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Department of Agricultural, Environment and Rural Affairs
GUIDANCE NOTES ARE PROVIDED FOR EACH QUESTION. YOU SHOULD READ THESE
CAREFULLY BEFORE ANSWERING THE QUESTIONS
General Data Protection Regulations (GDPR) - When you apply for Rural Business
Development Capital Grant Scheme we will ask for some personal information because, for
example, your personal email address or telephone number is used on the applicant
organisation’s behalf. When you provide this information it is processed in adherence with
the GDPR, Data Protection Act 2018 as well as the scheme’s Terms and Conditions to enable
us to communicate with you about the application.
Only fully completed application forms submitted with the required documentation (as per
checklist at end of application) will be considered. Any application submitted with missing
information or incomplete questions will be deemed incomplete and subsequently rejected.
This grant scheme accepts application and claim documentation in electronic
form. You must use the same email address throughout the process for
submitting your application form and any Letter of Offer and claim
documentation.
The closing date for receipt of applications is 12noon on Friday 11
th
September 2020.
Applications should be submitted to their local Council via the method listed in the guidance
notes. Applications submitted after this date/time will not be accepted.
For Offi ci al Use Only:
Application Ref:
RBDS -
Acknowledged
by:
Date Received:
Time Received:
Tackling Rural Poverty and Social Isolation (TRPSI) Programme
Rural Business Development Grant Scheme
APPLICATION FORM
FOR OFFICIAL USE ONLY
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Q1 Applicant Details
(a) Name of Organisation: ______________________________________
(b) Organisation/Individual Contact Details:
Contact name
Address
County
Post Code
Tel Number
Mobile Number
E Mail Address ________________________________________
Website ______________________________________
(c) What term best describes your organisation (select 1 option)
Sole Trader HMRC Self-Assessment Number ________________________
Limited Company Company Number ___________________________________
Business Partnership HMRC Self- Assessment Number for each partner:
__________________________________________________
__________________________________________________
__________________________________________________
Other Describe status and provide detail of business registration:
_________________________________________________________________________
Q2 Business Overview
(a) What date was your business established? ____________________
(b) If your business is located at a different address to Q1b, please provide your
business address:
______________________________________________________________________
______________________________________________________________________
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(c) What sector does your business operate in?
Agri cultur e / Gardeni ng
Automoti ve
Bui ldi ng/constructi on
Consultancy
Creati ve i ndustry
Food/Dri nk manufacture
IT/communi cati ons
Lei sure/fi tness
Manufacturi ng
/Engi neeri ng
Servi ces ani mal &
equestri an
Servi ces customer ,
health & personal care
Servi ces professi onal
Restaurant / café /
hospi tali ty
Retai l / Wholesale
Touris m
Trai ni ng / Coachi ng
Transpor t & Logi sti cs
Other
Please state:
(d) Provide an overview of your current business activities to include products /
services offered, types of customers, method of sale and any export.
(e) Provide the number of employees involved in your business, including yourself:
*Full-time employee must work at least 30 hours per week
Male
Female
Male
Female
Permanent
full-time*
Permanent
part-time
Temporary
full-time
Temporary
part-time
Maxi mu m 500 wor ds
Maximum 500 Words
Maximum 500 Words
Agriculture / Gardening
Consultancy
IT / Communications
Services - Animal / Equestrian
Restaurant / Café / Hospitality
Training / Coaching
Automotive
Creative Industry
Leisure / Fitness
Services - Customer, Health
and Personal Care
Retail / Wholesale
Transport & Logistics
Other
Please State:
Building / Construction
Food / Drink Manufacture
Manufacturing / Engineering
Services - Professional
Tourism
Other
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(f) What was your sales turnover last year?
Last financial year: £_________________
If you have been trading for less than 1 year, provide your sales to date: £______________
(g) Has your business been impacted by COVID 19? YES NO
If yes, please provide an outline of the impact to include details of staff furloughed
or temporarily laid off and impact on sales.
Q3 Project Details
(a) Project Title: ___________________________________
(b) Project Description: Describe your proposed project and detail any changes to your
existing activity and any new business activities such as new product or services, new
customers or markets that you intend to target or new methods of selling.
Maxi mu m 500 wor ds
Maximum 500 Words
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(c) Project Need: Describe the need for your project and outline your evidence of this
need:
Maxi mu m 500 wor ds
Maximum 500 Words
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(d) Project Outcomes: Outline what the anticipated outcomes of implementing the
project will be over the next 12months.
