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NSW-Israel R&D and Technological Innovation Program
Application form

Apply for the NSW-Israel Research and Development (R&D) and Technological Innovation Program

Instructions: The NSW and Israel based applicant must jointly complete and submit a Bilateral Form and a Letter of Intent (LOI). It is important that information submitted is agreed between both parties.

Word versions of the Bilateral Form and LOI will be made available on the NSW Department of Industry website to inform applicants of the information required.

Prior to lodging the application online, the NSW applicant should download a copy of the completed application and LOI, and provide these to the Israel partner for review. There must be agreement on the content of the application form and LOI before it is submitted. The LOI must be signed by both parties and be attached to the form.

Once the application is submitted online, the NSW applicant should download a PDF version of the submitted application form (including LOI) and provide this to the Israel partner.

The Israel partner must then inform the Israel Innovation Authority of their joint application by emailing the PDF versions of the application form and LOI to the Israel Program Manager.

Applicants must jointly complete and submit an online Bilateral Application Form and a Letter of Intent. Failure to submit correctly completed forms may result in the application being deemed ineligible and not being considered further.

1. Joint Project Information

Project Title

If the application is successful, this project title may be used in published material (Do not exceed 50 words)

Project Summary

If the application is successful, this summary may be used in published material (Do not exceed 150 words)

Technology Sector & Subsector of Project (Select one sector and one corresponding subsector)

Sector

Subsector

The Programme Funding Available is for a joint NSW / Israel project

Is there at least one Israel applicant?

Yes

Is there at least one NSW applicant?

Yes

Is the funding being sought to commercialise technology?

Yes

Participants' Contributions (AUD)

Total NSW project costs

Total NSW applicant contribution

Total third party contributions (if applicable)

Total contribution sought from the NSW Government

Total Israel project costs

Total Israeli applicant contribution

Total third party contributions (if applicable)

Total contribution sought from the Israel Innovation Authority

Note: breakdown of contribution will be sought at full assessment application stage

If third party contributions are being provided, please indicate the source/s.

What is the proposed start date of the Project?

Start date cannot be earlier than the date of submission

Detailed project description

Ensure your project description focuses on your project’s key activities and outcomes. Use plain English to explain:

· What it is you are going to do, including description of the product

· How it will benefit your business

· How each company will contribute to the project

· Aims and significance of the project

· Level of uniqueness of the product, process or service.

Technological development envisaged (level of innovation)

Use plain English to explain:

· Level of innovation and novelty of the product

· Technological barriers, risks and opportunities of the development

· The creation of intellectual property

· The ability of the collaboration to achieve intended results

Market potential and commercialisation plan

Use plain English to explain:

· The planned path to adoption (commercialisation / application) will achieve the identified outcomes

· The funding sought will generate a return on investment

· The solution answers market needs

· The domestic and global market size are identified and detailed

· The expected market share for the company

· Significant competitive advantage for the product / service based on a comparison of competitor companies and products

Cooperation between Participants (Synergies, advantages, complementarities, etc.)

Use plain English to explain:

· The position of the companies in the sector

· The capabilities of the management and research and development teams

· Financial capability

· Past performance

Expected outcome of project

Use plain English to explain:

· The potential contribution of the technology to the economy and society

· Commercialisation activities to occur in the Country

· New patents or inventions registered / protected

· Additional employment positions created or opportunities

· Support of an industry sector or user group to make productivity gains

· The development of new market or achievement of institutional benefits

Will the proposed project result in a unique technological product, process, or service?

Yes

Has an agreement been reached on IP ownership??

Yes

If yes, please attach a letter of intent signed by both parties

2. Project Participants - NSW Partner

General Profile

Full name of Organisation

Does the organisation have an Australian Business Number (ABN) or Australian Company Number (ACN)?

Yes

If No, will the organisation agree to obtain an ABN or ACN?

Yes

Prior name of Organisation (if applicable)

Type of Company

TechR&DResearch InstituteUniversityOther

Stage

SeedR&DInitial RevenuesRevenue Growth

Ownership

PublicPrivateGovernmentalOther

Year Established

No. Employees

Organisation Main Place of Business and Contact Information

Street Address

City

PO Box

Country

Post Code

Telephone

Website

Contact Person

First Name

Last Name

Title

Phone

Mobile Phone

Organisational Background

General Business Description

Please describe your organisation’s key business and area of expertise

Technology Description (Main Products/Services)

Targeted Customers

Revenue (for the last three years, if applicable)

2016/17

2015/16

2014/15

Revenue projection for 2017/18, if applicable

Total Employees (for the last three years, if applicable)

2016/17

2015/16

2014/15

Total employees projection for 2017/18

Technology Sector and Subsector of Organisation (select one sector and one subsector)

Sector

Subsector

Has the applicant already committed to funding the stage of the project which is the subject of the application?

Yes

If yes, please provide details:

Note: For NSW only, retrospective expenses for the project will not be funded. If the project is staged, it may be possible to apply for funding for a component of the project that has not commenced.

Has your organisation previously received other sources of Government support?

Yes

If yes, list sources, amounts and dates.

Has your organisation been involved in any litigation or impending litigation?

Yes

Confirm that the organisation is solvent and not under administration

Yes

Communications

Do you agree for NSW Department of Industry and Israel Innovation Authority to promote successful collaborations and make announcements on the project?

Do you agree for NSW Department of Industry and Israel Innovation Authority to provide organisation information to third parties for verification against eligibility criteria?

Would you like to receive emails from Israel Innovation Authority on news and events?

3. Project Participants - Israel Partner

General Profile

Full name of Organisation

Prior name of Organisation (if applicable)

Type of Company

TechR&DResearch InstituteUniversityOther

Stage

Seed

R&D

Initial Revenues

Revenue Growth

Ownership

Public

Private

Governmental

Other

Year Established

No. Employees

Organisation Principal Place of Business and Contact Information

Street Address

City

Post Code

Country

Telephone

Website

Contact Person

First Name

Last Name

Title

Phone

Mobile Phone

Organisational Background

General Business Description

Please describe your organisation’s key business and area of expertise

Revenue (for the last three years, if applicable)

2016/17

2015/16

2014/15

Revenue projection for 2017/18, if applicable

Total Employees (for the last three years, if applicable)

2016/17

2015/16

2014/15

Total employees projection for 2017/18

Technology Sector and Subsector of Organisation (select one sector and one subsector)

Sector

Subsector

Has the applicant already committed to the stage of the project which is the subject of the application?

Yes

If yes, please provide details:

Has your organisation previously received other sources of Government support?

Yes

If yes, list sources, amounts and dates.

Has your organisation been involved in any litigation or impending litigation?

Yes

Communications

Do you agree for NSW Department of Industry and Israel Innovation Authority to promote successful collaborations and make announcements on the project?

Do you agree for NSW Department of Industry and Israel Innovation Authority to provide organisation information to third parties for verification against eligibility criteria?

Would you like to receive emails from Israel Innovation Authority on news and events?

Please upload a letter of intent to support your submission. (Max File Size is 10 Mb)

Need assistance with this form?

Page link: https://www.business.nsw.gov.au/support-for-business/innovation-and-research/nsw-israel-r-and-d-program/apply

Apply for the NSW-Israel Research and Development (R&D) and Technological Innovation Program

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