Natural Disaster Assistance Loan / grant Application

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1 QRAA QRAA - GPO Box 211 BRISBANE Q 4001 Telephone: (07) Freecall: Facsimile: (07) Website: ABN: Natural Disaster Assistance Loan / grant Application Non-Profit Organisations OFFICE USE ONLY Client ID No: Application No: v2 25/02/15 Please advise which natural disaster has directly impacted your non-profit organisation: Section 1 - Organisation and contact details Full legal name of the organisation Is it incorporated? Yes No Under which Act are you incorporated? Incorporation number ABN (if held) Street address of organisation Postal address Postal Please tick if same as street address Address Town State Postcode Postal Address City/Shire/Regional Council Town State Postcode Business Phone No. Fax No. Mobile No. Address Please nominate a contact person for the organisation: Title Surname Given s Job title (e.g. CEO, Accounts Manager) Business Phone No. Fax No. Mobile No. Address Section 2 - Payment details Please provide the organisation s bank account details for payment of the assistance by Electronic Funds Transfer: Bank Branch BSB (Bank, State, Branch number) Account (e.g. Maroon Inc.) Account Number

2 Section 3 - Organisation description and background When did the organisation commence operations (DD/MM/YYYY)? / / Number of paid employees (excluding office bearers): Full time Part time Number of voluntary (unpaid) employees: Number of members: Please briefly describe the history of the organisation, what it does and its objectives. Please attach a separate page if more space is required. Section 4 - Details of natural disaster How did the eligible disaster directly affect your organisation? Please attach a separate page if more space is required. QRAA NDA Non-Profit Application Form - pg 2 of 11

3 Section 4 (cont.)- Details of natural disaster Details of Damage Item lost or damaged (e.g. property, equipment, stock) Details of loss/damage Estimated cost of repairs/replacement Does the organisation hold an insurance policy for any losses suffered from the disaster? Total No Yes - If yes, please provide the following details of your claim: Insurance Company Request Amount: $ Details of claim Section 5 - Proposed disaster-related project and funding details What repair/replacement and/or carry-on costs will you incur as a result of the eligible disaster? (Please detail below) Requirements (Note: include these costs in your cashflow projections - refer example next page) Carry-on** (Refer example next page) Requirements Sub total Total Cost How do you plan to fund the above requirements? (Please detail below) Funding (refer example next page) Peak Closing Bank Balance shown on cash flow projection Less your contribution - cash or investments* Less overdraft limit* Less other (please detail) Amount Indicated QRAA loan - (please do not include proposed loan in your cashflow projection) *You must use all liquid assets and available normal credit limits to be eligible for assistance under this scheme. Preferred terms and conditions Loan Terms - Natural Disaster Assistance (loan/grant up to $105,000) years (Max 7 years) Repayment Frequency Monthly Quarterly (months of / / / ) Half Yearly (months of / ) Yearly QRAA NDA Non-Profit Application Form - pg 3 of 11

4 Example Cash Flow Projection and Requirements and Funding Tables. C L IE NT NA ME C L IE NT ID MONTHLY CASHFLOW FOR CURRENT FINANCIAL YEAR Jul-09 TO Jun-10 INC OME AB Cricket Club Inc. J ul A ug Sep Oct Nov Dec Sales 25,000 25,000 30,000 35,000 40,000 35,000 30,000 40,000 40,000 55,000 45,000 40, ,000 Membership Fees 10,000 10,000 10,000 10,000 10,000 15,000 5,000 50,000 20,000 45,000 30,000 10, ,000 J an F eb Mar A pr May J un TOTA L Other- TOTAL INCOME: 35,000 35,000 40,000 45,000 50,000 50,000 35,000 90,000 60, ,000 75,000 50, ,000 EXPENDITURE - FIXED & VARIABLE (Amend add or delete headings as necessary to suit your business - refer to your past financials ) Fixed Costs 8,000 8,000 8,000 8,000 8,000 8,000 8,000 8,000 8,000 8,000 8,000 8,000 96,000 (Detail) Variable costs 22,750 22,750 26,000 29,250 32,500 32,500 22,750 58,500 39,000 65,000 48,750 32, ,250 (Detail) 30,750 30,750 34,000 37,250 40,500 40,500 30,750 66,500 47,000 73,000 56,750 40, ,250 PURCHASES Purchases 30,000 30,000 60,000 Ground Repairs 68,000 68,000 Drainage Repairs 30,000 30,000 Equipment Replacement 27,000 27,000 30,000 30,000 68,000 57, ,000 OTHER EXPENSES Lease/HP/Chattel Mortgage ,720 Interest ,570 Loan Repayments 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 48,000 Affiliation Fees 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 24,000 Players Insurance ,300 7,360 7,370 7,380 7,370 7,360 7,350 7,350 7,350 7,650 7,350 7,350 7,350 88,590 TOTAL EXPENDITURE: 38,110 38,120 41,380 44,620 47,860 47,850 68, , , ,350 64,100 47, ,840 SURPLUS (DEFICIT) -3,110-3,120-1, ,140 2,150-33,100-13,850-62,650-37,350 10,900 2, ,840 Opening Bank Balance -53,110-56,220-59,340-60,720-60,340-58,200-56,050-89, , , , ,100 Closing Bank Balance -56,220-59,340-60,720-60,340-58,200-56,050-89, , , , , ,950 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Overdraft Limit $60,000 Requirements (Please detail ) Ground Repairs Drainage Repairs Equipment Replacement Carry-On** Example One Cost $68,000 $30,000 $27,000 Requirements Sub Total $125,000 $18,000 Total $143,000 Example Two Cost $68,000 $30,000 $27,000 $125,000 0 Funding Peak Closing Bank Balance shown on cash flow projection Less your contribution - cash or investments Less overdraft limit Indicated QRAA loan A mount $203,000 nil $60,000 $143,000 A mount $203,000 $48,000 $60,000 $95,000 Example One ** When the Indicated QRAA Loan amount exceeds the Requirements Sub Total PLEASE REFER ALSO TO amount, the difference needs to be recorded against Carry-On to balance. CASHFLOWS AND GUIDELINES (eg. The $143,000 Indicated QRAA Loan amount exceeds the $125,000 Requirements PAGES 8,9 & 10 Sub Total amount by $18,000. Example Two When the Indicated QRAA Loan is equal to or less than the Requirements Sub Total amount, there are no requirements for Carry-On. QRAA NDA Non-Profit Application Form - pg 4 of 11

