GPIF Application Form

GPIF Application Form
Section 1: Your business
Contact details
(1) Applicant Name *
(2) Business / organisation name *
(3) Your role in the business *

(4) Business Address *




	Country

(5) Registered Company Address if different from above




	Country

(6) Telephone Number *

-
(7) E-mail *
(8) Website *
Please press the next button to save the completed pages of your application.

Section 2: Your project
Project summary:

Please outline your proposal for a loan from the Swindon & Wiltshire Growing Places Investment Fund.

Please state what you intend to invest in, the employment that will be created or new homes delivered and how economic growth will result.
(22) Name of project *
(23) Brief description of project (max 200 words) *

0/200

(24) What is the address for the proposed investment project? *




	Country

(25) What infrastructure is required? *
(26) Has spend on your investment project started? *

Yes No
If 'yes', please expand on what spend has taken place so far:
(27) How will the loan help your business (max 200 words)? Please also include information on the barriers which your project will specifically address; what has stalled which is potentially viable or which needs unlocking? *

0/200

(28) How many direct jobs will your project create? *

	Number	By when?
Full time ( > 30 hours per week)
Part time ( < 30 hours per week)

(29) In addition to direct jobs, will your project create any apprenticeships? Please give details including numbers, qualification level and timing.

	Apprenticeships Created	Qualification	By when?
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2
3

(30) If your project is successful in creating these jobs are there any other jobs that would be created (including temporary jobs as part of a construction phase) as a result of this?

	Please state	Number	By when?
1
2
3

(31) Are there any other outputs such as new homes built or commercial /industrial space created? Please give details including total numbers and timing. *
(28) Have you operated and closed down a similar activity in the last 2 years or do you have any plans to do so in the 2 years after the investment? *

Yes No
If 'yes', what was / is the operation called and where was / is it located?
(29) Is there any other relevant information about the project which you wish to include (max 200 words)?

0/200
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Section 3: Strategic fit

Please tell us how your project fits with the strategic priorities of the SWLEP
SWLEP Strategic Priority

(30) Please demonstrate how your project relates to, and makes most contribution to the SWLEP’s five strategic priorities (max 100 words each although you do not need to complete all 5 boxes)
Skills and talent: we need an appropriately skilled and competitive workforce to achieve our growth ambitions

0/100
Transport infrastructure improvement: we need a well-connected, reliable and resilient transport system to support economic and planned development growth at key locations

0/100
Digital capability: we need to deliver excellence in digital connectivity and cyber transformation to achieve business growth, innovative public services and influence societal change

0/100
Place-shaping: we need to deliver the infrastructure required to deliver our planned growth and regenerate our city and town centres, and improve our visitor and cultural offer

0/100
Business development: we need to strengthen the competitiveness of small and medium sized businesses and attract a greater share of foreign and domestic investment into the area.

0/100
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Section 4: Outputs

(31) Please provide additional information about the direct jobs which will be created by your project. Please allocate the full and part-time jobs which will be created in the relevant sector.

Sector *

	Number of full time jobs (more than 30 hours per week)	Number of part time jobs (less than 30 hours per week)
Advanced engineering and high value manufacturing
Health and life sciences
Financial and professional services
Digital and information communication technology
Land-based industries
Visitor economy
Adult health and social care
Low carbon economy
Construction
Other

If other, please mention the sector
Total number of full time jobs (calculated)
Total number of part time jobs (calculated)

(32) Timetable for job creation - please allocate how these jobs will be phased. For example, if 100 new jobs will be created in total with 50 created in 2018, 35 in 2019 and 15 in 2020 you would show that here. The total should match your answer to question 31. *

	2018	2019	2020	2021	2022	2023	2024	2025
New full time jobs
New part time jobs

Total number of full time jobs (calculated). Please ensure this figure matches the total in question 31.
Total number of part time jobs (calculated). Please ensure this figure matches the total in question 31.

(33) If new homes feature as an output of your project, what is the timetable for how these new homes will be phased? For example, if 200 new homes will be built in total with 50 in 2018, 75 in 2019 and 75 in 2020, you would show that here.

	2018	2019	2020	2021	2022	2023	2024	2025
New homes built

Total number of new homes (calculated)

(33) Please list any other outputs which your project will deliver or support. Please allocate these on an annual not cumulative basis.

	2018	2019	2020	2021	2022	2023	2024	2025
Low carbon energy capacity increase (kw/h)
Business-led innovation including the registration of new patents
Local procurement contracts within Swindon and Wiltshire, Value in £m
Apprenticeship starts
Temporary jobs created (e.g. construction)
Other

If 'other', please specify.
Total low carbon capacity increases kw/h (calculated)
Total innovations (calculated)
Total contracts £m (calculated)
Total apprenticeship starts (calculated)
Total temporary jobs created (calculated)
Total other created (calculated)
(34) How will you measure the success of your project in addition to the number of jobs created? (Max 100 words) *

0/100
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Section 5: Project timetable

(35) Please outline the key milestones proposed for the delivery of your project. *

	Milestone description	When will this be achieved (month and year)
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2
3
4
5
6

(36) What are the key risks to this timetable and what action can be taken to reduce them?

