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EIF version 10 July 2009 • Please read the EIF Guidelines for Applicants For offi

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					                                                                              EIF version 10 (July 2009)




•   Please read the EIF Guidelines for Applicants                             For office use only
    carefully before you complete this form.
•   All information required in the application form must   Date received
    be given.
•   Your application form must not be more than 15
    pages excluding appendices.                                 Reference



                                                            Project Officer




             ALL INFORMATION PROVIDED IN THIS APPLICATION
                    WILL BE TREATED AS CONFIDENTIAL


                         Ministry of Science, Technology and Innovation (MOSTI)
                                      Fund Section, Planning Division,
                Level 3, Block C5, Complex C, Federal Government Administrative Centre
                                              626621Putrajaya
                                                                                     EIF version 10 (July 2009)


I am / we are currently:
Please mark (X) in appropriate box
      Individual
      Sole Proprietor
      Micro Enterprise

      Small Enterprise



PART 1: APPLICANT PARTICULARS
Section A: Individual

1.1 Applicant Name                                     1.2 IC No


    *Please enclose CV

                                                       1.4 Designation
1.3 Occupation


                                                       1.6 Telephone No.
1.5 Address
                                                           Mobile:
                                                           House :
     Postcode

1.7 Fax No.                                            1.8 Email Address



Section B: Sole Proprietor, Micro & Small Enterprise

1.1 Company Name                                       1.2 Company Registration Number


                                                           * Please enclose a copy of Certificate Of Registration
                                                             (Form D) or Certificate of Incorporation (Form 9)
1.3 Date of Incorporation
                                                       1.4 Company Address


1.5 Telephone No.
                                                           Postcode
     Mobile :
     Office :                                          1.6 Fax No.

1.7 Email Address




                                                   2
                                                                                                                  EIF version 10 (July 2009)


PART 2: BUSINESS DETAILS
(Note: For Micro and Small Enterprises only)

Section A: Capital Structure

  2.1 Authorised Capital                                                       2.2 Paid Up Capital




  2.3    Structure of Shareholding
                                            RM               %
         Bumiputera
         Non-Bumiputera
          Total
        * Please enclose copies of Return of Allotment of Shares
          (Form 24) and Memorandum and Articles of Association



Section B: Manpower Structure (Full Time Employees
Only)

                              No. of          No. of Non-
  2.4    Sector
                            Bumiputera        Bumiputera
                                                                   Total

  1.     Managerial
         Technical &
  2.
         Supervisory
         Support
  3.
         Staff
         Total
  * Please enclose copies of Form 49 and Latest EPF Statement


Section C: Company Turnover

  2.5 Turnover (In your most recent annual accounts)                           2.6 Balance Sheet (Total assets net of depreciation)




                                                                                   * Please provide copy of latest company’s audited accounts




                                                                           3
                                                                       EIF version 10 (July 2009)


PART 3: PROJECT DETAILS                                •   Waste to Wealth
                                                       •   Processing Technology
      Type of Innovation
3.1
      Please mark (X) in appropriate box               •   Engineering Development
                                                       •   Environment
      Recombination / Fusion / Integration of
      technologies that lead to new products /
      processes and services
      Replication / Refinement of technologies
      that improve quality or reduce the cost of
      existing products / processes / services



      Technology Cluster
3.3
      Please mark (X) in appropriate box

      Biotechnology
            •    Plant
            •    Animal
            •    Food
            •    Biopharmacy
            •    Molecular Biology
            •    Medical Biotechnology
            •    Industrial/Environmental
                 Biotechnology
      ICT
            •    Information System
            •    ICT Infrastructure
            •    Software
            •    Emerging IT
            •    Communication
            •    Security System
            •    Signal Processing
            •    Database Technology
            •    ICT Application
      Industry
            •    Advanced Materials
            •    Advanced Manufacturing
            •    Nanotechnology
            •    Alternative Energy


                                                   4
                                                                                                   EIF version 10 (July 2009)



                                                                          At the designing stage
                                                                          At the development stage
        Innovation Stage
3.2                                                                       Have a functional model or prototype
        Please mark (X) in appropriate box
                                                                          which needs some improvements
        I / We currently:                                                 Have prototype for product testing
        Have initial idea or concept

