1. business and industrial
2. business operations
3. management
4. project management

Reference Number
Applicant
Information
Enterprise
Description
Project
Description
Project
Management
and Delivery
Project Risk
Analysis
Milestone
Budget
O
Submission Date
Economic
Impact
Merit
Criteria
Value
for
Money
Check List
Declaration
and
Submission
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Introduction
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Administration Only
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Important Information
South Australian River Murray Sustainability Program
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Regional Development and Innovation Fund
ROUND TWO APPLICATION FORM - LARGE PROJECTS
APPLICATION CLOSING DATE
RDIF Round Two has a focus on 'large' projects which create sustainable employment and economic
development. Projects for Round Two must have a minimum total project cost of $500,001.
or
To be included in the Round Two Application process, completed applications must be received by the South Australian
River Murray Sustainability Program - Regional Development and Innovation Fund (RDIF) by 5.00pm (ACST),
Monday 18 May 2015.
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CONTACTING US
For further information about RDIF, please contact:
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Mr Kym Walton
Team Leader – Regional Support, River Murray Sustainability
Department of Primary Industries and Regions
Telephone: (08) 8539 2118
Email: [email protected]
Alternatively, please call 1300 364 322 or email [email protected]
Getting Started
Using this example form
This example Application Form is for information only, please do not complete this form and try to submit. An interactive Smart Form
will soon be available on the RDIF website
www.pir.sa.gov.au/regions/sarms/regional_development_and_innovation_fund_rdif
The below instructions are provided to assist in the preparation of an Application.
Completing this Form
PIRSA-RDIF Example Form
7 April 2015
Page # of ##
An Application Form can only be submitted once.
If you are submitting multiple applications you must download and submit a new Application for each individual project. Each
Application has a unique identification number. Application Forms can be downloaded from the RDIF website
www.pir.sa.gov.au/regions/sarms/regional_development_and_innovation_fund_rdif
To navigate through this Application Form, use the tabs in the blue header at the top of each section.
Fields marked with an asterisk (*) are required fields.
You may collapse or expand a section at any time by clicking on the “
” or “
” icons located at the top left of each section.
Tool Tips have been embedded throughout the Application Form to assist you with providing information sought by the RDIF. Tool
tips will appear when you hover your cursor over the relevant section in the form.
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Saving Application
If you don’t have all the required information on hand, you can save the form locally to your computer and complete it when you have
all the necessary information. The "Save" button can be found at the bottom of each section and can be pressed at any point. This will
allow you to continue to fill in the form at a later date. We recommend saving the form on a regular basis. Once saved onto your
computer, most of this Application Form can be completed offline.
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Uploading Attachments
You will be asked to upload documents to support your Application during the submission process. Each attachment must be no
larger than 10 Megabytes.
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It is suggested you create a separate folder on your computer directory for each Application, containing all of your attachments for
submission.
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The types of files we prefer are : jpg, jpeg, tiff, gif, doc, docx, xls, xlsx, pdf, zip
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When uploading attachments, please title files according to their subject i.e tax returns, property map, business case. It is strongly
recommended that you do not use symbols such as "&" in the title of any supporting attachments.
Each attachment must only contain one document.
Submitting Application
Once the Application Form is complete it may be submitted by clicking ‘Submit’ at the end of the Form.
You must be connected to the internet to submit your completed Application Form.
or
Are you applying for RDIF Round 2 or Round 3?
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Round Two has a focus on creating employment opportunities and economic development in the Region by seeking to fund projects
that will provide significant economic return on investment. Projects for Round Two have a minimum total project cost of $500,001,
with at least 50 per cent of the total project cost covered by cash and in-kind co-contributions.
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Round Three has a focus on regional economic diversification by preferentially funding innovative projects that will drive the creation
of the next wave of economic opportunities and initiatives in the Region. Projects for Round Three have a total project cost of
between $200,000 and $500,000, with at least 50 per cent of the total project cost covered by cash and in-kind co-contributions.
The opening and closing dates, some eligibility and merit criteria for Round 2 and Round 3 differs. Refer to the relevant guideline for
more information.
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Applicants may apply for funding in Round Two and/or Round Three, however project activities will only be funded once. To make an
application for both rounds, a separate Smart Form Application for each round is required. Please refer to the guidelines for Round
Three for further information.
