Business Incubator Proposal

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					                                          Incubator Funding Application Form




                                   Application Form
                      Business Incubator Funding 2009


      In order to apply for the 2009 – 2011 Incubator Funding Round, please:

             Complete all sections within this template.

                  o    If you want to submit additional support documentation as appendices, please refer to
                       them in the text of your application.

                  o    While New Zealand Trade and Enterprise’s Incubator Development Manager may
                       have had the benefit of previously visiting your facility, not all of the people assessing
                       this proposal, nor the Board of New Zealand Trade and Enterprise, will have had the
                       opportunity to see your operation first hand. Therefore it is important to fully complete
                       your application to enable the best assessment of your incubator.

             Attach all information required in the Appendices.

                  o    Financial information (see section 6)

                  o    1-year business plan (see section 7)

                  o    3-year strategic plan

             Complete and sign the declaration.

             Submit the application by 30 April 2009.

                  o    Submit one (1) electronic copy of your application and appendices to
                       Richard.white@nzte.govt.nz.

                  o    Submit five (5) physical copies of your application to one of the following addresses.
                       One of the copies must be signed.
                       Postal:                                        Courier:

                       New Zealand Trade and Enterprise               New Zealand Trade and Enterprise
                       P O Box 2878                                   Level 15, Majestic Centre, 100 Willis Street
                       Wellington 6140                                Wellington 6011
                       Attn: Richard White                            Attn: Richard White

New Zealand Trade and Enterprise reserves the right to reject any or all applications, to discuss applications on an
individual basis with applicants, and to provide funding in such amounts and on such terms and conditions as New
Zealand Trade and Enterprise perceives best meets the objectives of the Incubator Support Programme

Enquiries should be directed to:

                      Richard White                                   Phone (04) 910 4353
                      Manager Incubator Development                   Mobile (027) 268 3258
                      New Zealand Trade and Enterprise                Email richard.white@nzte.govt.nz




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                                           Incubator Funding Application Form


                         SECTION CONTENT

                         Contents Page

                 1.      Applicant details

                 2.      Other government assistance

                 3.      Incubator operations

                 4.      Client information and performance data

                 5.      Influence

                 6.      Financial management

                 7.      Appendices




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                                                    Incubator Funding Application Form


SECTION 1 – APPLICANT DETAILS

INCUBATOR NAME

LEGAL STATUS (e.g. Incorporated Society)

DATE OF ESTABLISHMENT

PHYSICAL ADDRESS




POSTAL ADDRESS




PHONE NUMBER                                                             FAX NUMBER

EMAIL ADDRESS                                                            WEBSITE

PRIMARY CONTACT PERSON

DESIGNATION

(Director/Board Member/Manager etc.)

PRIMARY CONTACT PERSON DDI NUMBER

PRIMARY CONTACT PERSON MOBILE NUMBER

PRIMARY CONTACT PERSON EMAIL ADDRESS

PRIMARY FOCUS OF INCUBATOR (e.g. ICT, Biotech, Mixed Use)

PAID UP MEMBER OF INCUBATORS NEW ZEALAND? (Y/N)

AMOUNT OF THIS REQUEST (GST EXCL.)                                       Year 1:    $

                                                                         Year 2:    $

                                                                         Year 3:    $



SECTION 2 – OTHER GOVERNMENT ASSISTANCE

2.1 Have you previously applied for any other government funding (whether or not you were successful) in relation to this business, or do you
    have any other applications underway?




2.2 If yes, please provide details, including name of funding scheme, date of application, total approved amount (or note if declined).




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                                                     Incubator Funding Application Form


SECTION 3 – INCUBATOR OPERATIONS

3.1 Activities

Briefly describe the range of activities undertaken by your incubator.




3.2 Organisation Chart.

Please provide an organisation chart for your incubator




3.3 Governance and Management

Please provide brief profiles of your Board and management team including brief descriptions of individual managers’ roles and responsibilities.




SECTION 4 – CLIENT INFORMATION AND PERFORMANCE DATA

4.1 Current Client Information (Please use the following format for each current incubatee)


Client Name




Client Type                     e.g. pre-incubation/incubation

Entry Date                      Month/year

Value proposition               If the firm has been a client of your incubator for more than three years, please explain the reason the firm is
                                still receiving support / what the value is that your incubator adds to the client

Source                          e.g. university

Sector
                                Brief description please e.g.
Technology Status
                                      -   is it a platform technology that could generate many products?
                                      -   is it first-in-space, having the potential to create a whole new industry?
                                      -   is it close to market, with few barriers remaining to commercial application?
                                      -   does it have IP protection?
Patent Registered?              y/n

