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Application form for Atomic Pictures

The deadline for applications is 5.00pm on Thursday 16 August 2007. If you are
interested in applying you MUST speak to Helen Stearman (0191) 269 9216 .

Please make sure that you complete all questions on the application form and provide 3 copies
of the following:

        A minimum of one full feature length script
        Treatments for all potential projects on the slate (maximum 4)
        CVs for key staff involved (exec, producer, writer, director and HOD)
        CVs of all company employees involved in the project
        Cashflow for first project

You must complete every section of this form. If you don’t, we will return your application
and ask you to provide the missing information.

There are two ways of answering questions electronically
   1. Double click on relevant box     , a dialogue box will appear, then click default value
      ‘Checked’ which will insert an X in the appropriate box
   2. There is a rectangular text box to complete longer answers, which will expand as you

Atomic Features Application Form      June 2007                           Page 1 of 9
                                   Section A – About You

A.1      Main Contact Name
A.2      Name of Organisation

A.3      Position or job title
A.4      Address

A.5 The above address is                          home               work
other, please state

A.6 Contact details
Office telephone                                 Home telephone
Mobile phone                                     Mini Com
Email                                            Website

A.7 In which local authority area is the above address?
North East Area     Local Authority
Durham              Chester le Street         Darlington                Derwentside
                    Durham City               Easington                 Sedgefield
                    Teesdale                  Wear Valley
Northumberland      Alnwick                   Berwick                   Blyth Valley
                    Castle Morpeth            Tynedale                  Wansbeck
Tees Valley         Hartlepool                                    Middlesbrough
                    Redcar & Cleveland                            Stockton
Tyne & Wear         City of Sunderland                            Gateshead
                    Newcastle City                                North Tyneside
                    South Tyneside
Elsewhere UK, please state here
Elsewhere non UK, please state here

A.8      Have you received National Lottery funding before?
No             Yes      what is the total amount you have received from all sources?

A.9      Have you had public funding from any other sources in the last three years,
         prior to the date of this application?
No              Yes       what is the total amount you have received from all sources?

Atomic Features Application Form     June 2007                          Page 2 of 9
                                   Section B - Your organisation

B.1 What is the legal status of your organisation?
Private Company                            Company limited by guarantee
Registered charity                         Other public sector body
Legally constituted Partnership            University, College or School
Local Authority
Other – please specify
Company registration number, if applicable
Charity registration number, if applicable

B.2    You need to provide one of the following with your application. Please tick the
       box of the one you are supplying
A copy of your Memorandum and Articles of Association
Your organisation’s constitution
Set of rules for your organisation

If you have already provided these for an earlier application you do not need to send them
again, please state below
Title of application
NFM reference number                 200

B.3 You also need to provide with your application form
A copy of your last set of year-end accounts, if available
A set of management accounts for the last quarter
If you are unable to supply either of these, please state why

B.4      Which month and year was your organisation set up?

B.5 Is your organisation VAT registered?
No                  Yes
Vat Registration number

B.6 Are you a branch or subsidiary of a larger organisation?
No                  Yes
Parent Organisation Name

B.7      What was your organisation’s turnover for the last financial year?

B.8 How many full time employees work in this organisation?
Female                   Male                        Total

Atomic Features Application Form           June 2007                  Page 3 of 9
                                   Section C – Micro Feature Film Ideas

C.1 What experience do you and your company have in producing feature films?

C.2 What are the titles of the feature film ideas, where known.

C.3 Please list the key staff that will be involved in these feature films, where known.
Please provide CVs where possible.
                  Film 1             Film 2             Film 3            Film 4
Exec Producer

C.4 Please list the cast you have attached to these feature film, where known
Film 1                 Film 2               Film 3                 Film 4

C.5 Please list the key partners you have involved, including sales agents in these
      film ideas?

C.6 What activity do you anticipate will take place in the North East region?

C.7 Please give an audience overview and distribution plan for these film ideas.

Atomic Features Application Form            June 2007                     Page 4 of 9
C.8      Please inform us of any training opportunities that will be made available
         through your slate of productions.

C.9      How does the slate of projects fit within the overall development of your

                                   Section D – Project Viability

D.1      Describe your project’s schedule including your milestones or target dates,
         complete on a separate sheet if necessary

D.2      What plans do you have in place to ensure you meet your milestones or target

D.3   List the company employees, including yourself, who will be working on this
CV’s or biographies must be supplied for all people listed, note remember to include these
people on the equal opportunities form at the back.
Name                           Job Title                           Female/Male       CV

D.4      Identify the key risks to your project and how you plan to address them.

D.5      How will you measure the success of your projects?