This Application Form is for Round Two.
Eligibilty Checklist
In addressing the Eligibility Criteria, please carefully read the RDIF Round 2 Guidelines. Please note that
some eligibility criteria has changed from RDIF Round 1. Also note there is a Round 3. Round 3 has
Guidelines and an Application Form specific to Round 3. Funding information, eligibility and merit criteria
and submission timing for each fund are outlined in the relevant Round’s Guidelines.
1
Does the applicant hold an Australian Business Number (ABN) or Australian Company Number (ACN)?
No
2
Is the applicant a recognised legal entity capable of entering into a legally binding funding deed with the
Minister for Regional Developement. (refer to RDIF Round 2 Guidelines for more information)
No
3
Has the applicant previously failed to meet the conditions in any Australian Government Funding
Agreements?
Yes
PIRSA-RDIF Example Form
7 April 2015
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Is the applicant directly involved in irrigation in the Region?
Yes
5
Is the applicant seeking payment for activities to which they have a prior financial commitment from another
grant program(s)?
Yes
6
Have the project activities outlined in this Application received funding or a loan from, or have a
commitment for funding or a loan from any other Australian Government program/s.
(Note:Section 4.3 in the Round 2 guidelines contain exemptions to the use of Australian Government funds
for co-contributions. If you qualify for an Exemption do not check the box.)
Yes
7
Is the Applicant or any of its owners currently under bankruptcy or insolvency administration (i.e. external
administrator, receiver, receiver manager, liquidator appointed, or own assets/property where there is a
mortgagee interest).
Yes
8
Do the project activities you are seeking funding include the costs of operation and maintenance of existing
businesses, back-office costs and/or costs of foregone business activities?
Yes
9
Does the project you are seeking funding for include a feasibility study or business plan?
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4
Yes
10
Does the project you are seeking funding for include cost benefit analyses or economic impact studies that
are NOT part of a larger project that meets the criteria for RDIF?
11
Is the project proposal located within the Region, as defined in the RDIF Guidelines?
No
12
Is the Applicant a Federal or State Government agency, and instrument of the Crown or a commercial arm
of these agencies?
Yes
13
Will your project commence within 6 months of signing the Deed of Grant and conclude by February 2017?
14
Is the total project cost greater than $500,001 with at least 50 per cent of the total project cost covered by
cash and in-kind co-contributions?
15
Does the project have a focus on creating employment opportunities and economic development in the
Region?
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Yes
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No
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No
No
Enterprise
Description
Project
Description
Project
Management
and Delivery
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Applicant
Information
or
Proceed to Form >>
Introduction
Project Risk
Analysis
Milestone
Budget
Economic
Impact
Merit
Criteria
Value
for
Money
Check List
Declaration
and
Submission
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Part 1: Applicant Information
Project Title and Timeframe
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Project Title *
Proposed Project Start Date*
Proposed Project End Date *
NOTE: Project to end no later than February 2017
Applicant Details
Name of Enterprise/Organisation
Select Applicant/Enterprise *
ABN
ACN
Australian Business Number (ABN) *
Full Name / Trading Name *
Australian Company Number (ACN) *
Company Name *
PIRSA-RDIF Example Form
7 April 2015
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Date incorporated *
Business Type
Please Specify
Enterpise Type
Please Specify
YES
Registered for GST
NO
PO Box / Street Address *
Suburb / Town *
State *
Postcode *
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Phone *
Mobile
Email *
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Fax
Please note that during the assessment of your application if we need to clarify anything we will contact you by email.
Tick if you would prefer an alternate mode of communication.
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Alternative contact
Related Business Entity
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Are there any other business entities that are financially linked to the Applicant/Enterprise?
Yes
No
If the Deed of Grant requires more than one Enterprise to commit to the RDIF Project you must attach financial information relevant to
all Grantees and associated entities.
Name of related business entity *
Remove this entity
or
Relationship of related business entity to the RDIF Applicant *
Business Solvency
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Add another related business entity
Have any related entities been insolvent within the last 5 years ?
Yes
No
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Please provide details of any related entities and insolvency issues e.g bankruptcy, administrator, receiver manager, liquidator,
mortgagee in possession.