Capital Raised                  Please provide information on any capital raised by the company in calendar 2008 by type (e.g. angel, seed,
                                    grants, debt, VC) and date (month/year)

Equity/Royalty Arrangement      y/n and type

Advisory Board                  Please advise if an advisory board or full board has been established

Achievements                    Please describe any notable achievements recorded by the company e.g. contracts, awards, exports,
                                    partnerships

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                                                       Incubator Funding Application Form


4.2 2008 Exits

Please list all your 2008 calendar year exits and in accordance with the following exit definition identify if they were successful and provide a
    brief explanation for why it exited when it did, its notable characteristics or near-term prospects, and the particular value that your
    incubator added to this company.

A successful exit is defined as:
          The exit is by mutual agreement on the basis that the company has developed its capabilities, structure, systems and plans. It has
           an effective governance and management structure in place and there is limited further value to be added through being part of the
           incubator.
          The company is likely to have established a reasonable trading record, is showing steady growth in turnover and if it is not already
           profitable, it has the potential to trade profitably or be cash flow positive within a timeframe appropriate to the business or the industry
           it operates within.
          The company will be globally ambitious. It may not yet be generating export revenues but will have products with identified export
           potential and have a thorough understanding of its target markets.
          The company is likely to have attracted equity investment but will at least be investment ready and have a realistic capital plan.

         Client Name               Product/Service         FTEs at exit      Exporting     Exit Date   Successful               Comment
                                                                               (y/n)                     (y/n)




4.3 Alumni Information

Please list all your historical exits with relevant information in the following format.

 N.B. The performance of your graduate companies is becoming an increasingly important measure of your incubator’s success, and the impact
of NZTE’s Incubator Support Programme. It is critical that this data is obtained from as many of your exited companies as possible, and is as
accurate as possible.

Company Name



     Year of Exit

     Successful Exit?                                     (y/n)

     Sector/Product

     Still Trading?                                       (y/n, as at 31/12/08)

     Total Annual Revenue                                 (Last financial year)

     Export Revenue                                       (Last financial year)

     Capital Raised                                       (Last financial year, by equity/debts/grants)

     FTEs                                                 (as at 31/12/08)

     Achievements                                         Please describe any notable achievements recorded by the company e.g. contracts,
                                                          awards, exports, partnerships

     Status Changes                                       Please describe any major changes in company status such as merger, acquisition, trade
                                                          sale or liquidation




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                                                     Incubator Funding Application Form


SECTION 5 - INFLUENCE
5.1 Please comment on the significance of your incubator to the local and national economy in terms of your leadership within the community,
influence and reputation amongst key stakeholder groups, and pro-activity with respect to new initiatives intended to benefit your stakeholders,
the wider community or the incubation industry.




5.2 Please comment on how you engage with other incubators to collaborate, exchange lessons learnt or improvements in operations, or
otherwise work towards improving the level of best practice in the incubation industry.




5.3 Please comment any collaborative or industry-good projects included in your three-year business plan and budget.




SECTION 6 – FINANCIAL MANAGEMENT

6.1 Historical Performance. Please comment on your incubator’s financial performance in the last financial year, e.g. did it achieve or exceed
    budget; what were the major variations (surplus or deficit) in income/expenditure items; what were the reasons for performance exceeding
    or not achieving budget; if there was a deficit result, how was it funded.




6.2 2008/09 YTD performance. Please comment on how the current year is tracking (actual/budget), any areas of concern, and how you are
     planning to deal with these.




6.3 Financial Independence Plan. Please describe the model you have adopted to achieve financial independence for your incubator (i.e. not
     reliant on central government funding) and the expected timeframe. If your plan is based on equity stakes, please note the note the
     number of companies in your portfolio and provide an estimate of their total current values.




SECTION 7 - APPENDICES

7.1     Financial Appendices. Please attach:

7.1.1   Full financial accounts for your last financial year including notes to the accounts and signed by the Directors.


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                                                   Incubator Funding Application Form


7.1.2   YTD management accounts (actual/budget).

7.1.3   A detailed income/expenditure budget for your next financial year. If you are including notional (non-cash) income/expenditure
        (e.g. in kind services provided by a sponsor) please highlight these separately. Please ensure projections include detailed
        assumptions.

7.1.4   Summarised income/expenditure projections for the three years covered by this funding application. Please ensure projections include
        detailed assumptions and commentary on significant items or major year-on-year variations e.g. income from sale of equity in a resident
        company; cost of implementing a significant new initiative or project.

