Company Form

Please complete all fields of the form below. Please note that this information may be shared with Invest NI for information only

Company Application Form

Company Name

Company Address (including postcode)

Company Telephone

Company Contact Name

Company Contact Email

Company Website

Date of Establishment

Day Month Year

Financials (please state company year-end date):

Day Month Year

Sales last year (£ 000s)

Sales Forecast current year (£ 000s)

Sales Next year (£ 000s)

EBIT Last year (£ 000s)

EBIT Forecast current year (£ 000s)

EBIT Next year (£ 000s)

Net Assets (£ 000s)

Net Debt / Cash (delete as appropriate) (£ 000s)

Employee numbers

Target completion date for the investment

Day Month Year

Industry Sector

Type of Investment Opportunity

Type of Investment Opportunity - Other

Brief description of the business activity and specific use of funds being raised

Total amount and sources of funding being sought including equity, grant and other finance

Total amount and sources of private investment

Lead private investor(s) name(s)

Lead private investor(s) telephone(s)

Lead private investor(s) email(s)

The Company has tried to raise its total equity funding requirement from private sources and been unable to do so, and so has a funding gap

yesno

If yes please outline details of the Companies efforts to source private investment.

Please attach documents supporting your application to the fund including as a minimum a business plan, financial projections and most recent management accounts. You may also attach copy of any further documents that you think are appropriate including for example fund raising or technical presentations, term sheet or offer letter, share cap table, external dd reports or market analyst reports; and any other supporting documents already provided to your private investors.

Business Plan

Financial Projections

Management Accounts (most recent available)

Any other relevant documents (single zip file please)

Submit