3.4         Project Overview
3.4.1       Project Title




3.4.2       Executive Summary

                 A brief description not more than 1 page which includes the following:-

                 i)          Objectives
                 ii)         Methodology
                 iii)        Project Milestones
                 iv)         Technology used
                 v)          Output expected / Deliverables
                 vi)         Total Project Cost




           * Please attach full project proposal

3.4.3      Proposed Start Date:


3.4.4      Project Duration :
           (max. 18 months for Small Enterprise; 12 months for Individual / Sole Proprietor & Micro Enterprise):




                                                              5
                                                                                                      EIF version 10 (July 2009)



3.4.5   Eligible Project Funding
        ( Please detail out the cost for each component )
                                   Component (where applicable)                                                   RM
          Consumables / materials
            •      _________________________________
            •      _________________________________

                                                                               Sub Total
         Equipment (not more than 40% of total amount requested)
          •     _________________________________
          •     _________________________________

                                                                               Sub Total
         Expenditure for services (consultancy and testing)
          •      _________________________________
          •      _________________________________

                                                                               Sub Total
         Project documentation
          •       ____________________________
          •       ____________________________

                                                                               Sub Total
         Regulatory and standard compliance
          •      ____________________________
          •      ____________________________

                                                                               Sub Total
         Product testing (including samples, fees and documentation)
          •       ____________________________
          •       ____________________________

                                                                               Sub Total
                                                                               Grand Total


        Note: The quantum and duration of funding approved under EIF will be based on the merits of each application as listed below:

                                                           Quantum                                Maximum Duration
                   Category
                                                          (Maximum)                                   (Months)

                   Individual                           RM 50,000.00                                       12

                     Other                              RM 300,000.00                                      12




                                                               6
                                                                                                EIF version 10 (July 2009)



3.5     Innovation Aspects

        Please elaborate on the following:

          (a) How is your proposed product, service or process innovative?
          (b) How does your proposed product / service / process improve value, enhance efficiency or reduce cost?
          (c) Is there an existing IP for the proposed product, service or process?(Please attach results of IP search if any)


3.6      Commercial / Business Potential

3.6.1   For Micro and Small Enterprise

        Please elaborate on the following:

             (a) Market Size & Demand
             (b) Market & Financial Risks
             (c) Product Competitiveness (Quality, Pricing)
             (d) Potential Revenue Generated
            (e) Business / Commercialisation Plan (Financial projections, assumptions and projected cash flow)



3.6.2   For Individual / Sole Proprietor

        Please elaborate on the following:

            (a) Market Size & Demand
            (b) Product Competitiveness (Quality, Pricing)
            (c) Potential Revenue Generated



        How do you plan to fund the portion of the project costs not funded under EIF?
3.7
        Please provide evidence (e.g. bank statement, bank facility / OD)




        Have you been awarded any Government grants or funds? If yes, please provide details and
3.8
        amount of grant / fund awarded


           (a)   Project Title
           (b)   Name of Grant / Fund Received
           (c)   Funding Agency
           (d)   Amount Approved
           (e)   Duration Approved
           (f)   Status ( completed / on-going / terminated )



                                                             7
                                                                            EIF version 10 (July 2009)


PART 4: REFEREE (For Individual Only)

4.1 Name                                    4.2 IC Number



4.3 Address                                 4.4 Mobile No.


     Postcode
                                            4.6 Occupation / Designation
4.5 Email Address


                                            4.8 Office Telephone No.
4.7 Office Address

                                                * Referee must be a Government officer from the Management and
                                                  Professional Group ( Grade 41 and above )

     Postcode




                                        8
                                                                                                  EIF version 10 (July 2009)


PART 5: DECLARATION


5.1   Declaration


      I hereby declare that the particulars furnished in this form including attachments are correct and true to the best of my
      knowledge.

      Name




      I/C Number



      Signature (Digital/Scanned)




      Date



                     Please complete this application form and email to MOSTI via innofund@mosti.gov.my
                            or post the form ( in both hardcopy and softcopy) to the following address:

                                              Innofund Secretariat
                                              Fund Section, Planning Division,
                                              Ministry of Science, Technology and Innovation
                                              Level 3 Block C5, Complex C
                                              Federal Government Administrative Centre
                                              62662 PUTRAJAYA


             MOSTI reserves the right to withdraw approval based on false information submitted by applicants.




