Upload
azira-roshan
View
221
Download
0
Embed Size (px)
Citation preview
7/28/2019 Proposal & CList Form-(is EDIT)
1/15
ALL INFORMATION PROVIDED IN THIS APPLICATION
WILL BE TREATED AS CONFIDENTIAL
Please read the Technofund Guidelines carefully before
you fill in this form.
All information required in the application form must be
given.
Please submit the project proposal together with the
business plan (1 hard copy and 20 CDs) but save theproject proposal in a separate file.
Incomplete application and/or application received after
the closing date of each cycle will be returned.
For office use only
Date Received
Reference No
Project Officer
PART 1: APPLICANT DETAILS
1.1 Particulars of Entity
Entity name:
FQ FEEDMILL SDN BHD
Company registration number (if applicable):817754-V
Date of Incorporation (if applicable):
We are currently a (Please mark (X) inappropriate box):
Start-Up Company
Spin-Off Company
PROJECT TITLE COST-EFFECTIVE FEEDS FOR MARINE FISH FARMING
Please read the latest version (updated 31th July 2007)
of TechnoFund Guidelines for Applicant carefully beforeyou fill in this form.
Please submit 2 hard copies and 15 CDs (saved in
separate files) of project proposal, business plan andexecutive summary.
All information required in the application form must be
given. Incomplete or ineligible application will not beentertained.
Development and Procurement Division,Ministry of Science, Technology and Innovation (MOSTI)
Level 3, Block C5, Complex C,Federal Government Administrative Centre, 62662 Putrajaya
http://www.mosti.gov.my
Tel: 03 - 8885 8810 / 8163 (Helpdesk)Fax: 03 - 8888 9473e-mail: [email protected]
http://www.mosti.gov.my/mailto:[email protected]://www.mosti.gov.my/mailto:[email protected]7/28/2019 Proposal & CList Form-(is EDIT)
2/15
Small Company X
Medium / Large Company
Public Listed Company
Government Linked Company
Institution of Higher Learning
Government Research Institute
Authorised capital :
RM 100,000.00
Paid up capital:
RM 100,000.00
Structure of Shareholding:
Malaysian:
Bumiputra
%
66.66
Non- Bumiputra 33.34
Foreign:
Total: 100.00
Core Business of Entity:
1. Manufacturing Animal Feed2. Sales & Marketing Finished product
3.
Address:
Lot 13G,Kawasan Perusahaan BukitAngkat,43300 Kajang,Selangor
Company Directors (if applicable):
2
7/28/2019 Proposal & CList Form-(is EDIT)
3/15
1.Hj Anuar bin Ibrahim
2.Dr.Iskandar Roshan bin Abdullah
3.Razis Shahrizan bin Zainal
Principal Researcher / Leader:
Hj Anuar bin Ibrahim
Designation :
Managing Director
Telephone no : Fax no :
03-87336073 03-87336095
E-mail:
3
7/28/2019 Proposal & CList Form-(is EDIT)
4/15
1.2Have you or your business previously applied or been connected with an application, forother Government R&D, commercialisation or related funding? Please mark (X) in theappropriate box.
Yes No x
If yes, please give details:
1.3
Have you or any other partner, member or director of your business ever been
disqualified from becoming a director?Please mark (X) in the appropriate box
Yes No x
If yes, please give details:
1.4Have you or any other partner, member or director of your business ever been an owner,partner or director of a business which went into bankruptcy, liquidation or receivership?Please mark (X) in the appropriate box
Yes No x
If yes, please give details:
1.5
How do you plan to fund your share of the project costs? Provide proposedsource of funding (for start-up, spin-off and small company) or evidence offunding (e.g. bank statement, bank facility / over draft, etc)
4
7/28/2019 Proposal & CList Form-(is EDIT)
5/15
PART 2: COLLABORATOR DETAILS
2.1Particulars of Collaborator(mandatory for IHL/GRI Applicant):
Company Name:
Universiti Malaysia Sabah
Company registration number:
Date of Incorporation:
24 Nov 1994
Our collaborator is:Please mark (X) in appropriate box
Start-Up Company
Spin-Off Company
Small Company
Medium / Large Company
Public Listed Company
Government Linked Company
Institution of Higher Learning x
Government Research Institute
Authorised Capital :
Paid-up Capital:
Structure of Shareholding:
Malaysian:
Bumiputra Non-Bumiputra
%
Foreign:
Total:
Core Business of Collaborator:
1.Education
2.
3.
Address:
Universiti Malaysia SabahLocked Bag 2073,88999 Kota KinabaluSabah Malaysia
Company Directors:
1.
2.
Contact Person:
Prof. Dr. Rosnah Ismail
Designation:
Deputy Vice Chancellor (Research &Innovation)
Telephone no :
088-320000 - 1407
Fax no :
088-448886
E-mail:
5
7/28/2019 Proposal & CList Form-(is EDIT)
6/15
PART 3: PROJECT DETAILS
You are applying for(Please mark (X) in the appropriate box)
Type ApplicationProposed Project Cost
(RM)
A: Pre-Commercialisation x3,195,080.00
B: IP Acquisition
Total
Note: Applicants can apply for a combination ofTypes A and B orType A only
6
7/28/2019 Proposal & CList Form-(is EDIT)
7/15
7
Technology Cluster(Please mark (X) in the appropriate box
Agriculture
Biotechnology X
Information and CommunicationTechnology
Industry
Sub cluster(please refer to the List of Sub Clusters at
http://ernd.mosti.gov.my/escience and indicate accordingly)
Sub cluster:
3.1 TYPE A: PRE-COMMERCIALISATION
3.1.1 Project Title
COST-EFFECTIVE FEEDS FOR MARINE FISH FARMING
3.1.2 Project Summary
New fish feed formula that serve as a replacement fish-based feeds, using a mixture ofpoultry by-products and vegetable oils. The feed produced that was not only profitablefor aquaculture farmers but one which would also contribute to the environment.
