4) Business address details. (4a)
Registered business address.

Number and Street Name……………………………………………………… Suburb/Town ......................... …………. State… ................ Postcode ………….

(4b) Principal place of business (Not PO Box).
Number and Street Name……………………………………………………………... Suburb/Town .................................. …………. State… ................ Postcode ………….

(4c) Postal address.
Number and Street Name or PO Box………………………………………………… Suburb/Town .................................. …………. State… ................ Postcode ………….

(5) Contact details for contract and financial assessment queries.
Please provide contact details for correspondence regarding this contract. Position/Title Name:

Telephone Number

FAX Number

E-mail

If different to above, please provide contact details of someone who would be available and have the authority to answer any queries about this application. Position/Title Name:

Telephone Number

FAX Number

E-mail

(6)

How would you describe the structure of your organisation? Tick ALL appropriate boxes. You may be required to provide your Articles of Association or company constitution (where applicable). Please have them available should you be contacted. Aboriginal Corporation established under the Aboriginal Councils and Associations Act 1976 Partnership Proprietary company Public company An Australian Stock Exchange listed company Company limited by guarantee Government Agency (Commonwealth/State/Local) Commonwealth/State Owned Corporation Incorporated association Unincorporated association Registered charity Sole trader Trust/Unit trust Union (recognised under Industrial Legislation)

Other – please specify.

(7) Is your organisation registered with:
    Dun and Bradstreet Number (DUNS); Australian Business Number (ABN); Australian Registered Business Number (ARBN); and/or Australian Companies Number (ACN)? provide details

No

Go to next question

Yes

State all, if applicable) ACN ABN ____-____-______ ____-_____-_____-_____

ARBN _____-_____-_____ DUNS _____-_____-_____

(8) Is your organisation regarded by the Australian Taxation Office as a non-profit
organisation? No Yes

(9) Is your organisation registered under any legislation?
No Legislation Go to next question Yes provide details

Legislation issued number

State/Territory/Federal

(10) Does your organisation intend to be incorporated under the Commonwealth
Corporations Act 2001 or any State/Territory Associations Incorporation Act prior to entering into any contract with DEWR? provide details

No

Go to next question

Yes

Date you expect to be incorporated

State/Territory of expected incorporation

(11) How long has your organisation been in operation?
Years Months

(12) Does your organisation have an accountant? No Go to next question Yes provide details

If yes, what is your accountant’s name and address? Name Address

Qualifications*:

Telephone:

* It is expected that the accountant holds professional membership of CPA Australia, the Institute of Chartered Accountants (ICA), the National Institute of Accountants (NIA) or for foreign companies, is an appropriately qualified member of an equivalent internationally recognised body.

(13) If required, may we contact your accountant to clarify any information provided?
No Yes

(14) Does your organisation have an external auditor?
No Yes provide details

If yes, what is the auditor’s name and address? Name Address

Qualifications*:

Telephone:

It is expected that the auditor is a company auditor under the Commonwealth Corporations Act 2001 or an appropriately qualified member of CPA Australia, the Institute of Chartered Accountants (ICA), the National Institute of Accountants (NIA) or, for foreign companies, is an appropriately qualified member of an equivalent internationally recognised body.

(15) If required, may we contact your external auditor to clarify any information
provided? No Yes

(16) Does your organisation have any overdue acquittals for funding received from the Commonwealth?
If your organisation has any outstanding acquittals, you may be required to acquit these prior to any contract being signed. Note the Commonwealth may not enter into a Programme Funding Agreement (PFA) with your organisation if it has outstanding acquittals.

Name of organisation which provided funding

Name of programme or scheme under which funding was provided

Funding received to date $

Unacquitted funds $

Date acquittal was due

(17) Relevant person information.
Relevant persons are persons who have direct or indirect interest in the business of the organisation with the potential to exert significant influence over its management or operation. Provide details of all directors/ partners / office bearers / chief executive officers or other relevant persons in your organisation including all partners in a partnership. Driver’s licence number

Position

Surname

Given names

Date of Birth

Place of birth (town and country)

Residential address

Number of years in position(s) of influence in your organisation

(18) Relevant person declaration for the past 5 years (from the date of this application).
If one or more of these events applies to any relevant person listed at question 17 select the appropriate box(es) and if applicable provide details. Check that all the relevant persons have provided information where appropriate. Note that in your statutory declaration you will be asked to confirm that this information has been supplied. Failure to notify relevant information may result in your tender application being rejected. Except for the last box, attach details for each box you have selected. Ensure you put at the top of the first page of each attachment:  the name of the organisation  the question number to which it refers. Choose one or more, of the following:  Government investigation of relevant person(s)      Any business failure of relevant person(s), for example, liquidation/voluntary administration/receivership Bankruptcies of relevant person(s) Bankruptcy proceedings against relevant person(s) either current, pending or during the last five years Significant litigation against relevant person(s) including judgement debts There is no adverse information on any relevant person(s) associated with this organisation

(19) Does your organisation have a contract in the current or next financial year with any public funding bodies (Commonwealth,
State, Territory or Local Government) to provide either the same or similar services to those for which you are applying? No Name of public funding body to which you are contracted go to next question Name of programme or scheme under which funding is provided Type of services your organisation is contracted to provide Yes Provide details

Contract period (Month/YYYY) Amount of funding $ Contact person at the public funding body to which you are contracted (*)

From

To

Name

Phone

(*) These people may be contacted

Supplementary and Supporting information
The onus is on you to satisfy DEWR of your financial viability. If DEWR is unable to confirm your financial viability because insufficient supplementary or supporting information has been provided, DEWR may not be able to contract with you. The following questions list types of supplementary and supporting information that may be supplied to DEWR in order to verify financial viability. Applicant should provide the most relevant information to prove financial viability.