Are any of the owners of the business undischarged bankrupts?
Yes
No
Please list any owners that are undischarged bankrupts and provide details below.
Person Authorised To Commit Applicant To Proposal
Same as Applicant
The Person nominated below will be the person who can legally commit the business, company or trust to the RDIF Project.
This will be the person who will sign the RDIF Deed of Grant ('Funding Agreement') in line with Guidelines. If the Deed of Grant requires
more than one Enterprise to commit to the RDIF Project you must submit financial information relevant to all Grantees and associated
entities.
PIRSA-RDIF Example Form
7 April 2015
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Title *
Other *
First name*
Remove this Applicant
Last name *
Position in Enterprise *
Postal Address (if different from the Applicant/Enterprise's site address)
PO Box / Street Address
State
Phone (business/home) *
Mobile
Fax
Email *
Postcode
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Suburb / Town
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Relationship to Applicant (e.g. Director, Secretary, Chief Executive- refer below)*
Add Another Person to Commit
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Primary Contact
Same as Applicant
Title *
First name*
Last name *
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Other *
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The person nominated below will be the person contacted during the Application assessment period should any clarification regarding
the Application be required e.g a consultant or relative who may have completed the Application on behalf of the Applicant.
Position in Enterprise *
Postal Address (if different from the Applicant/Enterprise's site address)
Suburb / Town
State
Postcode
Mobile
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Phone (business/home) *
or
PO Box / Street Address
Fax
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Email *
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Please indicate preferred contact number
Relationship to Applicant (e.g. consultant, relative, employee, director) *
Public Liability Insurance
The Enterprise is required to have Public Liability Insurance for at least $10 million for the life of the Project prior to the Project
commencing.
Do you have Public Liability Insurance to the value of at least $10 million?
Yes
No
What is the date of expiry of your policy ?
If you do not currently have adequate Public Liability Insurance, please state the steps that you will take to ensure that you will have
a suitable level of cover. (Approx. 50 words, 300 characters)
PIRSA-RDIF Example Form
7 April 2015
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Introduction
Applicant
Information
Enterprise
Description
Project
Description
Project
Management
and Delivery
Project Risk
Analysis
Milestone
Budget
Economic
Impact
Merit
Criteria
Check List
Declaration
and
Submission
Value
for
Money
Part 2: Enterprise Description
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Please provide a brief description of key business activities for the applicant/enterprise (approx. 50 words)
Please describe the location and current industry sector(s) of your Enterprise.
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Location Information
Council Area
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Location of current Enterprise
Industry Sector
Other
Enterprise
Description
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Introduction
Applicant
Information
Project
Description
Part 3: Project Description
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Number of current employees (full time equivalents - FTE's)
Project
Management
and Delivery
Project Risk
Analysis
Milestone
Budget
Economic
Impact
Merit
Criteria
Check List
Declaration
and
Submission
Value
for
Money
or
Round Two focus is on creating employment opportunities and economic development in the Region by seeking to fund
projects that will provide significant economic return on investment.
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Project Description
Please provide a summary of your RDIF project. (approx. 500 words)
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Please list the Project Outcomes (an outcome describes what will be achieved by successfully implementing the project
e.g improve productivity). There should be no more than 5 outcomes.
Please list (if applicable) any Project Outputs ( an output is a product, new infrastructure, service or other material that will be
produced as a result of the project).
Type of Project
infrastructure works
provision of services
equipment
training
research or similar
other
studies
Describe other
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7 April 2015
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Project Background & Need
Please describe how the project came about, the need for the project, why it is so important, what would happen if it did not go ahead
and any other relevant contextual and background information. If this project is part of a bigger program or portfolio of projects,
explain its place in the big picture. (approx. 500 words)
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Please describe how the project will benefit others (e.g. community and or industry) in the Region. (approximately 500 words)
Enterprise
Description
Project
Description
Project
Management
and Delivery
Project Risk
Analysis
Economic
Impact
Merit
Criteria
Value
for
Money
Check List
Declaration
and
Submission
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Part 4: Project Management and Delivery
Milestone
Budget
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Applicant
Information
Introduction
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Explain the unique aspects of the project and why the project is not a duplication of existing or proposed activities within the Region.