3.1.3 Proposed Project Duration (months)
24 months
3.1.4 Location of the Proposed Project
Selangor
http://ernd.mosti.gov.my/http://ernd.mosti.gov.my/7/28/2019 Proposal & CList Form-(is EDIT)
8/15
3.1.5 Technical Aspects (Refer Attachment)
a. Previous Work Done (Laboratory Proof of Concept)
b. Project Objectives
c. Methodology
d. Technology Benchmarking
e. Project Deliverables
f. Regulatory and Standards
g. Patentable Output
h. Project Risks
i. Project Benefits
j. Project milestones and activities (List the major milestones of the project(typically 5 to 8) in the table below. Outline the major activities of eachmilestone. A milestone typically consists of 8 to 12 activities. These activitiesshould collectively cover the scope of the milestone. The activity costs shouldbe equal to the total project cost.)
NO. MILESTONES ACTIVITIES DELIVERABLES COSTCOMPLETION
DATES
1.
2.
3.
4.
5.
6.
7.
8.
k. Project Gantt Chart (Please attach)
8
7/28/2019 Proposal & CList Form-(is EDIT)
9/15
l. Project Costing(Please itemise and provide breakdown for expenses of each componentand sub-component involved)
9
NO EXPENSES ITEMSCOST(RM)
TOTAL(RM)
1.Pilot Plant & Equipment (ifapplicable)
2.Clinical Trial / Field Trial (ifapplicable)
3.Commercial Ready Prototype (ifapplicable)
4.IP Preparation and Registration(excluding maintenance)
5.Market Testing of CommercialReady Prototype
6.Regulatory and StandardsCompliance
7. Contract Expenditure
8.
Expenditure of Services (marketsurvey, consultancy andtesting)
Total Proposed Project Cost
7/28/2019 Proposal & CList Form-(is EDIT)
10/15
10
3.1.6 Project Team(Describe the technical and business capabilities, qualifications and experience ofproject team members. Please attach CV of each team member.)
Refer CV
3.2 TYPE B - IP ACQUISITION
3.2.1 Title
nil
3.2.2 Description(commercial potential, etc)
nil
3.2.3 IP Registration number and expiry date
nil
3.2.4 Original Owner(Please attach IP Acquisition Agreement with owner)
nil
3.2.5 Country of origin
nil
3.2.6 Cost of acquisition
3.2.7 Details of training provided
nil
NO EXPENSES ITEMS
COST
(RM)
TOTAL
(RM)
1.Acquisition of IP(laboratory scale
nil
2. Training (technology transfer) nil
Total Cost of Acquisition
7/28/2019 Proposal & CList Form-(is EDIT)
11/15
11
3.2.8 Novelty of IP to be acquired
nil
3.2.9 Proposed Acquisition Date
nil
7/28/2019 Proposal & CList Form-(is EDIT)
12/15
PART 4: DECLARATION
This form must be signed by someone with the legal authority to bind the applicant entity/institution(for example, an executive director of your entity)
I / We certify that:
a. I / We have read, understood and agreed to abide by the latest version of the TechnoFundGuidelines For Applicants;
b. The information provided in this application, including attachments, is true and correct to thebest of my knowledge; and
c. The Entity/Institution is free from any litigation pertaining to the proposed project in Malaysia
and overseas.
Name:
Designation:
Signature:
Date:
For enquiries, please e-mail: [email protected]
Applicants must use the latest version of the Project Proposal Form for submittingapplications and fill in the TechnoFund Application Checklistseparately. MOSTI
reserves the right to revoke application or withdraw approval based on falseinformation submitted by applicants.
12
4.1 Declaration
mailto:[email protected]:[email protected]7/28/2019 Proposal & CList Form-(is EDIT)
13/15
TECHNOFUND APPLICATION CHECKLIST
Reference No.
Entity Name FQ FEEDMILL SDN BHD
Project Title COST-EFFECTIVE FEEDS FOR MARINE FISH FARMING
13
No. Please mark ( ) in the appropriate box
( ) (For Official Use)Book 1 (2 hard copies)
1. Executive Summary (maximum 2 pages)
2. Project Proposal
3. Curriculum Vitae of project team
4. Form 9 (Company Act,1965)
5. Form 24 (Company Act,1965)
6. Form 49 (Company Act,1965)
7.
Recent EPF statement of all employees / work permitof foreign workers (Company Applicants and IHL/GRIMain Collaborator)
8.
MOU between IHL/GRI and Collaborator (to financethe portion of project cost not funded by TechnoFundand to commercialise project output) (IHL/GRIapplicants only)
9. IP Acquisition Agreement (for Type B only) 10. Itemised costing
Book 2 (2 hard copies)
11. Business Plan
12.Latest audited Financial Report (annual turnover,profit and loss statement, balance sheet, cash flow,etc) (Company applicants and IHL/GRI Collaborator)
CD (15 copies)
13.Project Proposal + Business Plan + ExecutiveSummary (in separate files)
7/28/2019 Proposal & CList Form-(is EDIT)
14/15
14
7/28/2019 Proposal & CList Form-(is EDIT)
15/15
(For Official Use Only)
Status: Complete
Incomplete & Returned
Ineligible & Returned
Status: Complete
Incomplete & Returned
Incomplete & Returned
Remarks: Remarks:
Name of Desk Officer : Name of AD:
Signature: Signature:
Date: Date:
Ministry Chop:
Acknowledgement by Applicant:
Name :
Signature:
Date:
Updated: 31 th July 2007
15