Atomic Features Application Form        June 2007                     Page 5 of 9
D.6   What are all the sources of funding for this project and how much money are
      you applying for from them? Please itemise below.
                  Source                        COLUMN A             COLUMN B
 Costs should include VAT unless you are Applied for and          Funds confirmed
 VAT registered and able to recover it.   awaiting confirmation
 Northern Film & Media                    £100,000
 Local Authority Funding
 Other Lottery funds
 European Regional Development Fund
 European Social Fund (ESF)
 Other public sector funding
 Charitable funding
 Other Income
 Private sector funding
 Your own funds
 Help in Kind
 Total of Column A
 Total of Column B
 Total Project Cost (equals total of
 column A plus B)
You must attach written evidence for all funds that have been committed including your

                                   Section E - Data Protection Act 1988
The information on this application form will be processed by Northern Film & Media. The
information you give us will be held on computer at the UK Film Council and Northern Film
& Media and we will use it for statistical purposes. We may provide copies of the
information to individuals or organisations that are helping us assess applications or
monitor funding.

In returning your application you are consenting to us using your information for this
purpose. Please note it may be a requirement of certain funding sources that information
about applications is shared with other Lottery Distributors.

E.1   Would you like to receive from Northern Film & Media
Information about events, workshops and services?      No                      Yes
Our newsletter?                                        No                      Yes

E.2      Would you like to receive similar information from the UK Film Council or the
         other Regional Screen Agencies?                    No          Yes

E.3   Would you like Northern Film & Media to provide your details to people or
organisations for similar publicity and information purposes, note Northern Film &
Media do not sell mailing lists?                         No          Yes

Atomic Features Application Form            June 2007                     Page 6 of 9
                                   Section F – Your Declaration

F.1   Declaration of Interests - do you have, or are you aware of, any close personal
      or professional link with any staff or board member of Northern Film & Media
      or the UK Film Council?
No           Yes      list names and connection, for example member of board, and
whether they would stand to make a financial gain.

Note under Northern Film & Media’s memorandum and articles, board members must
declare an interest to other members of the board before the application is submitted,
please let them know if you are applying to us for funds. A full list of board members is
available on our website.

Time Limits
All Northern Film & Media offers of funding are time limited. If you do not reach agreed
milestones or complete the project in the time specified by Northern Film & Media the offer
will be withdrawn and any money left in the award will fall back into Northern Film & Media’s

Northern Film & Media will take legal action to recover funds from an applicant who has
provided fraudulent information in this application.

Any misleading statements by you the applicant could render this application invalid and
you or your organisation liable to return any money already paid on the project or scheme in

I confirm that the information I have given is true and I have answered all the relevant
questions on the form. I will let you know immediately about any material change to the
information provided. I have the power to accept funding subject to conditions and the
ability to repay funding in the event of funding conditions not being met

F.2    Signature                                             Date
The signature on this application form must be original. Photocopied or faxed signatures
cannot be accepted.

Atomic Features Application Form        June 2007                       Page 7 of 9
Section G - Equal Opportunities Monitoring
Please note you should return this form as part of your application, the information
requested is optional. This section of the application will not form part of the assessment
process. We are committed to pursuing equality of opportunity, monitoring applicants and
applications is one way of helping to ensure that there is no discrimination in the way
applications are assessed

For Organisations only: The following information should be self assessed. Please give
your colleagues the opportunity to select the description which best applies. It is suggested
that this form is photocopied and circulated and the results collated.

Ethnic Monitoring Category: This checklist contains the standard ethnic monitoring
categories provided by the Commission for Racial Equality and included in the 2001

G.1 Of the people working on this project, including yourself, how many are
Asian or British Asian        Number                                    Number
Bangladeshi                               Chinese
Indian                                          Pakistani
Any other Asian background please state
Black or British Black              Number                                            Number
Caribbean                                       African
Any other black background please state
Mixed                               Number                                            Number
White and Asian                                 White and black Caribbean
White and black African
Any other mixed background please state
White                               Number                                            Number
British                                         Irish
Any other white background please state
Any other background please state

G.2   Of the people working on your project, including yourself has anyone declared
      a disability under the Disability Discrimination Act: Defined as a ‘physical or
      mental impairment which has a substantial and long-term adverse effect upon
      his/her ability to carry out normal day-to-day activities’
No                  Yes       please indicate below the number who have
Hearing Impairments                            Mental Disability
Visual Impairments                              Physical Impairments
Other, please specify
G.3       Of the people working     Number                                            Number
          on your project how                   Aged under 19
          many are
Male                                            Aged 19 to 26
Female                                          Aged over 26
Atomic Features Application Form    June 2007                           Page 8 of 9
                                   Section H - CHECK LIST
Have you:
        Completed all questions on the application form
        enclosed your memoranda & articles, or rules or constitution
         see question B3?
        enclosed your organisation’s recent accounts see question B4?

        Kept a copy of this application for your own records

        Provide a copy of a minimum of one full feature length script (3 copies)
        Treatments for all potential projects on the slate (maximum 4) (3 copies)
        CV for key staff involved (exec, producer, writer, director and HOD) (3 copies)
        CVs of all company employees involved in the project (3 copies)
        cash flow for first project (3 copies)

Note that gathering additional missing information once you have submitted your
application will slow down the application process and could result in you missing your
deadline, so please make sure your application form is complete with additional copies and
supporting materials.

Send original with copy and supporting materials to

Atomic Pictures
Northern Film & Media
Central Square
Forth Street
Newcastle upon Tyne

Atomic Features Application Form       June 2007                         Page 9 of 9

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