( approximately 500 words)
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Project Management
Please outline the project management approach for the project in both the developmental and operational phases of the project
(who will do what, and how the project will be managed to ensure delivery of activities and milestones). (500 words)
Diagrams and/or further information can be provided as an attachment and/or as part of a business plan when uploading your application
form.
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Approval
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Staff Resources and Credentials
Please list key staff within your organisation that will be involved in the project delivery, and their relevant experience/qualifications.
(500 words) Further detail such as CV’s can be attached.
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List all approvals necessary to carry out your proposed RDIF project (e.g. development approvals, Aboriginal Heritage Act, Native
Vegetation Act, Environment Protection and Biodiversity Conservation Act). Include approvals for all elements of your project.
Required Approval
Status of approval
(e.g. application submitted and awaiting response)
Expected timeline to
approval (months)
Remove this
Approval
Add another Approval
Please attach evidence of seeking all required approvals when you are prompted to attach documents during submission.
Notes: The Program appreciates that it may not be possible to finalise development approvals before submitting your application.
However you can make reference to the status of actions underway.
If the project involves upgrading or installing equipment, please attach documentation to show that the Applicant has the legal right to
install such infrastructure and has the access right for on-going maintenance.
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7 April 2015
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Project Dependencies
Yes
Are there any other studies, pilots, research or other work required before the project can commence or
that will impact on the success of this project?
No
Please describe those dependencies and how they may impact on the success and/or timing of this project. (100 words)
Project Readiness
Is there any other reason that the project may not be able to start on the identified start date?
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Please describe the current readiness of the project. Is it in development or delivery stage and what needs to occur to implement it?
Yes
No
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Please describe those dependencies including what steps you will take to mitigate them and the impact that delay in commencement may
have on your project. (100 words)
Yes
No
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Have you or the enterprise previously received grant funding?
Amount of funding
received / requested
Add another Funding
Applicant
Information
Enterprise
Description
Year
Project
Description
Project
Management
and Delivery
Project Risk
Analysis
Milestone
Budget
Description
Remove this
Funding
Economic
Impact
Merit
Criteria
Check List
Declaration
and
Submission
Value
for
Money
or
Introduction
Program
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Funding Source
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List previous Australian or State Government assistance, current applications and/or contracts received by applicants relating to this
and/or other projects.
Part 5: Project Risk Analysis
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Part 6 - Project Risk Analysis
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Please identify relevant risks to the delivery of your RDIF project and how you will address these risks. For each risk identified, use the
matrix below to assess the likelihood of this risk occurring and the consequence to the project if this risk did occur.
Please discuss strategies you will implement to minimise the impact of the identified project risks.
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Project Risk Matrix
Likelihood
Consequence
Insignificant
Minor
Moderate
Major
Catastrophic
Almost certain
Low
Medium
High
Very High
Extreme
Likely
Low
Medium
High
Very High
Very High
Possible
Low
Low
Medium
High
High
Unlikely
Minimal
Minimal
Low
Medium
High
Rare
Minimal
Minimal
Low
Low
Medium
Project Risk Table
Risk
No.
Risk Description
PIRSA-RDIF Example Form
7 April 2015
What is the
likelihood of
risk ?
What is the
consequence
of risk ?
Risk
Rating
Impact of risk
Strategy to overcome risk
Page # of ##
Risk
No.
What is the
likelihood of
risk ?
Risk Description
What is the
consequence
of risk ?
Risk
Rating
Impact of risk
Strategy to overcome risk
Delete
Add Project Risk
Applicant
Information
Introduction
Enterprise
Description
Project
Description
Project
Management
and Delivery
Project Risk
Analysis
Milestone
Budget
Economic
Impact
Value
for
Money
Merit
Criteria
Check List
Declaration
and
Submission
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Part 6: Budget and Milestones
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(Reminder: Projects must have a minimum cost of $500,001 and at least 50% of the total project cost must be covered by cash or in-kind
co-contributions).
Budgeted costs are to be provided for each project activity.
All budgeted costs related to the project are required to be GST exclusive.
An Activity describes a measured task that contributes to a milestone and project outcome.
