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Application for funding – Strategic Cropping Land Mitigation FundUse this form to apply for funding from the strategic cropping land mitigation fund to deliver a project that will deliver tangible benefits to Queensland’s cropping agribusinesses.

Eligibility

The project must be able to deliver tangible benefits to Queensland cropping agribusiness The project must identify and address the following Mitigation Criteria established in the

Regional Planning Interests Act 2014.a) aim to increase the productivity of cropping in the Stateb) provide a public rather than a private benefitc) aim to provide an enduring effectd) be quantifiable and able to be independently valuede) benefit the largest possible number of cropping agribusinesses, and f) if a cropping activity or cropping system existed for identified permanently impacted

land to which the measures relate – provide a benefit to that system in the relevant local area.

The types of organisations that can apply include, but are not limited to:o Research and development (R&D) organisationso Natural resource management groupso Universitieso Cropping industry agribusinesses seeking to develop or build industry capacity for

the region as a wholeo Grower groups that can demonstrate that a project will deliver productivity to the

wider industry.

For more information on eligibility, please refer to the application guidelines.

How to complete and submit this form

All responses within this application should be written using plain English. The use of jargon and technical language should be limited.

You can complete this form, save it, and submit it as an attachment via email to [email protected]

You can print this form and post to:Strategic Cropping Land Mitigation FundDepartment of Agriculture, Fisheries and ForestryGPO Box 46Brisbane QLD 4001

Field names with * are mandatory. For assistance, please contact the department’s Customer Service Centre on 13 25 23 or

email [email protected].

mailto:[email protected]

mailto:[email protected]

http://www.daff.qld.gov.au/environment/strategic-cropping-land-mitigation-fund-grant-program/guidelines

Part AApplicant detailsProvide details of the person completing this application.

Applicant/Business Name (if trust is applying please supply the Trust Deed)*

Australian Business Number (ABN)

Australian Company Number (ACN)

Are you registered for GST* ☐ Yes ☐ No If you are not registered for GST please

refer to guidance notes

Registered Trading Name

Postal Address Line 1

Postal Address line 2

Suburb State Postcode

Address of Other Office Locations

Website Address

Project contact and location detailsProvide contact details for the primary contact for the project, and the address where the project will be primarily based.

Salutation (e.g. Mr, Ms, Mrs, Dr)

First name*Surname*

Position Title (e.g. CEO, Manager)

Telephone number (including area code)Mobile number

© State of Queensland, Department of Agriculture, Fisheries and Forestry, 2014.

Email Address*Project location (full address)*

Business detailsDetailed information about the organisation requesting funding

Trading detailsNumber of years tradingNumber of years trading under current ownersNumber of employees

Full-time (FTE)

Part-time (PTE)

Total FTE equivalent

Nature of business

Core services

Business history

Previous funding assistance

Have you previously applied for any other Federal, State or Local Government financial assistance, including grants?

Yes ☐ No ☐

If yes, please provide the following details:

Name of funding application 1

Agency and scheme

Funding purpose

Date of application

Dollar amount ($) excluding GST

StatusComments, outcomes and/or financial issues



Agency and scheme

Funding purpose

Date of application




Agency and scheme

Funding purpose

Date of application



Financial historyProvide three years of the most recent audited financial statements (Profit and Loss/Balance sheet). Accountant prepared financial statements can be accepted if audited financial statements are not available.

Co contributionsCo contributions for the proposed project are funding sources additional to the funding that may be received from this grant application. Provide all evidence of co contributions to the project.

Details of all external funding approvals Details of funding bodies

Provide all evidence of matching cash

Letter of credit

Resolution of an organisation committing the funds to the projectCurrent dated bank statement


PartneringPlease provide details of any partnering arrangements, and if the applicant is acting as the lead agency then please provide details of the roles and responsibility of all entities involved.

Partner organisation

Details of partner arrangement (i.e. project role, contribution etc.)Contact details:

Salutation (e.g. Mr, Ms, Mrs, Dr)

First name*Surname*

Position Title (e.g. CEO, Manager)

Telephone number (including area code)

Mobile numberEmail Address*

Other information

For multiple partnerships, please copy and paste the fields from above to the rows below to detail each partnership arrangement.

Partner organisation 2


Part B – Project details

Please provide plain English response and limit highly technical language when answering the following questions.