Likelihood score: 4 - very high, 3 – high, 2 - low, 1 - very low

Impact score: 4 - very high, 3 – high, 2 - low, 1 - very low

In the Score column, please multiply the Likelihood x Impact
*
Risk 1
What would you do, or are you planning to do to mitigate or reduce the risk?
Likelihood
Impact
Likelihood x Impact Score (calculated)
Risk 2
What would you do, or are you planning to do to mitigate or reduce the risk?
Likelihood
Impact
Likelihood x Impact Score (calculated)
Risk 3
What would you do, or are you planning to do to mitigate or reduce the risk?
Likelihood
Impact
Likelihood x Impact Score (calculated)
Risk 4
What would you do, or are you planning to do to mitigate or reduce the risk?
Likelihood
Impact
Likelihood x Impact Score (calculated)
Risk 5
What would you do, or are you planning to do to mitigate or reduce the risk?
Likelihood
Impact
Likelihood x Impact Score (calculated)
(37) Have you obtained all the permissions and consents you need to carry out your project? (Planning consents, change of use, listed buildings, etc.) *

Yes No

To meet our procurement rules, you will need to demonstrate that you have gathered comparable written quotes for the investments that you will make using the loan. We require:
- 4 quotes for expenditure up to £100,000
- Evidence of suitably advertised tenders over £100,000 (open or restricted access tenders).
Please be ready to supply copies of specifications, quotes, tenders, plans, etc.
(39) Do you have all the required quotations in line with our procurement rules? *

Yes No
(40) If your quotes are not in place yet, when do you plan to complete your procurement by?
(41) If you feel that you cannot meet our procurement rules, what is the reason?
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Section 7: Growth potential, impact and sustainability
(52) How will the GPIF loan to your project support your business to grow? (200 words max) *

0/200
(53) What will be the immediate impact and outcomes on your business from the project investment in the 12 months following the start of a GPIF loan? (100 words max) *

0/100
(54) What will be longer-term impact and outcomes of the project investment over the next 3 years after the investment has been completed? (100 words max) *

0/100
Section 8: Project management
(55) Who will be the Project Manager in charge of the delivery of your project? *
(56) What project management experience do they have? *
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Section 9: Supplementary information

Items to submit as part of the stage 1 application for GPIF investment
Your project plan/business plan for the investment and previous three years of business accounts *
Please press the next button to save the completed pages of your application.

Section 10: Declaration
Please note the following:

I/ We undertake that if this application is successful I/we will:
- fulfil the obligations of the Growing Places Infrastructure Fund (GPIF), as set out in the GPIF Prospectus and in our loan agreement;
- provide any further information as may be required by the GPIF Team at the SWLEP;
- provide any further information as may be required Wiltshire Council as the SWLEP’s accountable body for the GPIF loan funding;
- allow access to records and premises, to which this application relates for the purpose of carrying out an inspection and ensuring the compliance of this undertaking. This will include allowing access for external auditors and consultants;
- co-operate and participate as required in any monitoring or evaluation exercises conducted by the Swindon & Wiltshire Local Enterprise Partnership GPIF Team or Wiltshire Council acting as its accountable body; and
- inform the SWLEP GPIF Team immediately in writing if any changes occur to the application details.
Please note, that where any claims or statements contained within this application form, or the supporting information, are found to be made fraudulently or negligently, as misrepresentations, knowingly or otherwise, any approval for a loan could be rendered invalid and the loan made subject to immediate clawback, and with further action by relevant authorities taken if deemed appropriate.

Note: For partnerships, all partners must sign this form. For limited companies at least one director must sign the form. For other organisations the closest equivalents to one Trustee/Committee member and the Chief Executive/Finance Director should sign. For sole traders, the business leader should sign. Where submitted by email, a signed application will be requested in due course.
Name *
Position in organisation *
Date *

- -
Name
Position in organisation
Date

- Day - Month Year
For more information contact:

Phil Clement

Head of Investment & Export

Swindon and Wiltshire Local Enterprise Partnership

c/o Wiltshire Council

Monkton Park

Chippenham

SN15 1ER

Email: phil.clement@swlep.co.uk
Once the form is submitted, you will receive an email with a PDF copy of your responses.
Should be Empty:

	Date (dd/mm/yy)	Source	Programme	Grant (£)	Loan (£)	Other (£)
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2
3
4
5
6
7
8
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10

	£	On what basis have these costs been calculated and confirmed?
Total revenue budget (please note that GPIF can only be used for capital expenditure)
Total capital budget

	£	State of funding (secured / in principle / unconfirmed)
(a) Total GPIF loan sought
(b) Investment directly by the company/organisation’s own reserves

GPIF Application Form

Section 1: Your business

Section 1 cont'd: Your business

Section 2: Your project

Section 3: Strategic fit

Section 4: Outputs

Section 5: Project timetable

Section 6: Financial information

Section 7: Growth potential, impact and sustainability

Section 8: Project management

Section 9: Supplementary information

Section 10: Declaration

	Permissions and consents etc still required, please list	Date expected (mm/yy)
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