Table 1. Project Budget Summary
Provide a summary of the costs associated with the project, the year the cost will occur and the source. (GST exclusive)
Applicant contributions
RDIF funding Sought
cash
in-kind
Total project
budget
in-kind
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2014-2015
cash
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Year
Other Contributions
2015-2016
Project TOTAL
Table 2. Project Budget Costs Detail
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2016-2017
Outline all costs associated with the project in detail including the year in which the expenditure will occur. Costs should be GST
exclusive. The costs include both cash and in-kind contributions.
Activity Details
2014-2015
2015-2016
2016-2017
Total activity cost
Delete
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Salaries (including on costs)
or
Other Funding
Salary sub total
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Add Another Salary
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Goods (equipment, infrastructure, other items to be
purchased)
Delete
Goods sub total
Add Another Goods
Services & Other (investigations, etc. associated with
project)
Delete
Services and Other sub total
Add Another Service
Project TOTAL
Table 3. Milestone Summary
Milestones will be used to develop the Deed of Grant. Funding will only be provided once evidence is supplied of completion of
milestone. Ensure dates and evidence are realistic.
Application Contributions
PIRSA-RDIF Example Form
7 April 2015
Other Contributions
Page # of ##
Evidence
(measurement/proof that
milestone has been achieved)
Milestone
Description
Milestone
Date
Milestone Activity
Description
RDIF
Funding
Cash
In-Kind
Cash
In-Kind
Total
Project
Cost
Cost
Add Another Activity
Total
Add Another Milestone
Project TOTAL
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Table 4. Co-contributor detail
Amount of co-contribution
Name of all co-contributions
Cash($)
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Applicant Contributions
In-kind($)
Add Another
Delete
Application co-contribution sub-total
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Other co-contributions
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Add Another
Delete
Other Co-contributions sub-total
Table 5. In-Kind contributions
In kind co-contributions
Add Another
Value ($)
Delete
Application co-contribution sub-total
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Other co-contributions
Delete
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Add Another
How has the in-kind contributions been calculate
or
Applicant Contributions
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TOTAL Co-contributions
Other Co-contributions sub-total
Grand Total
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Please Note : In-kind contributions include the commitment of non- monetary resources (e.g. labour, equipment use, time etc) to
complete a project. An in-kind contribution related to the delivery of the RDIF Project can be made by the RDIF applicant or a third party.
All in-kind contributions must be relevant work included under the approved activities of the RDIF Funding Agreement. When stating the
value of an in-kind contribution, successful RDIF applicants must ensure that it is done at a competitive commercial rate and provide
evidence of this rate (e.g. cost and time allocation). The Program will need to be satisfied that in-kind commitments are completed to
appropriate quality standards in order to receive milestone payments.
Table 6. Personnel (FTE)
Please list each position, including their role, salary and funding source that can be attributed to the project and if they are new or
existing position.
Positions
New or Existing
FTE
Ongoing
2014/15
2015/16
2016/17
Total Value($)
Delete
Add Another
Financial Details:
Attach 3 most recent years audited financial statements (profit and loss, balance sheet) of the applicant
Attach next 3 years financial projections (profit and loss or cashflow basis) of the applicant.
PIRSA-RDIF Example Form
7 April 2015
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Introduction
Applicant
Information
Enterprise
Description
Project
Description
Project
Management
and Delivery
Project Risk
Analysis
Milestone
Budget
Merit
Criteria
Economic
Impact
Check List
Declaration
and
Submission
Value
for
Money
Part 7: Economic Impact
Goods and Services: For goods or services valued at over $110,000 purchased by the Applicant in the course of
delivering this project, will they be exclusively sourced from or performed by South Australian businesses?
Yes
No
Supply Chain: Please complete the table below for goods or services valued at over $110,000 purchased by the Applicant in the
course of delivering this project. Goods and services include, but are not limited to; items of merchandise, finished
products, supplies, raw materials, outsourced labour of any type, and any outsourced work.
Estimated
Value of item
($A)
Have you
already
established
supply
arrangements?
Name of supplier
(if known)
Location where
Location where the
supplier is based product is manufactured or
(if known)
the services mainly
performed
Please specify the
(if known)
state of Australia or
if not Australian, the Please specify the state of
name of the country. Australia or if not Australian,
the name of the country.
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List the goods and services over $110,000
(including bundled work packages) to be
purchased in the course of delivering this
project.
