Screenwest (Australia) Ltd ABN 43 620 492 30030 Fielder Street East Perth WA 6004P +61 8 6169 2100 | T 1800 463 043 E info@screenwest.com.au W screenwest.com.au W filminwesternaustralia.com.au

Documentary Production Application FormBefore completing this form please read the relevant Guidelines in conjunction with the Screenwest Terms of Trade.

Screenwest is supported by

Screenwest Documentary Production Application Form – June 2019 Page 1 of 15

2.0 Applicant / Applicant Production Company Details

ABN Year Incorporated:

Registered Business Address

State Post Code

Applicant Contact Name

Address (if different)

State Post Code

Phone Mobile

Email

Website

*Please attach a copy of the Company Certification of Incorporation and the names of the company directors Attached

Are you a Western Australian Resident Producer or Production Company as defined in the Screenwest Terms of Trade ? Yes No

Do you have any other Producing Partners? Yes No *If you answered “YES”, please also provide the additional information below

Are you in a Genuine Co-Production Partnership with a non-WA resident company as per the Screenwest Terms of Trade? Yes No

Are you in an Official Treaty Co-Production relationship with a non-WA resident company as per the Screenwest Terms of Trade? Yes No *Please provide confirmation of compliance

Other Producing Partner/ Company Name

Contact Name

Address

Phone

Email

If a Co-Production or Official Treaty Production, who holds what percentage of the copyright?

WA: %Non-WA %

Percentage Share of the Producers net recoupment? WA: %Non-WA %

Does the WA Producer have creative input in to the project? Yes No

Will the WA Producer be the physical Producer? Yes No

Screenwest is supported by

Documentary Production Application Form – June 2019 Page 2 of 15

Documentary Production Application Form – June 2019

*Please also attach a co-production agreement or deal memo between the producers outlining their relationship as well as roles and responsibilities including during physical production, indicating level of creative involvement, ownership of rights and recoupment position, if any. State % split of production and post-production responsibilities between co-pro partners.

Attached

3.0 Applicant Statistical information

Applicant Age 18-24 25-34 35-44 45-54 55-64 65+

To which gender identity do you most identify with? Female Male Other Prefer not to answer

Is the applicant based in Western Australia? Yes No

Is the applicant a Western Australian Resident as defined in the Terms of Trade? Yes No

Does the applicant identify as Indigenous? Yes No Prefer not to answer Any additional Comments:

Does the applicant identify as being from a CaLD (Culturally and Linguistically Diverse) background? Yes No Prefer not to answer Any additional Comments?

Does the applicant identify as having a disability? Yes No Prefer not to answer Any additional Comments?

4.0 Project Diversity Information

Screenwest seeks to reflect the diversity of Western Australia’s community on screen and behind the camera, through projects funded and practitioners supported. The funding panel will take into consideration diversity elements of a submission during the assessment process.Please address any diversity elements of the project and/or production company. These can include Diversity elements in the areas of:

The Story Key Talent – Onscreen and Offscreen Key Creatives

*Please also attach a Diversity Statement of no more than one page maximum. Attached

5.0 Applicant’s current funding obligations (if relevant)

Activity/project currently in receipt of funding (not yet acquitted)

Current status/ action required

Delivery date

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Documentary Production Application Form – June 2019

6.0 Project Creative Details

6.1 Creative Vision

*Please attach a statement from the director detailing their creative vision for the project (include creative pitch material- e.g. mood boards, etc, if you have it).

Attached

*Please attach a statement from the producer (s) detailing their vision for the project (including notes about target audience).

Attached

6.2 Key Creative Team (Director, Producer, Writer/s)

Role Name State of Residence

Director (s)

Please write a short biography for the director (s) (max 100 words p/person)

Biography:

*please attach CV separately Attached

Role Name State of Residence

Writer (s)

Please write a short biography for the writer (s) (max 100 words p/person)

Biography:

*please attach CV separately Attached

Role Name State of

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Documentary Production Application Form – June 2019

Residence

Producer (s)

Please write a short biography for the producer (s) (max 100 words p/person)

Biography:

*please attach CV separately Attached

6.3 Key Cast - Please provide name (s) of approached or confirmed cast (include presenters and narrators)

*Separately attach relevant cast letters of interest, deal memos or agreements.

Role Name Approached Confirmed

Yes No Yes No

Yes No Yes No

Yes No Yes No

Yes No Yes No

7.0 Project History

*Please provide a brief summary of the history of the project- include a history of the team’s development of the project and liaison with Screenwest to date (e.g. location and/or crew enquiries, etc.) (no more than 100 words)

History summary:

7.1 Previous Funding

Has the project been previously submitted to Screenwest Yes No

*If you answered “Yes” above answer the following questions

Was the application successful? Yes No

Program applied for (e.g. Development) and Amount ApprovedAlternative title(s) (if the project’s name has changed since a previous submission)

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Documentary Production Application Form – June 2019

8.0 Western Australian Elements Points TableProjects are required to reach a minimum of 10 points, as per the point allocation table below, to qualify as eligible Western Australian content

*Please also include names/details and any justifications of your points selection in the space belowPosition Maximum

PointsYour points

Position Maximum points

Your Points

A WA Production Company with at least joint creative control

2 F WA Writer/s; at least 50% of the writers (receiving full credit) attached must be filled by West Australians to receive this point.

1

A F

B Original concept with at least 50% copyright owned by WA Production Company

2 G WA Editor 1

B G

C Identifiable WA location/setting or character

2 H Post: 75% of your post budget spend in WA

1

C H

D Series - WA Series Producer and Series Director. 1 point awarded per position.Single – WA Director attached. 2 points awarded.

2 I 75% of crew to be West Australian to get 2 points. Points cannot be pro rata’d.

2

D I

E WA Supervising Post Producer and WA Supervising Post Director. 1 point awarded per position.

2 J Flexible Points*

*Please refer to the Guidelines regarding Flexible points

1

E

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Documentary Production Application Form – June 2019

Your Total Points:

9.0 Proposed Production Schedule

Date Number of Weeks

Start of pre-production

Start of principal photography

Start of post-production

Picture edit complete

Sound edit complete

Project complete

Delivery

10.0 Marketplace Summary Please include proof of all market place commitments and other investments with this application ensuring that all agreements are consistent with one another (i.e. delivery dates, territories, number of runs).

Please provide sales estimates including returns from all media in all territories verified or provided by the distributors or sales agents named in this application.

* Applicants must also present a marketing and distribution plan for Australian domestic and Rest of World (ROW) sales. It is expected this will be prepared with input from the market partners named in this application. Attached

10.1 DOMESTIC DISTRIBUTOR

Company

Advance / Guarantee Payable

Term

Rights

Minimum P&A

Anticipated Release

Commissions

Approvals / Conditions(brief summary only)

10.3 DOMESTIC BROADCAST

Broadcaster

License Fee Payable

Territories

Term

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Documentary Production Application Form – June 2019

Rights

Delivery date

Approvals / Conditions(brief summary only)

10.3 INTERNATIONAL BROADCAST (must have Australian audience footprint)

Broadcaster

License Fee Payable

Territories

Term

Rights

Delivery date

Approvals / Conditions(brief summary only)

10.3 ONLINE PLATFORM (must have significant audience reach in Australia e.g. Netflix, Amazon, Google, Vice, The Guardian)

Broadcaster

License Fee Payable

Territories

Term

Rights

Delivery date

Approvals / Conditions(brief summary only)

10.2 ROW SALES AGENT

Company

Advance / Guarantee Payable

Territories

Term

Rights

Commissions

Costs

Approvals / Conditions(brief summary only)

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Documentary Production Application Form – June 2019

10.4 PRESALE (S)

Company

License Fee Payable

Territory

Term

Rights

Delivery date

Approvals / Conditions

11.0 Funding Calculator*The minimum Qualifying Western Australian Expenditure (QWAE) for all applications is $300,000.*The ratio of funding to Qualifying Western Australian Expenditure (QWAE) must be at least 1:3.

Total funding per project can be calculated in one of two ways (as below)Option 1: For productions with a per hour cost of $500,000 and aboveScreenwest will match the amount of cash funding provided by legitimate, at arms-length, market partners up to a maximum of $400,000 or 25% of the total cash production budget, whichever is less.

Total Market Partner Cash Funding $

Matched Screenwest Funding $Ratio of funding to Qualifying Western Australian Expenditure (QWAE)

Option 2: For productions with a per hour cost of lower than $500,000. Up to a maximum or $400,000 per application or 15% of the budget, whichever is less. Total funding per project is calculated by a combination of Base Funding plus a number of Funding

Incentives

Option 2a. Base Funding (10% of the Production budget up to $250,000) $

Ratio of funding to Qualifying Western Australian Expenditure (QWAE)

Option 2 b.Funding Incentives (represent additional equity provided on top of the Screenwest Base Funding)

Please provide *Please provide a short rationale for each Incentive claimed and the amount requested.

1. WA Content – Authorship and WA on screen (up to $50,000) Amount Requested: $Rationale:

2. WA Spend Incentive (up to $50,000) *Where the QWAE represents 60-80% of the production budget, an additional incentive is accessible, as per

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Documentary Production Application Form – June 2019

the below sliding scale: 60% -70% - $20,000 70% -80% - $30,000 80%+ - $50,000

Amount Requested: $Rationale:

4. WA Key creatives and crew (up to $50,000 for the below roles) Series Director Series Producer Supervising Post Director/Producer

5. Volume of content (up to $50,000) Amount Requested: $Rationale:

6. Flexible Incentive (up to $25,000 as determined by the Screenwest Board, where a project demonstrates significant industry outcomes in the areas of the below)

Diversity Industry Development Digital Innovations Employment (of an ex-WA key creative (Executive Producer, Writer) or HOD where they have

worked interstate or internationally for more than 2 years) Significant WA profile onscreen talent attachment

Amount Requested: $Rationale:

Total Screenwest Finance Requested (Base + Total Funding Incentives)

12.0 Budget, Proposed Finance Plan and Recoupment Schedule

Complete the table below (adding additional rows if needed) making sure all the appropriate columns add up or total 100% *Please check your figures, cells do not auto-calculate

*You will also need to provide a detailed budget A-Z Budget (preferably a Screen Australia budget), including a highlighted column that shows any Qualifying WA Expenditure (QWAE).

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Documentary Production Application Form – June 2019

TOTAL BUDGET $

ConfirmedY / N

Investors Form of Investment

$Amount

% of Budget

MARKET

$ %

$ %

$ %

Subtotal $ %

NON-EQUITY INVESTORS%

Recoup%

Profit%©

$ % % % %

$ % % % %

Subtotal $ % % % %

EQUITY INVESTORS

$ % % % %

$ % % % %

$ $ % % %

Subtotal $ % 100% 100% %

Total $ 100% 100% 100% 100%

Please provide a brief summary of your proposed Finance Plan. If there are any gaps in the plan when do you anticipate confirming all financing partners? (no more than 100 words)

Summary:

If your project includes the Producer Offset as part of the financing plan please provide a statement on how you will cash-flow the Producer Offset. (no more than 100 words)Statement:

*Please attach a Provisional certificate from Screen Australia or a copy of the application for a Provisional Certificate

Attached

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Documentary Production Application Form – June 2019

12.1 Project Status with Screen Australia (if Applicable)

Is Screen Australia funding part of the Financing Plan? Yes No

If you answered “Yes” above, also answer the following questions

What date will/did you apply for Screen Australia funding? DD/MM/YY

What is the date of the Screen Australia Decision Meeting for your project? DD/MM/YY

Who is your Screen Australia Project Contact?

13.0 Indigenous Content and participation (if relevant)There must be strong indigenous representation on all projects that tell indigenous stories, through the involvement of an indigenous key creative or through thorough consultation and collaboration that is adequately budgeted for.

Where Aboriginal or Torres Strait Islander community participation or content is part of the project written confirmation of the willingness of both the subject(s) and the community to be involved is essential.

Please refer to Screen Australia’s Pathways & Protocols: a filmmaker’s guidelines to working with Indigenous people, culture and conceptsDoes your project have Indigenous content and/or participation?* If yes, please provide the following (a minimum of one page) Yes No

Describe what Indigenous content plays in the project, and the role of Indigenous collaboration or community consultation involved.

Please provide any agreements or arrangements in relation to any indigenous involvement and confirmation in writing of the participation of both the relevant subject(s) and the community

Does the project have an Aboriginal or Torres Strait Islander producer, director or writer? * If yes, please advise their details and current CV Yes No

If you have not yet consulted with the individual/community or the content is not specific to a particular community or person(s), please explain how you intend to manage the Indigenous content with regard to appropriate protocols.

*Please provide/describe your Indigenous consultation plan moving forward (a minimum of one page)

Please refer to Screen Australia’s Pathways & Protocols: a filmmaker’s guidelines to working with Indigenous people, culture and concepts

14.0 Ownership of Rights The Applicant must either hold appropriate rights or have an appropriate option to acquire the necessary rights to produce the project (e.g. the copyright in the screenplay/format/concept and/or the rights to any underlying work on which the project is based)

Do you hold copyright in the screenplay, format, concept? Yes No

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Documentary Production Application Form – June 2019

If you answered “Yes” above, under what kind of agreement? (e.g. a writer’s agreement, format holders agreement or an assignment agreement)

Is the screenplay, format, concept for the project an original work? Yes No

Is the screenplay, format, concept an adaptation of an existing or underlying work? Yes No

If the project is an adaptation please provide the title and author of the original or underlying work and the type of underlying work (e.g. novel, play, song, short, format)

Do you hold the rights to produce the existing or underlying work? Yes No

If you answered “Yes”, under what kind of agreement? (e.g. an option or an assignment agreement):

If you have an option what year was this acquired? DD/MM/YYWhen does your option expire? DD/MM/YY

*Applicants must warrant that they have all the required Chain of Title documents. Screenwest Management can and will request these at any stage during the application and assessment process. If your application is successful, you will be required to provide all Chain of Title as part of the contracting process and before cashflow can occur.

Attached

15.0 Application Checklist

*Please ensure this application form has been fully completed.

Below are the required materials that should be submitted together in one email with PDFs that are clearly labelled.

Check once attached

(double click on box)

Applicant / Applicant Production Company Details

Copy of the Company Certificate of Incorporation and the names of the Company Directors.If a co-production, any relevant agreement or deal memos between the producers/production companies.For International Treaty Co-productions either a Letter of Preliminary Compliance (if issued), or a copy of an application for provisional co-production approval.

Project Creative Details

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Documentary Production Application Form – June 2019

A one page synopsis.

A completed script including date and draft number.

A statement from the director detailing their creative vision for the project.

A statement from the producer(s) detailing their vision for the project.

CV’s of the key creative team - Director(s), Producer(s), Writer(s).

Any relevant cast letters of interest, deal memos or agreements.

Correspondence confirming the participation of the key crew listed as confirmed.

Marketplace Summary

Proof of all marketplace commitments and other investments (e.g. signed letters of offer, deal memos or agreements).Sales estimates including returns verified or provided by the distributors or sales agents named in the application.

Marketing and distribution plans for Australian domestic and Rest of World ROW sales.

Budget, Proposed Finance Plan and Recoupment Schedule

A detailed budget (preferably a Screen Australia A-Z budget), including a highlighted column that shows Qualifying WA Expenditure (QWAE).An allowance in the budget for Screenwest’s administration fee (2% of the total approved Screenwest Production Funding Amount capped at $5,000). Allowance in the budget for the repayment of any development funding and interest occurred. If a Slate Development recipient company, also allowance for repayment of slate.

Funding approvals of over $100,000 will be required to include an allowance in the budget for attachments.

If not also Screen Australia funded, allowance in the budget for National Film and Sound Archive delivery items.

A brief summary of your proposed Finance Plan

If relevant, allowance in the budget to adequately cover the cost of cash-flowing the Producer Offset.

If relevant, a Producer Offset Provisional Certificate or a copy of your application for a Provisional Cert.

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Documentary Production Application Form – June 2019

An executed letter of intent from a completion guarantor.

Documented evidence relating to any private equity investment.

Indigenous Content and participation (if relevant)

Any agreements or arrangements in relation to any Indigenous involvement and confirmation in writing of the participation of both the relevant subject(s) and the community

16.0 Applicant warranty

In submitting this application, I, the applicant warrant that:

I have read, understand and will adhere to Screenwest's current relevant guidelines and Terms of Trade. In particular, I acknowledge that Screenwest reserves the right to vary any of its terms and conditions without notice.

I warrant that I have all the required Chain of Title documents. I acknowledge that Screenwest Management can and will request these at any stage during the application and assessment process. I acknowledge that if my application is successful, I will be required to provide all Chain of Title as part of the contracting process and before cashflow commences.

I will always act in good faith in all dealings with Screenwest.

I am in good standing with all previous Screenwest funds and programs.

I have the capacity, resources and rights to carry out the proposal listed above.

Note: You must ensure that all particulars you have supplied are true and correct and that you have not concealed information relevant to this application. In making this application you are seeking a benefit from Screenwest. Under section 409 of the Criminal Code Act Compilation Act 1913 (WA), a person who gains a benefit by deceit or any fraudulent means is guilty of an offence. Company directors may be personally liable for the statements of the company. In the event that the particulars you have knowingly supplied are false, Screenwest may (a) revoke any offer made in conjunction with this applications; (b) demand immediate repayment of any funds which had been paid under a funding contract for funding approved based on this application; and/or (c) cease to consider any application (whether current or future) from you.

Signed [ELECTRONIC NAME / SIGNATURE IS ACCEPTABLE]

Name / Title Date

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