Please provide specific detail on the impact this grant will have on your
business in the relevant sections below
Sustaining existing
or creating new
employment
Sustaining existing
income levels or
generating
additional income
as a result of
proposed project
Business recovery
plans due to COVID
19
Increased
innovation in the
market place or
within the business
(eg new product,
services, markets
entry, selling or
delivery methods)
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(e) Management Strength: Outline your skills and experience to deliver the proposed
project and sustain and develop your business. Please include details of any other
external support you have received to set up or develop your business (eg Go for It
Programme, business mentoring, management of previous grant aid etc)
Maxi mu m 500 wor ds
Maximum 500 Words
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Q4 Project Costs
(h) Is your business VAT registered? YES / NO
If yes, please provide the VAT registration number:
*If you are VAT registered, TRPSI funding should be applied for against the Net cost. You do not need to
complete the VAT and gross cost column. If you are not VAT registered, you should complete all columns and
you may apply for funding against the gross cost. Grant request is 50% grant rate between £500 and up to
£4,999.
(j) Please provide details of all sources of funding for the project:
(k) Please confirm that you can purchase the item(s) in full before claiming funding
back against the item: Yes No
(i) Breakdown of costs:
Item
Net Cost (£)
VAT Amount
(£)
Gross cost (£)
TRPSI Funding
Applied for (£)*
Total Cost
£
£
£
£
Source of funding
Name of Funder
Current status of
application
Total Amount
applied for £
TRPSI Scheme (this
application)
DAERA
Submitted
Own resources
cash
Self
Own resources
loans
Other please state
TOTAL (this should match the total cost listed above)
£
(s)
Yes
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Q5 Project Timescales
To be eligible for grant aid, you must be able to complete your project in a short timeframe,
between Letter of Offer issue (anticipated November 2020) and 26 February 2021. By 26
February, all works must be completed and onsite and must be fully paid and cleared the
bank. Your claim for payment must be submitted to your local Council by 26 March 2021.
Please confirm if you can complete your project as described by 26 February 2021 and
submit your claim by 26 March 2021:
Yes No
Q6 (a) Does you project involve any building works to your premises?
Yes No
If no, please proceed to question 7.
(b) Is planning permission required for your project? Yes
No
If required, this must be in place at the time of submitting your application for funding and a
copy must be provided with your application form. The onus to ensure necessary statutory
approvals are obtained and in place lies with the applicant.
(c) Is building control applicable? N/A / GRANTED / APPLIED FOR / STILL TO APPLY
(d) Do you own or lease the land /building in which the works are to be carried out?
Own land/building
Lease, for minimum period of 5 years
Please note, that a 5 year lease is the minimum requirement for this project. Shorter lease
periods cannot be considered for projects applying for building works to alter premises.
Q7 Would you like to be registered onto your local Councils Economic Development
Database to be kept up to date with other relevant programmes and initiatives?
Yes
No
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CHECKLIST
Please ensure you have:
Filled in all parts of the form, including Annex A
Provided copies of all specifications for items detailed at Annex A
Provided copies of all quotations as detailed at Annex A
A copy of most recent Bank / Building Society Statement for account used by the
business
Provided a copy of your 5 year (minimum) lease/ proof of ownership
(only for projects involving work to buildings / land)
Provided a copy of your full planning permission
(only for projects involving work to buildings / land and if required)
Provided additional pages, where appropriate.
DECLARATION
(a) Application
I declare that all of the information provided in this application and
accompanying documents is true and correct.
I confirm that I am age 18 or above.
I confirm that the project detailed in the application has not commenced.
I confirm that I can complete this project by 26 February 2021 and it will
be paid and cleared through the bank account used by my business by 26
February 2021.
Signed by Applicant: ___________________________
Print name: ___________________________
Date: ___ / ___ / ___
Position held: ___________________________
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(b) De Minimis Aid Declaration
Financial Assistance awarded under the Rural Business Development Grant Pilot Scheme is
classified as De Minimis Aid as set out in European Commission Regulation (EU) No 1407/2013 of
18 December 2013 on the application of Articles 107 and 108 of the Treaty on the Functioning of
the European Union to de minimis aid. If you have received other de minimis aid from
Government Departments, Intertrade Ireland or Local Councils over the last 3 years this might
impact on your eligibility to receive mentoring support.
The maximum amount of de minimis aid that an undertaking can receive within a 3 year fiscal
period in the UK is €200,000. Where an undertaking is part of a group, linked either though
limited companies or individual shareholders, the de minimis limit may apply to some or all of the
combined group and not just individual undertakings.