Delete Row
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Please add more rows as required or attach
additional pages.
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Add Row
Local Opportunities
Introduction
Applicant
Information
Enterprise
Description
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Please describe how you will notify South Australian suppliers of opportunities to supply to your business in the course of delivering
this project and the process/criteria for assessing tenders and /or awarding contracts.
Project
Description
Project Risk
Analysis
Milestone
Budget
Economic
Impact
Merit
Criteria
Value
for
Money
Check List
Declaration
and
Submission
or
Part 8: Merit Criteria
Project
Management
and Delivery
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Economic Benefits Merit Criteria
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Projects in Round 2 must demonstrate that they adequately meet the Mandatory Economic Merit Criteria and demonstrate that the project
will achieve at least one of the other outcomes against the Economic Benefits Merit Criteria to be recommended for funding (refer to Round
2 Guidelines.).
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Describe how the project will contribute to the economic diverisification of the Region in relation to primary production, processing and
business development. (250 words)
Employment Opportunities *
Estimated outcomes directly linked to the project
Estimated Outcome
(Indicate number)
(note: part-time jobs should be included pro-rata)
How many of these jobs will be new?
(indicate number)
Total number of full-time equivalent jobs directly
employed by your business expected for the delivery of
the project. (Do not include subcontracted jobs).
How many full-time equivalent jobs (from line above) will
be performed in South Australia?
How many new jobs will be part of construction start up
and how many will be ongoing as a result of the project?
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Describe how the project will stimulate economic growth in the Region. (250 words)
Describe how the project will contribute to the long-term (at least five years post-funding) and sustainable economic development of
the Region. (250 words)
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Demonstrate how your project delivers on at least one of the following. More than one can be addressed (250 words per criteria)
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DELETE
Add another Economic Benefits Merit Criteria
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Innovation Merit Criteria
Projects should deliver innovation to the Region to meet identified needs, improve existing and/ or introduce new practices or businesses.
Applicants should describe the new ideas, opportunities and business/operating models that will be delivered by the project and how this
will result in significant improvements in the Region’s social fabric, infrastructure or economic activity.
Demonstrate how your project delivers on at least one of the following. More than one can be addressed (250 words per criteria)
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DELETE
Add Another Innovation Merit Criteria
or
Social Impact Merit Criteria
Projects should strengthen, expand or enhance regional institutions to improve social conditions and contribute to the liveability of the
Region.
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Demonstrate how your project delivers on at least one of the following. More than one can be addressed (250 words per criteria)
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DELETE
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Add Another Social Impact Merit Criteria
Introduction
Applicant
Information
Enterprise
Description
Project
Description
Project
Management
and Delivery
Project Risk
Analysis
Milestone
Budget
Economic
Impact
Merit
Criteria
Value
for
Money
Check List
Declaration
and
Submission
Part 9: Value for Money
Maximising Value for Money & Leveraging
Describe how the project maximises funding support from a range of sources, including private sector and regional organisations, local
government and the community. (250 words)
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Describe here how the project will deliver value for money for the South Australian Government. Applications should identify that RDIF
funding will be used in an efficient, effective, economical and ethical manner and deliver the outcomes of the program. This may involve
illustrating that project costs will be reasonable compared to industry benchmarks; that an acceptable level of project planning has been
undertaken to ensure that the project will be delivered on time and within budget, and that open and competitive procurement processes
will be employed to deliver the project.
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Please describe how you will notify SA River Murray and South Australian suppliers of these opportunities and the process/criteria for
assessing tenders and /or awarding contracts.
Applicant
Information
Enterprise
Description
Project
Description
Project Risk
Analysis
Milestone
Budget
Economic
Impact
Merit
Criteria
Value
for
Money
Check List
Declaration
and
Submission
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Part 10: Check List
Project
Management
and Delivery
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Introduction
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Describe why this project needs government funding and why other avenues of funding (e.g. venture capital, loans, private investment)
could not achieve the outcome being sought.
Required Documents to Support Application
Documentary evidence of support from all co-contributors. *
Last 3 years audited financial information of applicant.
or
Next 4 years (minimum) business financial projections of applicant as a result of the implimentation of this project.
Project Plan / Business Plan for the project.
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Itemised Budget with supporting comments.
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* The co-contributor support letter/documents should outline the value and nature of the commitment and any conditions relating to this
commitment and be signed by the authorised representative of the co-contributor
Other Relevant Attachments
(Please tick to show attached)
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Risk Plan (if applicable)
Marketing Plan (if applicable)
Existing Feasibility Studies (summary only)
Letters of support from within the Region
Details of relevant experience of applicant and other co-contributors
Industry Participation Plan (for applicants seeking more than $1.25 million in program funding). **
Other(s) please list
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**Industry Participation Policy : To ensure regional businesses leverage maximum opportunities from programs such as SARMS, all
applicants requesting program funding of $1.25 million or more (GST exclusive) are required to submit an Industry Participation Plan with
your Application. The plan will be reviewed by a team of experts from the Office of the Industry Advocate.
Applicants should be familiar with the requirements of the Industry Participation Policy at www.dpc.sa.gov.au/office-industry-advocate
PIRSA-RDIF Example Form
7 April 2015
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Part 11: Declaration
In signing this document I acknowledge that submission of this document and receipt by PIRSA of this proposal does not create an offer
or a binding agreement. I also acknowledge that successful applicants will have to execute a Deed of Grant that will include (but not be
limited to):
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identification of any existing, apparent or potential conflicts of interest when applying for RDIF funding or delivering the project
acknowledging the contribution of the South Australian and Australian Governments on any promotional material
providing opportunities for the South Australian Minister for Regional Development and the Federal Minister for Infrastructure
and Regional Development, or their representatives, to take part in any launch of the project
a requirement to complete the project and all reporting requirements, and acquit funds within the agreed timeframe
an undertaking to only apply the funds to the intended purpose
provision of annual financial statements relating to the project
the return of any unspent funds to the RDIF on completion of the project
a requirement that the applicant retain assets purchased with project funds for at least five years from project completion
a requirement that the principal component of the project will commence within six months of the date that the Deed of Grant is
executed
a requirement that the project must be completed with all funding acquitted and proponents must have submitted their Final
Report to PIRSA by February 2017
a requirement that projects will comply with all applicable laws, regulations and Australian standards
a statement that the Deed of Grant may be disclosed by PIRSA pursuant to Department of the Premier and Cabinet Circular
27-Disclosure of Government Contracts
a statement that any cost overruns or losses will be the applicants responsibility.
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I hereby declare that I have read the RDIF Guidelines and that the information provided in the Application Form is true, complete and
correct in every particular and that I am duly authorised to sign this Application Form on behalf of the applicant.
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Declared by person authorised to
commit the Applicant to the proposal
Full Name *
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Position in Enterprise *
Date *
Privacy Statement
Lodgement
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The Government of South Australia is committed to protecting the privacy of your information. In 1989, the Government of South
Australia issued a set of Information Privacy Principles (IPPs) (reissued 30 July 1992 and 18 May 2009) to regulate the way personal
information can be collected, used, stored and disclosed.
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If you have not completed your Application and want to work on it later click the Save button.
The 'Save' button allows you to save a draft copy of this form to your local computer so you can access the
application without being connected to the internet. You may want to print or save a copy of this form for your own
records.
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Save
When you are ready to submit your Application click the Submit button.
Submit
The 'Submit' button allows you to submit your Application for processing. Once you submit your Application you will
receive a confirmation message indicating it has been sent for processing.
You will be asked to upload documents during the submission process. Each attachment must be no larger than 10 Megabytes.
Multiple documents of the same type can be uploaded by selecting the relevant document link.
If the form is incomplete or contains errors it will not allow you to continue to submit the form (see 'Errors in Section' below).
PIRSA-RDIF Example Form
7 April 2015
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Errors in Form
The following errors were found in your form. Please correct them before submitting your form.
To go directly to the errors on your form, please use the buttons below or double-click on the error(s) in the list.
Refresh Error List
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Go to Selected Error
Errors in Section
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The following errors were found in your form. Please correct them before submitting your form.
To go directly to the errors on your form, please use the buttons below or double-click on the error(s) in the list.
Refresh Error List
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Go to Selected Error
Save
PIRSA-RDIF Example Form
Print
7 April 2015
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