Our flow of venture and development capital requests and inquiries is substantial and, as a result, we find it extremely useful if this Venture Information Sheet is completed as a First Contact reference point.

Please complete this form as fully and accurately as you can. This information will be used to determine the nature and extent of advice and assistance that First Corporate may be able to provide to you. Time is precious, both your time and ours. This information will enable us to familiarize ourselves with your concept and requirements, in advance of meeting or speaking with you in person.

We give you our complete assurance that this information will be kept in strict confidence, in anticipation of signing a confidentiality agreement between yourself and First Corporate Pty Ltd.

We understand that some of the questions may be difficult to answer at this stage and appreciate that your responses may be first estimates that are subject to discussion and variation.

Please submit the completed form and we will respond after reviewing the information.

If you need the know the type of business plan we prefer to receive please refer to our web site where we have included two sample business plans for your use.

Ideally we would like to receive an executive summary of a few pages to see if the project fits our funding mandate.

Venture Information Sheet
Project Number(office use only)

Contact Details
Name
Full Company and/or Business Name
Business Address
Phone Business
  After Hours
  Mobile
Fax Business
  After Hours
Email
Website

Project Information
Industry

Please describe the industry in which the business operates:

Product/Concept Description

Please provide a brief description of the project

Key Benefits

Please list the key features, advantages or savings associated with the use of your product/idea

Please provide a dollar estimate of the market size for your product, together with your actual or expected market share
Stage of Project
bullet Click on the button to view a description of the stages of a project
Is there any intellectual property associated with your project?

If yes, have you applied for any form of intellectual property protection?

If yes, please describe and provide the status of the application(s).

If no, do you believe your venture has Patent or Trade Mark potential?

Yes No

Yes No

Yes No

Funding Information
Funding Requirement

Please state the approximate amount of funding being sought via First Corporate Group

Do you have an estimate of the value of the entity?

If yes, please note this value

Yes No

What is the minimum investment parcel you are willing to accept from each investor?
Timing

Please provide an estimate of the required timing of these funding injections (eg. 25% of the total amount each quarter for 1 year):

Investor Interest

Please indicate whether you have considered what the investor will receive in return for its funding, and if yes, please describe (x% of the business, x number of preference shares etc.):

Yes No

What is your preferred investor type (eg. individual, Venture Capital company, Institutional Investor, Industry major etc.)?
What is your preferred type of funding (eg equity, debt, convertible redeemable preference share etc)?
Has your project previously received any external funding? Yes No
Has the project ever received any Government Grants?

If yes, please note the date, type and amount of the Grant

Yes No

Investment Readiness
Have you prepared a Business Plan?

If yes, it would be useful for us to view this prior to our meeting.

Yes No

 

Have you prepared a 5-year Strategic Plan? Yes No
Do you have an accounting system in place?

If yes, please describe (eg. manual, Accpac, MYOB, Attache, Solution 6 etc.)

Yes No

Do you prepare budgets and measure against actual results? Yes No
Do you prepare timely financial statements?

If yes, to what date has the most current set been prepared?

Yes No

Do you employ or engage the services of a qualified and competent accountant? Yes No
Have you prepared costing information for your venture? Yes No
What is the anticipated Gross Margin of the product?
Have up to date financial forecasts been prepared? Yes No
How many employees does the project have at present?

Company Information
If not already operating under a registered company structure, are you willing to convert your business to a company? Yes No
Place and Date of Incorporation
(if applicable)
What is the legal structure of the entity
(Pty Ltd, Unlisted Public Company etc.)?
Does the entity have any overseas associations? Yes No
Is this entity Australian Owned?

(Indicate the percentage of any foreign ownership)

Yes No

How many years has the entity been in this industry?
How long has the entity been in business under the current name?
If any of the entity’s shares are listed, please note the name and location of the relevant Stock Exchange(s)
 

  

Please forward this information, together with any enclosures, to:

First Corporate Group
Capital Funding Division
PO Box 7218
PERTH WA 6850

Facsimile: +61 8 9480 1120

Email:       jbroun@firstgroup.com.au

 
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