1. Small Business Grants Application Council Policy 6.18 – Small Business Grants

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2. APPLICANT DETAILS Surname: First Name: Address: Telephone: Postcode: Mobile: Facsimile: E-mail: Property Address: Postcode:

3. BUSINESS DETAILS Business Name: ABN: Business Address: Postcode: Postal Address: If different from the above Postcode: How long has your business been located in the city? Operating Day/Hours: Lease Period & Expiry Date:

FXXXX (dd/mm/yy) Economic Development Unit P1032888 What is your normal or core business activity? Provide a brief summary of your business & operation [500 words max]

Aside from your core business, what other activities is your business involved with (if any)? [250 words max]

Explain how your business has demonstrated business success and/or strong market potential. [500 words max] 4. GRANT REQUEST DETAILS

How much grant funding are you applying for? [up to $2,000] What do you want to use this grant for? Provide details about the specific business project that you intend to use the grant for [500 words max]

How does your business and proposed project support the objectives of the Small Business Grants program? a. Support the effective implementation of the City’s Economic Development Strategy; b. Support and encourage small businesses to operate in the city; c. Encourage innovative and creative small business projects; and d. Support businesses that demonstrate a notable benefit to the city’s people and/or business communities.

Is the business project financially viable? I have attached a business plan including financial figures and forecast demonstrating the financial viability of the business and a project plan of the proposal.

Explain how your business meets a least one of the following: [500 words max]

FXXXX (dd/mm/yy) Economic Development Unit P1032888 . Demonstrates business readiness; . Introduces a new or innovative product or process (goods or services) to the city; . Creates networks with other businesses or organisations; . Is involved in small-scale manufacturing or production within the city (e.g. Jewellers, designers, software developers) and exports to other regions; . Enhances public safety or the environment; . Activates underutilised space (e.g. laneways, upper/ground level/basement floors, vacant tenancies); and . Contributes positively towards the City’s social, environmental or economic development.

5. CHECKLIST Your business must meet all of the criteria below to be eligible for a grant My business has not previously received a Small Business Grant from the City of Perth in the past three (5) years. My business has not received a Matched Funding Business Grants from the City of Perth in the past three (5) years. My business is located within the City of Perth Local Government Area (Northbridge, West Perth, East Perth, CBD, or applicable locations of Crawley and Subiaco) My business has secured a commercial lease agreement at a property within the City of Perth Local Government Area for at least 12 months from the time the application is submitted. My business has a valid Australian Business Number (ABN). My business is defined as a small business as per the Australian Taxation Office (ATO) and the Australian Bureau of Statistics (ABS), which is a business employing less than 20 people and with an aggregated turnover less than $2 million per year. My business has the appropriate insurances, permits and licenses by relevant authorities. My proposal does not include financing for operational costs (e.g. salaries, utilities, relocatable assets and consumables). My business project will not jeopardise public safety or damage the environment. If successful, I understand that my business must use the grant money before 30 June 2017. I understand that to claim reimbursement of approved spending, I must complete and submit a Claim Form (to be provided), a business invoice and proof of payment. I understand that grant money will be provided as reimbursement for spending after approval of a Small Business Grant application by the City of Perth and on completion of the project (not before). I understand that I may be required to engage and report to the City of Perth to provide updates in the use of the grant money (when/if required), and that this may require provision of brief written updates and publicity opportunities arranged by the City. I understand that to claim reimbursement of approved spending, I must provide the City of Perth before and after photographs of the project undertaken using grant funding, a short testimonial to be used for promotional purposes and display a ‘City of Perth Grant Recipient’ sticker (to be provided) in a visible position on their business premises. I understand that I must allow the City of Perth to publicise information about my business in promotion of the grants. I have attached a detailed business and project plans including a financial assessment.

FXXXX (dd/mm/yy) Economic Development Unit P1032888 6. APPLICANT DECLARATION I certify to the best of my knowledge that the statements made in this application are true. I have read the City of Perth’s Small Business Grants Information Package and I understand that should this application be accepted, I would be required to accept the conditions of the grant. I acknowledge that the City of Perth’s acceptance or refusal of this grant application is final and is not subject to an appeal process. Name: Position: Signature: Date: