Selective Financial Assistance Application Form
If you would like to contact us, please complete and submit this form and we will reply to you as soon as possible. Required fields are marked with a red asterisk*  
     
Applicant(s)
Name:* Telephone:*
Address:*
Fax: Email:* Website:
 
Project Location (Please tick one)
Which Electoral Area Are You Within?
Borris-in-Ossory
Emo
Portlaoise
Luggacurren
Mountmellick
Status:
Individual
Family
Company
Group
    
If a company state name, address and registered number:
Company Name:
Company Address:
Company Registered Number:
 
Applicant's Status
Home Duties Unemployed Self-employed Employed
Occupation:
Is this a start-up or expansion        
 
Promotor's relevant qualifications and experience:
What training do you envisage doing in the next 12 months to develop your business:
Which of the County Enterprise Board's priority sectors are you within?
Applicant is long term unemployed Manufacturing
Internationally Traded Service Applicant was made redundant
 
Business Purpose
Industry Craft Food Horticulture Health
Leisure Personal Textile Forestry    
If other please specify:
Brief history of the business:
 
Project
Project Title: Address of premises:    
Is premises:
Owned Rented    
Sketchmap of Premises Location (should our staff call to you)
Description of Product/Service:
Do you expect the project to be commercially viable? Yes No
Type of Assistance now being applied for: Capital Employment
If employment assistance being applied for, please indicate if labour shortages exist? Yes No
Will I proceed with the project if financial assistance is not offered? Yes No
If service-type project please indicate if labour shortages exist Yes No
 
Markets
Markets to be served:
Estimate of size/value: Basis of Estimate      
Estimated market percentage Local % National % Export %
Results of market research
Projected annual turnover: Year 1 Year 2 Year 3
Project annual profit: Year 1 Year 2 Year 3
State main competitors:
 
Finances
Proposed Expenditure: Euro Sources of finance: Euro
Acquisition of land or buildings Applicant's Cash
Construction / adaption costs Equity
Machinery and equipment Borrowings
Working Capital Grant
Please attach confirmation from the lending institution regarding borrowing, if any.
*List items of new equipment and new machinery to be bought:
(Please note second hand or leased equipment is not eligible for grant aid)
Please note grant aid will not be paid in retrospection
Have you applied for or received grant aid from any source in respect of
this or any previous undertaking?		 Yes No
If yes, please give details:
Are you registered for TAX? Yes No
Are you registered for VAT? Yes No
Do you have a safety statement? Yes No
 
Personnel
How many people do you employ at present?
Number of jobs expected to be created by this project?
 
Production
Describe the production process:
 
Declaration
I declare that the above information and details are true to the best of my knowledge and belief and I make this application on the basis of the information and details given. I also accept, as part of the application process that my replies to the question on other grants are subject to verification measures, which include oral and written enquiries and exchanges of information with such bodies. I understand that the decision of the board in relation to this application may be published.
Describe the production process:
Signed Applicant(s)
Date

Please append seven copies of your business plan and other supporting documentation. In the case of existing enterprises, audited accounts for the last two years should be submitted. Applicants should note that if incomplete applications are submitted, further details may be
requested and this may delay the decision.

The Laois County Enterprise Board Limited is a private company limited by guarantee.

The board’s offices are at:
Portlaoise Enterprise Centre, Clonminam Business Park, Portlaoise, Co.Laois.
Contact details: Telephone: 0578661800; Fax: 0578666989; e-mail: admin@laoisenterprise.com
The Board’s website is www.laoisenterprise.com Directory:www.laoisenterprises.com
Company Registration Number 223813; Registered in Dublin
County & City Enterprise Boards are funded by the Irish
Government and partfunded by the Euopean Union
under the National Development Plan 2007-2013