Application Form

Please fill out the form below as fully as possible as this will be the basis of our initial decision on your proposal. Fields marked with an (*) are mandatory. Please carefully check the figures that you have inputted particularly in the 'Valuation' field. If you do not know your valuation, please enter a zero. NB: Please be sure to read our Privacy Statement.

Personal
Company
Funding
Market
Projections
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Personal Information

First Name:(*)
Surname:(*)
Tel:(*)
Mobile:
Fax:
Email:(*)
Are you a shareholder, director or employee of the Company or an adviser to the Company?
Role:(*)

Company Information

Company Name: If you do not have a name for the company please enter Newco and a few words to describe what your company does. i.e. "Newco - Specialist Printing" or "Newco - Scientific Instruments"

Company Name:(*)
Street:
Town/City:
County:
Region:(*)
Post Code:(*)
Website:
Registered Company Number:
Number of Employees:
Do you have any of the following?
Research & Development Grant (formerly SMART)
Loan under SFLGS
R&D Tax Credits
Do you intend to sell your business in the next 5 years?:
Do you have any institutional shareholders (e.g. venture capital funds)?
Institutional Shareholders:
How did you find out about the scheme?:(*)
Please specify:
Start of Company Trading (mm/yyyy): /

Funding Requirements

Funding required from 1stEthical (£):(*)
Please enter the full amounts in the funding requirement section i.e. 100000 rather than 100 or 100k. No decimal points or commas are permitted.
Other Funding (£):
Total Funding (£):(*)
Enter the total funding required at this stage including the amount specified in the box above.
For what will you use your funding? (500 chars):(*)
Valuation (£):
What valuation would you place on your business today?

Your Business/Market

Industry Sector: (*)
Stage of venture: (*)

Business Description (500 chars):(*)

What do you produce and how? Who buys your products and why? How do you market and sell? Why is your business better than your competitors?

Recent History (500 chars):

The key events and activities in your business that have brought you to your current position.
Market (500 chars):

How is your industry sector structured and what are the key changes which have created the opportunity for your business?
Management Team Information (500 chars):

Tell us about the people who will be making this business a success.
Product Features (750 chars):

What are the principal features of the goods and services you sell?
Are your products fully developed?:
When will your products be ready?:
How much will full development cost?:
Competitive Advantages (500 chars):

What do your products have that competing products lack?
Customer Needs (500 chars):

What customer needs do your products satisfy and why are customers going to buy them?
Month Sales Start (mm/yyyy): /
The month in which you made your first sale.
Breakeven Month (mm/yyyy):
The first month in which the Company made/will make a profit.
/

Projections

Note: The model should assume that the funding required goes into the company 4 months after the date of application. All figures in the financial fields should be in pounds sterling (£). No decimal points or commas are permitted.

Financial Projection Model
	Last £ (actual)	Current Year £ (actual year to date)	Current Year £ (projected total)	Next Year £ (projected total)	Year 2 £ (projected total)	Year 3 £ (projected total)	Year 4 £ (projected total)	Year 5 £ (projected total)
Profit and Loss
Sales
Gross Profit
Overheads
Depreciation
Profit before interest & tax
Cashflow
Capital Expenditure
Balance Sheet
Fixed Assets - Net Book Value
Cash resources
Other current assets
Bank overdraft
Other loans
Other current liabilities
Long term loans
Share Capital
Reserves
Retained earnings/losses

Important Information – Disclaimer

Whilst 1st Ethical Ltd has taken all reasonable steps to ensure that the information contained within these pages is accurate and up-todate, no liability can be accepted for any error or omissions appearing in this site.

If you are in any doubt as to the validity of information made available within these oages, or if you wish to rely on this information, then it may be in your best interest to seek verification by contacting us. Everything is provided for information purposes only, and is not investment advice. Professional advice form an authorised independent adviser should always be sought before acting or relying on any of the information, and we accept no responsibility for any loss which may arise from reliance on the information in our website, or any site to which we have provided a link. No contracts will be entered into by electronic means.

Privacy Statement

The names, logos, domain names, images and web site design of 1st Ethical and associated Companies form part of its intellectual property. No-one has the tight to use or reproduce any of the above without the permission of 1st Ethical and any such attempt will be regarded as a breach of its intellectual property rights and will result in steps being taken to protect those rights. The 1st Ethical website does not store or capture personal information, but merely logs the user’s IP address which is automatically recognised by the web server. Information that has been provided whether of a personal or financial nature will only be used by 1st Ethical, will be held in accordance with the Data Protection Act 1998 and will not be passed on to a third party without prior written consent.

We will only obtain personal data from you for specified and lawful purposes and any personal data which we obtain will be processed fairly and lawfully. We do not disclose personal information to third parties, except where you have given your consent or where we have a legal obligation to do so. We do not provide your details to third parties for any marketing or promotional purposes. We will take all reasonable steps to ensure that that the data held is adequate, relevant and not excessive for this purpose. We may need to share personal information with other companies within 1st Ethical. All these Group companies follow the same Data Protection policy and maintain the same levels of confidentiality and security. We take all reasonable steps to protect the confidentiality and security of your personal information and to keep our personal information accurate and, where necessary, up to date. We take all reasonable steps to retain data only for the duration of the purpose for which it was obtained. Where requested, we will delete personal information from current operational systems where it is no longer required. We may need to continue to hold some details about you after your relationship with us has ended, for example for legal and regulatory purposes.

In accordance with the terms of the Data Protection Act 1998, you are entitled to a copy of the information that we hold about you. On receipt of your written request, together with a cheque in the sum of £100 made payable to 1st Ethical, we will release a copy of such information within 40 days. We do not use cookies for collecting user information from the site and we will not collect any information about you except that required for system administration of the web server.