Project title

Project cost (populated from detailed cost breakdown in Part C)

Total project cost* $ Incentive Requested* $

Project overview

Describe the overall project including what benefits will be generated and the expected outcomes for cropping agribusiness in Queensland.

Describe expected project timeframes, milestones and outputs.

Project personnelProvide the details of all key individuals that will be involved in the project, including their date of birth. It is necessary to collect this information for due diligence. Project personnel may include people from your organisation, or other partner organisations.

Full Name Position title Organisation Date of birth


Government priorities

Describe how the project will deliver the innovation to Queensland cropping industry.

Describe how the project will contribute to the local community economy.

Demonstrate how the project will deliver value for money.

Describe how the project will support effective management of Queensland natural resources.

How will the project address biosecurity threats?

Eligibility criteria

Provide detailed information on how the project will demonstrate the required Eligibility Criteria as outlined in the Strategic Cropping Land Grant Application Guideline.

Please limit response to 250 words or less for each criterion.

Business Project Plan

Identify the technical capability of the organisation and expertise of your key personnel and or contractors that will ensure the success of this project.

Please limit response to 500 words or less

Risk Management


What are the key risks associated with the project and what mitigation strategies are in place?

Please limit response to 500 words or less

Intellectual Property

Does this project depend on access to patented / protected IP?If yes, please provide the information requested below.

Please provide details on the IP, ownership and any access arrangements in place.

Will new IP be developed under the project ☐ Yes ☐ No

If yes, please provide details on any new IP patents or other IP commercialisation rights which will arise from the proposed project

Part C – Funding and expected outcomes

Project cost breakdownProvide detailed project cash flow projections for the first two years of the projects operation, including detailed assumptions (in addition to table below).

Project Activities/ Tasks

Provider Proposed Activity Start Date

Proposed Activity Finish Date

Total Activity Cost (excluding GST)

Applicant Cash Funding

Other Sources Funding

SCL Mitigation Grant Funding Sort

$ $ $ $$ $ $ $

Total Project Cost $ $ $ $% distribution of Total Project Cost % % % %

If you would prefer to work in a spreadsheet program like Excel so that you can use calculations, please use the format provided in the table above and then attach the file as additional/supporting documentation when submitting your application.


Other funding commitments

Please provide any additional information in reference to project funding, including to what extent the project is being internally or externally funded.

Project OutcomesPlease provide plain English responses to milestones and the evaluation method and limit highly technical language when answering the following questions.

Objectives Inputs Process Milestones Evaluation

Banking detailsProvide the following details to assist with the electronic funds transfer process, should funding be approved for this project

Bank NameBranch LocationBSB Account NumberAccount NameVendor number For department use only

Required documentation:

☐ Application form - completed and signed by authorised person☐ Copy of signed Trust Deed and subsequent variation documents since the Trust inception (if applicable)☐ Diagram of the company/group structure☐ If applicant is acting as lead agency on a group project then please provide details of the role and responsibility of all entities involved☐ Copy of Business Project Plan☐ Copy of any external funding approvals


☐ Copy of three years accountant prepared financial statements, including other relevant supporting documentation (if applicable)☐ A copy of current management accounts to support year-to-date figures☐ Please attach CVs of relevant individuals☐ If applicable please provide evidence of any IP registration and access arrangements authorising your use of any IP required for this project☐ If applicable please provide evidence of the steps taken to protect the intellectual property developed from this project☐ All relevant quotes to support project costing☐ Copies/evidence of business insurance for the business and the project☐ Copy of any cross institutional collaboration agreements (e.g. memorandum of understanding) relevant to project.


Applicant’s declaration

I/We have read the standard Agreement Terms and Conditions and understand that if a financial incentive is approved, a formal Agreement will be required to be signed by all parties, before any reimbursement can be made. I/We understand that additional specific conditions may also be included in the formal agreement, on case by case bases.

I/We understand that:

1. Submission of a signed application does not guarantee financial incentive approval for either all or part of the incentive being sought

2. Project costs incurred prior to the date the final signed application form is lodged with the department are not eligible for reimbursement and are incurred at the applicants own risk.

I/We, as the undersigned, authorise the department to undertake any necessary due diligence and hereby certify that all details provided in this application are true and correct and understand the department's policy on confidentiality, commercial-in confidence and privacy statement as stated in this document.

Name and Position title _____________________________________________________

Signature _______________________________________ Date _______________


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