North King Country Development Trust's Application Form

Application Form

Please fill in the form below. It is important that you use this form to complete your application. You MUST complete ALL questions on the Application Form. Incomplete applications may be declined. If you have any questions about the application, email admin@nkcdt.co.nz
Part A: Details of the Applicant

Your progress will be saved as you fill out this form.
Application Name: *

First NameLast Name
Postal Address:*

Street Address

Street Address Line 2

Town / CityRegion

Postal Code
Physical Address:

Street Address

Street Address Line 2

Town / CityRegion

Postal / Zip Code
Contact Phone:*

Area CodePhone Number
Mobile No:

Area CodePhone Number
Email Address:*
Website:
example: www.yourwebsite.co.nz (or .com)
Have you undertaken business mentoring prior to making this application?

YesNo

Part B: Tell us about your business
What sector are you involved in? What services/products does your business currently provide?
How many years has your business been operating?
What are your business objectives or goals?
At present, how many people work for your business (Full Time Employees)?
Tell us about the person who will be managing the project/initiative. What skills and relevant experience do they have?

Part C: Contact Details

Please provide the details of TWO contacts who are authorised to make a declaration on behalf of your application.
CONTACT NO. 1:

First NameLast Name
Postal Address:

Street Address

Street Address Line 2

Town / CityRegion

Postal / Zip Code
Contact Phone Number (Daytime):

Area CodePhone Number
Email Address:
example@example.com
CONTACT NO. 2:

First NameLast Name
Postal Address:

Street Address

Street Address Line 2

Town / CityRegion

Postal / Zip Code
Contact Phone Number (Daytime):

Area CodePhone Number
Email Address:
example@example.com

Part F: Funding Criteria

Please describe how your initiative contributes to achieving the following funding criteria.
Promote economic development within the North King Country.
Support the establishment of new jobs within the North King Country.
Increase business activity within the North King Country.
Promotion of the North King Country as an attractive place to live and do business.
Other benefits.

Part G: Feasibility

WHY SHOULD THIS INITIATIVE BE FUNDED?
Please attach a detailed business plan and include any research or investigation that you have undertaken to establish the feasibility of this initiative.
Attach your file here:

Choose File
*Doc or pdf files only and no larger than 2MB in size. Cancelof

Part H: Budget

Please attach a copy of all your quotes with your application.
We would prefer that you attach an Excel Spreadsheet with your budget, including:
- Proposed Expenditure:
- Amount:
- Comments about expenditure (if required):
- Quote price:
- Total cost of Initiative:
Attach your file here:

Choose File
*Doc or pdf files only and no larger than 2MB in size. Cancelof

Part I: Funding from Other Parties
Have you, or do you intend to, apply for funding from any other party for this initiative?

YesNo
If yes, please provide details:
What would happen to the project if you don not receive the funding requested?

Part J: Previous Funding
Have you received any financial assistance from the North King Country Development Trust previously

YesNo
If yes, please provide details:

Part K: Future Development of the Initiative
If you are unsuccessful in receiving the full amount of funding applied for, how do you intend to meet any shortfall in funding?
How do you intend to progress with the initiative??

Part L: Financial Accounts

Please provide a copy of your businesses last financial accounts, or in the absence of these please detail income and expenditure for the last 12 months. If neither of these are available, please provide a statement as to why it is not possible to provide this information and attach a copy of your businesses last banks statement/s.
Attach a file:

Choose File
*Doc or pdf files only and no larger than 2MB in size. Cancelof
Statement:

Part M: Additional Information
Is there any additional information you wish to provide to support this application

YesNo
If yes, please provide details:

Part N: Awareness

We'd love understand how you became aware of the North King Country Development Trust.
How did you find out about the Trust? You may tick as many as are appropriate

Newspaper advertisingWorth of mouthNorth King Country Development Trust websiteOther websiteOther

Part P: Checklist

Please read and complete the following before submitting your application. Incomplete applications will not be accepted.
Your checklist:

Completed all sections of the formChecked all figures in the applicationAttached copies of financial reports/bank statementsAttached referee detailsAttached detailed business planAttached a bank deposit slip (if your application is successful, and on agreement of terms, a payment will be made via direct credit to your nominated bank account).
Upload your Bank Deposit Slip:

Upload Deposit Slip
*Doc or pdf files only and no larger than 2MB in size. Cancelof
Should be Empty:

Application Form