                                                             9
                                                                                              EIF version 10 (July 2009)




APPLICATION CHECKLIST
(For Micro And Small Enterprises)

Please ensure that the relevant supporting documents are attached to the application form.
(Please tick [ √ ] in appropriate box)

    1) Completed Application Form

    2) Full project proposal which includes the following:

        •    Project Title
             -    Provide project title

        •    Project Objectives
             - Describe the measurable objectives of the project

        •    Project Description
             - Provide a detailed description of the project in terms of:
                      The technology to be used
                      The methodology that will be used
                      How you expect the project to achieve its goals
                      The innovativeness of the product, process or service that you propose to develop compared to the
                      technology currently available
                      The deliverables
                      Market opportunity
                      Immediate and long term benefits

        •    Project Milestones
             - List the milestones and activities in the format provided below:

            No          Milestones                                Activities                 Completion Date




        •    Total Project Cost
             - Provide the detailed costs involved in developing the project
             - Include breakdowns for each component




                                                             10
                                                                                                EIF version 10 (July 2009)


    •        Total Amount Requested From EIF
             - Provide the detailed costs for each component requested
             - Attach quotation for the items to be purchased especially equipment

    •        Project Timeline
             - Provide a Gantt Chart to show the implementation schedule of your proposed project


                                                                                Month
        No             Activities               1             2             3            4                5         6
         1
         2
         3
         4


    •        Project Team
             - Please provide full CVs of all personnel involved in the project: -
                      Name
                      Position
                      Qualification
                      Experience
                      Achievement

    •        Technology Benchmark
             - Comparison between the proposed technology used with the existing or similar technologies
                 in the market.

    •        Project Risk
             - Please identify and describe the technical risks in the project and how these risks will
                 be managed

3) Copy of Certification of Incorporation (Form 9)

4) Copy of Return of Allotment of Shares (Form 24)

5) Copy of Return Giving Particulars in Register of Directors, Managers and Secretaries and
   Changes of Shares (Form 49)

6) Copy of Memorandum and Articles of Association

7) Company’s organization chart

8) Copy of Latest Company’s Audited Accounts

9) Copy of Latest EPF Statement

10) Soft copy of Application Form and Full Project proposal if submitted through post

11) Results of Intellectual Property Search (if Applicable)

12) Additional Supporting Documents (if Applicable)
                                                           11
                                                                                                EIF version 10 (July 2009)




APPLICATION CHECKLIST
(For Individual And Sole Proprietor)

Please ensure that the relevant supporting documents are attached to the application form.
(Please tick [ √ ] in appropriate box)

    1) Completed Application Form

    2) Full project proposal which includes:

         •    Project Title
              - Provide project title

         •    Project Objectives
              - Describe the measurable objectives of the project

         •    Project Description
              - Provide a detailed description of the project in terms of:
                       The technology to be used
                       The methodology that will be used
                       How you expect the project to achieve its goals
                       The innovativeness of the product, process or service that you propose to develop compared to the
                       technology currently available
                       The deliverables
                       Market opportunity
                       Immediate and long term benefits


         •    Project Milestones
              - List the milestones and activities in the format provided below:

             No            Milestones                           Activities                   Completion Date




         •    Total Project Cost
              - Provide the detailed costs involved in developing the project
              - Include breakdowns for each component
         •    Total Amount Requested From EIF

                                                           12
                                                                                                EIF version 10 (July 2009)


         - Provide the detailed costs for each component requested
          - Attach quotation for the items to be purchased especially equipment

    •        Project Timeline
             - Provide a Gantt Chart to show the implementation schedule of your proposed project

                                                                               Month
        No             Activities               1             2            3             4                5         6
         1
         2
         3
         4


    •        Project Team
             - Please provide full CVs of all personnel involved in the project: -
                      Name
                      Position
                      Qualification
                      Experience
                      Achievement

    •        Technology Benchmark
             - Comparison between the proposed technology used with the existing or similar
                 technologies in the market.

    •        Project Risk
             - Please identify and describe the technical risks in the project and how these risks will
                 be managed

3) Copy of Certification of Registration (Form D) (for Sole Proprietor only)

4) Copy of Latest Account/Bank Statement

5) Soft copy of Application Form and Full Project proposal if submitted through post

6) Results of Intellectual Property Search (if Applicable)

7) Additional Supporting Documents (if Applicable)




                                                           13

				
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