Innovation Vouchers Pooled Application Form (DOC) Web viewA company may apply for up to three vouchers for different projects but ... Strategy and Innovation Solutions ... Innovation

INVEST NI INNOVATION VOUCHER APPLICATION FORMVALID FOR APPLICATIONS FROM OCTOBER 2015

Code Number: IV/ (Invest NI use only)

Prior to completion, please refer to the application guidelines at http://www.investni.com/innovation-vouchers.html. Applications are only considered valid if all sections have been completed.

Applicant Details – Lead Business

Business Name

Business Address, including postcode

Type of Business (i.e. Ltd company, sole trader, partnership)Product/service area*

Is the Business a Social Enterprise? (Yes/No)

E-mail

Telephone Number

Contact Name(e.g. Mr. John Smith)

Title First name Surname

Job Title

*Businesses in the transport and agricultural sectors are excluded in line with State Aid Guidelines

DUE TO CONTINUING HIGH DEMAND FOR INNOVATION VOUCHERS, PRIORITY WILL BE GIVEN TO PROJECTS WITH THE GREATEST COMMERCIAL POTENTIAL.

Version 3.0 15th September 2015 1

http://www.investni.com/innovation-vouchers.html


DeclarationPlease provide the required information and insert ‘Yes’ or ‘No’ in the box as appropriate.The business is, or will be, predominantly based in Northern Ireland and will produce evidence to this effect if so requested and the signatory of this application is entitled to work in Northern Ireland for at least eighteen months from issue of an innovation voucher without any additional approvals and will produce evidence to this effect if so requested.Please state the number of fulltime employees (figure required).Programme is open to: - small enterprises in which the total number of full-time employees in the business, or if

part of a group, the group, is less than 50 and the annual turnover and/or balance sheet total is less than €10m.

Medium enterprises in which the total number of full-time employees in the business, or if part of a group, the group, is between 50 and 250 and the annual turnover is less than €50m or balance sheet total is less than €43m. Also, medium enterprises must not have received assistance through Invest NI’s R&D programme in the past 5 years..

Please provide a £figure for annual sales. If you are pre-trading, this might be NIL.

THE BUSINESS AGREES TO PAY THE VAT ELEMENT APPLICABLE TO THE VOUCHER AND ANY PROJECT COSTS IN EXCESS OF THE VOUCHER VALUE AND CAN FUND THE PROJECT TO COMPLETION.If this project has been supported/is likely to be supported by any other Invest NI programme, please provide the name of the support programme(s) and year(s) of any support.

If this project has been supported/is likely to be supported by any other non-Invest NI support programme, please provide the name of the support programme(s) and year(s) of any support.

In completing this Declaration I confirm that:

I have read, understand and agree to the Disclosure, Publicity and Confidentiality paragraphs (see Notes at end of form) and consent to use of the information provided for the purposes described.

The details provided on this form are current and accurate to the best of my knowledge.

The business is solvent and no distress or execution has been levied against it.

The business has not received more than €200,000 of Innovation Aid in the last 3 fiscal years (see Notes at end of form).

Signed on behalf of the business (please type name - actual signature not required)Print Name

Position Date



YES NOIf a knowledge provider has been identified to undertake the project work, has the business previously used the services of this provider for a knowledge transfer-type project?

Innovation vouchers are intended to stimulate new collaborations with the knowledge base and therefore priority may be given to those businesses that have not previously worked with a specific department of a knowledge provider on a formal knowledge transfer project.Has the business previously undertaken any research and development activity?

Has the business previously undertaken any innovation activity?If you have previously received an Innovation Voucher, what were the outcomes/benefits for the business arising from the Voucher project?



Applicant Details – Business 2

Business Name




E-mail

Telephone Number



Job Title







Medium enterprises in which the total number of full-time employees in the business, or if part of a group, the group, is between 50 and 250 and the annual turnover is less than €50m or balance sheet total is less than €43m. Also, medium enterprises must not have received assistance through Invest NI’s R&D programme in the past 5 years.





I have read, understand and agree to the Disclosure, Publicity and Confidentiality paragraphs (see last page) and consent to use of the information provided for the purposes described.



The business has not received more than €200,000 of Innovation Aid in the last 3 fiscal years (see last page).


Position Date









Business Name




E-mail

Telephone Number



Job Title

















Position Date









Business Name




E-mail

Telephone Number



Job Title

















Position Date









Business Name




E-mail

Telephone Number



Job Title







Medium enterprises in which the total number of full-time employees in the business, or if part of a group, the group, is between 50 and 250 and the annual turnover is less than €50m or balance sheet total is less than €43m. Also, medium enterprises must not have received assistance through Invest NI’s R&D programme in the past 5 years..










Position Date








Section Two: The Innovation Project

The information in this section will be considered by the assessment panel to determine if a voucher should be awarded. It is important that this section demonstrates the need for and benefits of engagement with a knowledge provider to develop an innovative solution to the particular business issue. In instances in which an existing solution is readily available from the private sector it is unlikely that a voucher will be awarded. If insufficient or unclear information is provided Invest NI may not be able to fully appraise the project.

Business OverviewPlease provide a brief outline of the group, which might include the following: sector, customer base, how long businesses have been established, main products and markets. If any of the businesses are at the pre-start phase with no trading history please provide information on the expertise/experience/knowledge in this business area.

What is the issue that you would like to address in your proposed Innovation project and what specific activity would you like the knowledge provider to undertake to help to solve the issue?

In the context of your target marketplace, please explain how you think your proposed product or service is novel/different/innovative/unique.



What work (i.e. initial development, market research, analysis, etc) has been carried out to assess the need/market for your project?

What skills and expertise do you require in a knowledge provider to address your issue?

What are the deliverables you expect from the knowledge provider at the end of your project, i.e. what do you hope to have from the provider once project work has been completed?

How will the group and Northern Irish economy benefit from the project and what are the expected results for the group at the end of the project?



Knowledge Provider Interaction YES NODoes the group agree that Invest NI can pass project and contact details to knowledge providers if required? This can be useful if a provider wishes to see a copy of your application to check the project scope.If you have identified a knowledge provider from the list of approved providers (http://www.investni.com/innovation-vouchers.html), please provide details below. It is not essential at this stage to have identified a provider.

Institution/Organisation:

Name of academic (if known):

Faculty/Department:

Additionality (need for Invest NI support)

Is Invest NI assistance essential to enable the project to proceed?Yes No

If Yes, what would be the likely effect of not receiving Invest NI assistance for this project? Please select ONE of the options below.

Project delayed

Project reduced in scale

Project quality adversely affected

Project abandoned




NOTES

General

1. A company may apply for up to three vouchers for different projects but may only have one ‘active’ voucher at any point in time. Please refer to http://www.investni.com/innovation-vouchers.html for further information.

2. Invest NI’s decision in the award of vouchers will be final and no discussions will be entered into with third parties.

3. Vouchers are non-transferable.

4. Please email your completed application as an MS Word attachment to [email protected], or post a hard copy to:

The Innovation Vouchers Programme TeamTechnical Advisory Unit, 7th FloorInvest NIBedford Square, Bedford StreetBelfastBT2 7ES

Disclosure, Publicity, Confidentiality

5. Invest NI shall be entitled to publish details of the amounts and types of assistance offered at such times and in such manner as Invest NI or the Commission may decide.

6. The Client shall render Invest NI such assistance as Invest NI may reasonably request in connection with any publicity and surveys which Invest NI may deem appropriate in respect of the Project.

7. Invest NI shall be entitled to disclose details of the Client to other government agencies and departments, and bodies engaged in economic development in the EU (subject to the terms of the Data Protection Act 1998 and any other applicable legal restrictions which prevent the disclosure of such information) where Invest NI considers that disclosure is in the Client’s interest.

8. Invest NI may include any information which it receives in relation to the Client in a database of economic, financial and statistical information and may publish or disseminate reports derived from such database provided that such reports do not specifically identify the Client.

9. Invest NI shall be entitled to disclose information on the Client to Invest NI’s professional advisers who are subject to obligations of confidence or to consultants working on Invest NI’s behalf provided such disclosure is made for the specific purpose for which the consultants are engaged.


mailto:[email protected]




10.Subject to paragraph 3 Invest NI shall treat all information received from the Client in pursuance of an innovation voucher as confidential and shall not disclose such information to any third party other than those referred to at paragraphs 7 and 9, without the consent of the Client, such consent not to be unreasonably withheld or delayed, except as may be required by law (including without limitation Freedom of Information legislation) or for the purpose of preventing or detecting crime or for the purposes of any parliamentary or governmental enquiry into the activities of Invest NI.

Innovation Aid

11.The assistance made available through the Innovation Voucher Programme is awarded under The Industrial Development (Northern Ireland) Order 1982 and is State aid (Innovation Aid for SMEs) under Article 28 of Commission Regulation (EU) No. 651/2014 of 17 June 2014 (the “General Block Exemption”), notification no. SA.40270 “Skills, Strategy and Innovation Solutions”. Companies must not have received more than EUR 200,000 of Innovation Aid for SMEs in the last 3 fiscal years. Where an undertaking is part of a group of companies, the Innovation Aid limit applies to the combined group and not individual companies or undertakings within the group.

12. The only other support offered by Invest NI that would currently contribute (at September 2015) to this total of Innovation Aid is the Technical Development Incentive scheme. Please note that it is your responsibility to check whether the support you have received was classed as Innovation Aid. If in doubt, please check with whoever provided the support to you.


Documents

Innovation Vouchers Pooled Application Form (DOC) Web viewA company may apply for up to three vouchers for different projects but ... Strategy and Innovation Solutions ... Innovation