(20) Supplementary Information.
DEWR uses this information to undertake checks of your organisation. Please tick the appropriate boxes and, if applicable, provide details of all such events relevant to your organisation for the last five years from the date of this application. You must tick at least one box. Except for the last tick box, you must attach relevant details for any box you have ticked - ensure you put at the top of the first page of each attachment the name of your organisation and the question number. Government investigation of the organisation or related entities Any significant change in the financial position of the organisation since the financial statements provided with this application Contract termination for cause Factors which might impact on your organisation such as significant litigation, business commitments, contingent liabilities, collections by debt collection agencies on behalf of creditors or liquidation proceedings Any outstanding tax liabilities Any other particulars which are likely to adversely affect your capacity to undertake this project There is no adverse information on this organisation

(21) Supporting Information.
This list is indicative of the type(s) of information you can supply in support of your organisation’s financial viability. You must attach details for any box you have ticked – ensure you put the name of your organisation and the question number at the top of the first page of each attachment. The latest three years annual reports, which should include the ‘Statement of Financial Position’ (Balance Sheet); ‘Statement of Financial Performance’ (Profit and Loss Account); ‘Cash Flow Statement’; ‘Notes to the Accounts’; ‘Director's Report’, and ‘Auditor's Report’; (if the entity has a parent or holding company the same details are required of that company, as well as its legal name, ACN, ABN, and registered business address). Please indicate below which years financial information have been included 2005 2004 2003 2002

Details of corporate and ownership structure including identification of parent entities

Letter(s) from any financial institution (for example bank or credit union) certifying an existing or proposed line of credit Copy of any guarantee or cross deed of indemnity from your organisation’s ultimate holding entity Bank or other guarantee Business references (up to three) Copy of certificate of incorporation and/or registration Minutes of last Annual General Meeting Deed of arrangement Business plans for the previous, current and future financial years (if available) Trust deed Other – please specify

(22) Organisations that have been operating for less then 12 months.
If your organisation operating for less then 12 months and historical financial information is not available, you may include financial reports or details of organisations which have formed or joined your organisation and you must explain what resources, mentioned in the financial reports, on which your organisation can call. You must advise DEWR of your source of funding and/or start-up capital available and include details of financial assets* your organisation could call upon in case of any adverse cash flow. Expected funding should not be taken into account. *Note: You will need to attach documentary evidence of the existence of the value of these financial assets. If the assets are owned by other organisations other than the applicant or there are prior encumbrances (such as caveats, mortgages, loans) on the asset, then attach on a separate sheet details of ownership and dollar amounts of prior encumbrances (if any). Please include the name of your organisation and the question number at the top of your attachment. Asset Estimated $ Value

(23) Ultimate Holding Entity Do you have an ultimate holding organisation?
No. Go to next question Name Australian Companies Number (ACN) Australian Registered Body Number (ARBN) Australian Business Number (ABN) Dun and Bradstreet Number (DUNS). Yes - Please provide details 

_____-_____-_____

_____-_____-_____

____-_____-_____-_____

_____-_____-_____-_____

You must provide financial statements for the past four years (if available) for the Ultimate Holding Entity. Indicate for which years the financial statements have been provided. 2005 2004 2003 2002

(24) Does your organisation have any loans which are secured by assets or guarantees
not listed on the latest Statement of Financial position (Balance Sheet)? (for example personal assets). No. Go to next question Yes (please provide details of these loans). Attach separate sheet if necessary. AMOUNT $

DETAILS OF LOAN

You must attach documentary evidence of the existence and unencumbered value of the assets.

(25) Funding Shortfall.
If your organisation was to have an unexpected shortfall in funds, please indicate what resources (contingency funding) your organisation could call upon. Type of resource Estimated $ Value

Attachment B
Authorisation to undertake Financial Viability Assessment I, << name of proponent >> of << add organisation and full address >>, being a person authorised to provide information on behalf of my Organisation, including financial information, hereby authorise the Commonwealth to undertake the necessary steps to assess the financial viability of my organisation by checking the information provided in our application for Community Development Employment Projects, programme funding or/and by obtaining additional information from the databases or agencies, mentioned below. In addition, all relevant persons listed at Question 17 have made a full disclosure of information, and have agreed to me authorising DEWR to undertake the necessary checks to determine whether there is any adverse information on the relevant persons, by checking the information provided in this application, or by obtaining additional information from:        Commonwealth databases Other Commonwealth agencies such as the Australian Taxation Office and the Australian Securities and Investments Commission State or Territory agencies Law enforcement agencies Credit reference agencies Courts or Tribunals Any other appropriate organisation or person reasonably required as part of these checks.

I confirm that the information provided in answer to questions 1 to 25 on the attached Financial Viability Information Sheet and any supporting documentation attached is true and correct to the best of my knowledge. I acknowledge that I have made appropriate inquiries to fully inform myself of the matters addressed in questions 1 to 25 and I have exercised due diligence in providing this confirmation. Signed _________________________________ Note: The person signing this Authorisation must be listed as a ‘relevant’ person in Q17. Full name (please print) Position Date _________________________________

_____________________________________________ ……../………/………

NOTE A person who knowingly provides false or misleading information or documents to the Commonwealth or omits information causing the information provided to be misleading or acts dishonestly with the intention of obtaining a gain for themselves or causing a loss to the Commonwealth is guilty of an offence which is punishable by imprisonment under the Criminal Code Act 1995 Please provide an estimate of the time taken to complete this form Include: - time actually spent reading the instructions, working on the question and obtaining the information - time spent by all employees in collecting and providing this information hrs mins


				
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