7.2     Planning Documents. Please attach:

7.2.1   A detailed 12 month business plan.

7.2.2   A three year strategic plan.

N.B. The activity described in these plans should be aligned to your operating budgets and funding requests. You are welcome to submit
financial budgets and operating plans as one document if this is how you prefer to complete and present your plans, provided you
are submitting all the information requested.




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                                                Incubator Funding Application Form


      DECLARATIONS/ACKNOWLEDGEMENTS
I/We confirm and declare that:                                         Acknowledgement

   The proposed project/activity would not be undertaken              I/We acknowledge that New Zealand Trade and Enterprise
    without the assistance of NZTE or that NZTE’s                      may receive requests for information on Incubator co-funding
    assistance will increase the scope or quality of the               including under the Official Information Act. The undersigned
    project/activity or the likelihood of it occurring or the          acknowledges that New Zealand Trade and Enterprise may be
    speed at which it can take place.                                  required to disclose information as required to do so by law.
                                                                       This information may include
   I/We have read the guidelines for making an application
    for Incubator co-funding that outline the process, terms,           the name of co-funding recipient
    conditions and criteria and I/we understand and agree to            the amount of co-funding
    these and will comply with them.
                                                                        the contact details of co-funding recipient
   The assistance sought in the attached application does
    not relate to expenditure that has been incurred prior to           a general statement of the nature of the activity/project as
    the receipt of this application by NZTE.                             agreed by co-funding recipient and New Zealand Trade and
                                                                         Enterprise
   The application involves an activity/project that is a
    lawful activity carried out lawfully, and is directed at            the outcome of the activity/project assisted.
    incubator development.
   Funding has not been sought nor will be sought from any            I/We acknowledge that the Government expects regular
    other government source for the same costs. (NB: this              reports on Incubator co-funding, including information on its
    does not preclude more than one government agency                  usage. The undersigned agrees to provide information on the
    contributing to the same overall project.)                         usage and outcome of the co-funding and acknowledges that
   The application is not being made by an organisation               this data may be made available to other government agencies
    that is in receivership or liquidation or by an individual         that have an interest in monitoring the fund’s usage.
    who is an un-discharged bankrupt.
   The project is not being managed by an undischarged                I/We acknowledge that New Zealand Trade and Enterprise is
    bankrupt or someone prohibited from managing a                     required to comply with relevant laws and government policies
    business.                                                          relating to conflicts of interest. To ensure that any conflict of
   The information contained in the attached application is           interest (whether actual or perceived) does not cause NZTE to
    true and correct and there have been no misleading                 act in a way that is not in its best interest, the undersigned
    statements, omission of any relevant facts nor any                 agrees to promptly notify the Director HR at NZTE of any
    misrepresentation made. NZTE is able to take legal                 conflict of interest position the applicant is aware of during this
    action if any information is found to be fraudulent or             application process and funding period, including:
    misleading.                                                         any financial or personal relationships with any external
   I/We acknowledge that NZTE may wish to promote any                   providers you are employing as part of the project/activity to
    successes that result from our proposal (while respecting            be funded
    your commercial confidentiality).                                   any financial or personal relationship with any employee or
   The success/benefits of any funding previously received              any contractors to NZTE that may be involved in the
    from NZTE or its predecessors have been described.                   decision to provide funding to you
                                                                        any financial or personal relationship with any former
I/We understand that:                                                    employee (who left NZTE in the 12 months before the date
                                                                         of this application) involved in seeking this funding.
   NZTE will liaise with other government agencies and
    may refer applications where appropriate.
   Background checks will be undertaken on all                        I/We acknowledge that New Zealand Trade and Enterprise or
    applicants/directors. Applicants will ensure that all              its representatives may audit the applicant to verify the
    necessary consents have been obtained from the                     programme funding was used appropriately and to NZTE’s
    relevant individuals to enable NZTE to undertake such              satisfaction.
    checks and all relevant laws have been complied with in
    relation with such checks.
                                                                       I/we understand that New Zealand Trade and Enterprise has
   NZTE may request additional information as part of the             the sole discretion as to whether or not to provide funding and
    assessment of the application.                                     that, if it does, the funding amount may be for a lesser amount
   NZTE may carry out checks to verify the contents of any            than that sought.
    information provided by me/us as part of the application
    process, and I/We confirm that I/we will provide access
    to my records/personnel for that purpose.


APPLICANT MUST SIGN AND COMPLETE DETAILS BELOW

SIGNATURE                                                               NAME
DESIGNATION                                                             DATE
COMPANY

This confirmation/acknowledgement must be signed by an authorised signatory.




      a36ea49d-5de2-47bb-ab30-281db5150545.doc                                                                                 8

				
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