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Expression of Interest form

CSIRO Australian Growth Partnerships Program

Expression of Interest (EOI) form


1 2 Date of EOI: Full Name of the entity applying (the Applicant) & Major Shareholders: ABN and/or CAN: Applicants Business Address: Applicants Postal Address: Applicants Registered Office Address: Name of Principal Contact for this EOI: Phone (mobile): Phone (office): Email address: How many employees does the Applicant have? How long has the Applicant been in its current business? Specify the Applicants Annual Turnover for at least the last 5 years. Identify the Applicants basic corporate structure, e.g. Private / Public / Joint Venture / Trust etc. Provide brief biographical data on each of the senior management and Directors of the Board with details of previous grants secured (as applicable). Describe the Applicants Principal Business. What proposed technological enhancement, innovation or R&D program do you propose the AGP investment be applied to?

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Expression of Interest (EOI) form


18 Describe how the proposed technological enhancement, innovation or R&D program would impact on the Applicants commercial success. If applicable, in the response please comment on issues such as: Anticipated increase in competitiveness and/or resulting change in market share over time. The anticipated improvement on the margin that might be gained. Changes to the level of export earnings. Changes in Applicant employment levels. How long after a successful R&D program before the Company expects to derive an economic benefit from the technological enhancement, innovation or R&D program?

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How would your proposed technological enhancement, innovation or R&D program align with our Flagship Program? Does the Applicant have a track record of commercialisation technology based innovations? If yes, provide details of the above and contact person details? Has the Applicant worked with CSIRO on a project related to technology which is the subject of this application? If yes, please provide details of the above in addition to the contact persons details. Does the Applicant have any capacity to coinvest with CSIRO on the program being contemplated? If so please provide indicative range. Have you read and understood the Terms and Conditions of this Expression of Interest (EOI)? Yes No

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Signed and dated by the Applicant:

_____________________________________ Signed and dated by the Director or duly Authorised Representative

_____________________________________ Signature of the Director / Witness

_____________________________________ Print name

______________________________________ Print name

Please post this EOI form to:


AGP CSIRO
PO Box 93 North Ryde NSW 1670

Please email a Microsoft Word version of this EOI form to:


agp@csiro.au

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Terms and conditions associated with submitting the EOI form


By completing and submitting an EOI, the Applicant agrees to the following terms and conditions: 1. General 1.1. CSIRO may exclude the Applicant from further consideration and evaluation if CSIRO considers, at any time and in its absolute discretion that the Applicant is not suitable for funding by CSIRO. 1.2. CSIRO may conduct reference checks, including site visits on the Applicant and its officers (all personal information collected will be treated in accordance with CSIROs privacy statement). 1.3. CSIRO may request further information from the Applicant during the selection process and will, as appropriate, engage in discussions or negotiations with any Applicant for the purpose of clarifying or improving its response. CSIRO may, in its absolute discretion, conduct simultaneous discussions with other applicants to clarify or improve proposals. 1.4. CSIROs AGP funding decisions will be in its absolute discretion and su bject to CSIRO internal approval processes and full execution of final transaction documents. No binding legal relationship will arise from the AGP funding process until all transaction documents are signed by all parties. 1.5. The Applicant must not engage in any behaviour which is anticompetitive, misleading or deceptive or attempt to improperly influence any officer, employee or agent of CSIRO in connection with AGP. 1.6. CSIRO is not responsible for any loss, damage, costs or expenses incurred by the Applicants or any third party as a result of the Applicant submitting this EOI or participating in the AGP funding process.

2. Use of EOI and other submitted material 2.1. The Applicants EOI response will be as part of the assessment of the Applicants suitability for funding by CSIRO through AGP. The Applicant warrants that all information it provides to CSIRO in the EOI is true and correct. 2.2. Subject to 3.1 and 3.2 below, all material submitted by the Applicant, including this EOI becomes the property of CSIRO (Material). The Applicant grants to CSIRO a nonexclusive, worldwide, royalty-free licence to copy, use, modify and disclose the copyright works in the Material, for the purpose of evaluating the Applicants response and negotiating final transaction documents if the Application is selected.

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3. Confidentiality 3.1. Subject to 3.2, CSIRO will treat as confidential, any information provided by the Applicant to CSIRO which the Applicant specifies in writing is confidential (excluding information which (a) was created by or for CSIRO independently of the information provided to it by the Applicant; (b) is rightfully known by CSIRO as a consequence of the information being disclosed from an independent source without any limitation on its use or disclosure; (c) in the public domain (otherwise than a result of a breach of these terms); or (d) required to be disclosed by law). 3.2. CSIRO and its advisors may use the Applicants confidential information for the purposes of administering, managing and reporting on AGP and determining suitability of the Applicant for AGP funding, including the negotiation and preparation of final transaction documents to effect AGP funding. 3.3. The Applicant must treat as confidential, any information and documents provided by CSIRO to the Applicant including all information and documents regarding CSIROs business, technology, operational and financial arrangements. If the Applicant is shortlisted for advanced due diligence, CSIRO will require the Applicant to enter into a nondisclosure agreement before the Applicant can enter into further discussions with CSIRO.

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