To allow us to determine whether awarding this grant will breach this limit, please complete the
table below that details the date and value of any de minimis aid the company has received
during your last 3 fiscal (accounting) years. Where the Company is part of a group, please
complete the table for all group companies.
Please note that it is your responsibility to check whether the support you have received was
classed as ‘de minimis’ aid. If in doubt, please check with whoever provided you with the
support.
Has the company (or any company within the Group if applicable) received
any form of public support or grant that was classed as de minimis in the last 3
years?
If ‘Yes’, please provide detail in the table below:-
Yes
No
Date support/grant funding
awarded
Funding body
Purpose / Scheme
Amount
Total
What is the date of the end of your accounting (fiscal) year (dd/mm)?
Declaration
I confirm that:
The details provided on this form are current and accurate to the best of my knowledge.
The company is solvent and no distress or execution has been levied against it.
I understand that completion of this form neither entitles nor requires me to take part in any
business support scheme in the future.
Si gned on behalf of
appli cant
Pri nt Name
Posi ti on
Date
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The closing date for receipt of applications is 12noon on Friday 11
September 2020. Applications submitted after this date/time will not be
accepted.
WARNING
To knowingly or recklessly make a fals e statement to obtai n ai d for yourself or anyone els e, will
lead to disquali fi cati on, li abili ty to refund of any ai d already pai d and possi ble prosecuti on.
The infor mati on provi ded on thi s form may be made available to other Depar tments/Agenci es
for the purposes of preventing and detecting cr i me.
DAERA FRAUD HOTLINE 0808 1002716
Data Protection and Freedom of Information Issues
DAERA and our deli ver y agents take data protecti on and freedom of i nformati on issues
seriously. We take care to ensure that any personal informati on suppli ed is dealt wi th in a way
whi ch comp li es wi th the requirements of the Data Protecti on Act 2018 and the General Data
Pr otecti on Regulati on. This means that any personal informati on you supply wi ll be processed
pri nci pally for the purpose for whi ch it has been provi ded. However, DAERA may also use it for
other legi ti mate purpos es in li ne wi th the Data Protecti on Act 2018 and Freedom of Informati on
legi slati on. These i nclude:
Occupati onal health and welfare;
Co mpilati on of stati sti cs;
Disclosure to other organi sati ons when requi red by law to do so;
Disclosure under the Freedom of Informati on Act 2000 or the Envi ronmental
Informati on Regulati ons 2004 wh ere such disclosure is in the publi c i nterest;
The preventi on and detection of fraud or maladmi ni strati on (e.g. The Comptr oller &
Audi tor General and HM Revenue & Customs ).
For further details on your privacy see the DAERA Privacy Statement (www.daera-ni .gov.uk/daera-
pri vacy-statement)
The Rural Business Development Grant Scheme is funded by the Department of
Agriculture, Environment and Rural Affairs (DAERA) as part of the Tackling
Rural Poverty and Social Isolation (TRPSI) Programme.
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The Rural Business Development Grant Pilot Scheme is funded by
the Department of Agriculture, Environment and Rural Affairs as
part of the Tackling Rural Poverty and Social Isolation Programme.
The Scheme is being administered by local Councils.
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Evidence of Value Annex A
Please use this form to provide detail of the quotes that you have obtained in respect of the individual items you wish to purchase. You must also
submit the specification and quotes with your application. An example has been provided in the first line. Continue on a separate sheet if necessary.
Please note:
At least 2 quotes from 2 separate suppliers should be sought for each item. You or a business that you are an owner/partner/director of, are
excluded from quoting for a project that you may be offered funding for. If quotations are being sought from a member of your family or extended
family then the relationship must be advised to the Council prior to any procurement activity and declared in writing on the procurement
documentation. In these cases you are required to provide 3 quotes i.e. 2 independent quotes in addition to the family member quote.
Quotes should be ‘like-for-like’ and a detailed specification for each item must be provided, which may state the make and model for equipment.
Email quotes are acceptable and should include any covering email.
Quotes must be dated prior to close of call and contain the supplier’s name.
Internet searches should be saved as a print screen or printed and scanned and sent with your application we will not accept website addresses
/ links to websites. The submission must clearly show the website used and the cost of the item.
The lowest quotation should be selected with corresponding costs detailed on the application form. Please note that DAERA will reimburse at the
cost of the lowest quotation.
ITEM
ESTIMATED COSTS QUOTES RECEIVED
PREFERRED SUPPLIER
COST
Supplier 1
Quote
Supplier 2
Quote
Example:
Printer, Model XYZ Windows 10
ABC Printers Ltd
£205.12
Printers R Us
£210
ABC Printers Ltd
£205.12
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