Business Planning Assistance Fund APPLICATION FORM

APPLICANT/S DETAILS

Name (Applicant 1) *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Postal address (if different from above)

Address Line 1

City

State / Province / Region

Postal Code

Name (Applicant 2) *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Postal address (if different from above)

Address Line 1

City

State / Province / Region

Postal Code

BUSINESS DETAILS *

Please outline/summarize your business proposal, i.e. what you want to do, what experience you have had, who is involved, what you have done to establish the business to date, what you want to make or produce;

Is your business any of the following? *

Please provide details below of any business registration already obtained;

ACN (Australian Company Number)

ABN (Australian Business number)

Registered Business name/entity

Trading name

If the business/proposal is a company, partnership or joint venture:

a) How much of it do you own?

b) Who else is involved/owns any of the business?

c) How have/will the other people involved contribute/d to the business/proposal?

d) If so, how much:

e) Are they contributing to the cost of what you want funding for

Yes
No

How much ($)

Have you had financial support for your business from KML or RRKAC before?

Yes
No

When?

What for?

How much ($)

What was achieved from the previous assistance provided?

WHAT ARE YOU APPLYING FOR NOW?

Whilst you may apply for more than one from of assistance, each requires a separate application and approval of each application will depend on the results of prior applications.

Multiple Choice

Assistance with Incubation support study (one off and limited up to $7,500)
Assistance with Business expert advice (one off and limited up to $7,500)
Business support to undertake a business review if the business has been operating for a minimum of 12 months (limited and up to $5,000)
Assistance with Contracting and workforce expert advice (eg negotiation support, becoming a vendor with a Mining stakeholder, tender and grant writing) again one off and limited up to $5,000.

In what way will the help applied for assist your business?

How much do you think the service/s will cost ($)

Have you obtained written quotes for the services you need

Yes
No

Please note that your application will not be considered for approval until quotes are obtained and will not be finalized unless the costs and an outline of the services to be provided are known and agreed to before-hand.

File Upload

Click or drag files to this area to upload. You can upload up to 5 files.

If you have please attach the quote/s to your application.

Name

Company/Firm

Contact telephone

Email

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Can you tell us about the background, capacity to provide the services and qualifications of your proposed provider/s.

________________________________________________________________________________________________________________

I have read and understand the guidelines for the KML/ RRKAC Business Planning assistance fund and agree that they form the basis of and conditions of approval of this application, and
The services are to be provided by persons who are in every way independent of my business and me personally, and
The information included in this application is true and correct.

Name *

Date *

Witnessed

Name of witness *

Signature of applicant *

Clear Signature

Signature of witness *

Clear Signature

Name

Date

Witnessed

Name of witness

Signature of applicant

Clear Signature

Signature of witness

Clear Signature

Business Planning Assistance Fund APPLICATION FORM

APPLICANT/S DETAILS

Please provide details below of any business registration already obtained;

If the business/proposal is a company, partnership or joint venture:

WHAT ARE YOU APPLYING FOR NOW?

________________________________________________________________________________________________________________

Witnessed

Witnessed

Robe River Kuruma Aboriginal Corporation RNTBC

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