Eligibility Application Form - SBCI, Strategic Banking Corporation of Ireland SBCI, Strategic Banking Corporation of Ireland

When completed, this form needs to be printed, signed and returned to the SBCI via email or post.

Statement of understanding

This application form relates to certain eligibility criteria for the SBCI Brexit Loan Scheme. Other eligibility criteria set out in the terms and conditions of the SBCI Brexit Loan Scheme (https://sbci.gov.ie) also apply.

This is not a guarantee of credit approval. Approval of a loan under the SBCI Brexit Loan Scheme is at the discretion of the relevant finance provider.

Please note: This application form contains mandatory binding declarations regarding eligibility for this scheme. If a false or misleading declaration is made, or if false or misleading information is provided with this application, it may lead to a demand for repayment of any sums advanced under this scheme by the finance provider and to any state aid received being recovered with interest.

Declarations

Please note that (1) an up to date business plan must be provided to the finance provider(s) when applying for an SBCI Brexit Loan Scheme and (2) in certain instances, documents must be provided to the SBCI with this application to evidence compliance with eligibility criteria as detailed in the section ‘Innovation Criteria’ below.

Please note that all declarations, business plans, and documentation can be audited by the European Commission and other bodies as part of periodic audits of European support schemes. Further details shall be provided in the terms and conditions to any loan made available under the SBCI Brexit Loan Scheme.

The SBCI Brexit Loan Scheme is offered in partnership with the Department of Enterprise, Trade and Employment, the Department of Agriculture Food and the Marine and is supported by the InnovFin SME Guarantee Facility, with the financial backing of the European Union under Horizon 2020 Financial Instruments.

I of confirm that:

The borrower satisfies one of the Brexit Criteria and one of the Innovation Criteria at the time of this application.

Brexit Related Criteria

Brexit Criteria (Choose one of the following criteria)

Please Tick

1. Export products, services or raw materials to the UK (including Northern Ireland) equating to at least 15% of business turnover.

2. Import products, services or raw materials from the UK (including Northern Ireland) equating to at least 15% of business turnover.

3. The combined exposure (of 1 and 2 above) equates to at least 15% of business turnover.

4. The business is indirectly exposed to the UK (including Northern Ireland) i.e. transacts products, services or raw materials with an enterprise that is directly exposed to the UK (including Northern Ireland) equating to at least 15% of turnover.

State Aid

I an authorised agent of

confirm that has received

of De Minimis Aid within the last three years (the current and previous two fiscal years), details of which are as follows:

Date Received	Grant Provider	Amount

SME & Small Mid Cap Details

Borrower Name*

Borrower Legal Form*

Address Line 1*

Address Line 2*

Address Line 3

Eircode*

County*

Country*

Contact Name*

Contact Telephone Number*

Contact Email Address*

Business Details

Sector*

Sector (NACE Code)*

Year of Establishment*

SME or Small Mid Cap

SME Small Mid-Cap

Number of Employees*

Annual Turnover*

Balance Sheet Total Assets*

Company Registration No. / VAT No.

Company Registration No VAT None

Company Registration No. / VAT No.

Established and operating in Ireland

Yes No

SME/Small Mid Cap part of a group

Yes No

Are you a family business

Yes No

Are you a client of Enterprise Ireland

Yes No

Are you a client of Bord Bia

Yes No

Are you a client of Local Enterprise Office*

Yes

It is necessary for the SBCI to process certain information (including personal data) to process your application. I confirm that I have read and acknowledge the SBCI Data Protection Notice.

I am happy for the SBCI to contact me by email for the purposes of market analysis and surveys related to my application:
(You can withdraw your consent by emailing: applications@bls.sbci.gov.ie)

Yes

In relation to loans over €1.25million, the European Investment Fund (“EIF”) may wish to publish certain details (including your name, address and type of financial support provided per the EIF Guarantee) on the EIF website or in press releases as explained in the SBCI Data Protection Notice. I consent to publication of my details by the EIF:
(You can withdraw your consent by emailing: applications@bls.sbci.gov.ie)

Yes

I am aware this scheme is being offered by the Strategic Banking Corporation of Ireland in partnership with the Department of Enterprise, Trade and Employment, the Department of Agriculture, Food and the Marine and with the support of the European Investment Fund and I confirm that the loan will not be used in contravention of any of the terms and conditions of the scheme, (https://sbci.gov.ie) which I have read and understand.

* Mandatory fields

Please note: None of the information contained in this form is saved by the SBCI.

When completed, this form needs to be printed, signed and returned to us via email or post.