5 Section 6 - Property details Please show all properties owned or leased by the organisation. Please copy and attach additional pages if the organisation has more than one property. Property Type e.g. clubhouse Current Market Value $ Owned Purchase Date Purchase Price $ Leased Lease Payment (pa.) $ Expiry Options Registered Owners Title Ref No or Lease No County Parish Area Lot/Plan No Property Address Section 7 - Security This Natural Disaster Assistance Scheme requires all loans to provide satisfactory security. Please detail the security available to secure your requested loan. Section 8 - Financial Please comment on any significant income or expense variations in your past 3 years financial statements, and any significant abnormalities (other than disaster related) in your projected cash flows. QRAA NDA Non-Profit Application Form - pg 5 of 11

6 Section 9 - Statement of assets & liabilities Please list below all the assets and liabilities of the organisation. ASSETS (Show present fair maket value) Cash at Bank Term Deposits $ $ LIABILITIES (Current amount owing) Overdraft (Limit:$ ) Term loans Real Estate Address: Other Loans Stock (show type) Plant & machinery Vehicles Hire Purchase, Leasing & Chattel Mortgage (transfer total from table below) Entitlements Owing to Employees Taxation Debt Accounts Receivable Accounts Payable Debentures/Shares/Investments Margin Loans Other Assets (detail) Other Liabilities (detail) Total ASSETS Total LIABILITIES Hire purchase and lease repayment schedule Item Lender (a) Instalment Amount INSTALMENTS Frequency eg. Monthly/ Yearly (b) No. of payments remaining Date of final payment (c) Overdue payments (Arrears) LEASE RESIDUAL (d) Amount Due Date Total Owing (a x b + c + d) Total Owing (transfer total to Statement of Assets and Liabilities above) QRAA NDA Non-Profit Application Form - pg 6 of 11

7 Section 10 - Supporting documents checklist The following information must also be provided to QRAA. Past 3 (three) Years' Financial Statements - including Profit and Loss Statement, Balance Sheet and depreciation schedules - Cashbook figures are acceptable if financial statements have not been prepared - Financials must be provided for the applicant entity and all associated entities Provided with this form Yes No - state why Annual Report Yes N/A Monthly Cash Flows for the Current Financial Year Monthly Cash Flows for the Next Financial Year Yes Yes Schedule of Account Details - A copy of the form is to be completed by each of your bankers/lenders (including banks, credit unions, lease/finance companies etc) and attached to this application. Please arrange for your bankers/lenders to return this form to you prior to submission of the completed application to QRAA. Organisation Constitution or Rules of Association Yes Yes Please provide any additional information or documentation that you feel may support your application. Authorisation I/We hereby confirm that the above financial and other required documentation is included with this application. I/We hereby authorise the QRAA to obtain and disclose such information as considered necessary in relation to this application from my/our Accountants, Solicitors, Business Consultants, Commercial lenders (e.g. Banks and other Financiers), other Government Departments, Regional and Shire Councils, Suppliers, or other agents. I/We certify that all of the information provided in the whole of this application is true and accurate and discloses our correct financial position. I/We also agree to participate in a follow-up survey if requested. Signed for and on behalf of the organisation by: Please ensure an authorised member of the Executive/Management Committee completes the section below. Member of Executive/Management Committee to complete Position Signature Date Please list the names and positions of the members of your management committee Position Position Position Position Privacy Information We understand and appreciate that our customers are concerned about their privacy and the confidentiality and security of any information that may be provided to us. QRAA has always prided itself on its standards of confidentiality, and will continue those standards, in line with new privacy legislation. The personal information collected and maintained by QRAA comprises your name, address, contact details and information specific to the support program. QRAA may use your personal information in order to provide the services you require, administer and manage those services, and research and develop our services. Your personal information is also collected to advise or offer information on other support programs that may be relevant and of interest to you. If you do not wish to receive these offers or information, please call and ask for the Privacy Contact Officer. It should be noted that financial information received by QRAA for the purposes of assessing eligibility and level of assistance under specific schemes of support, that may enable an individual to be identified, at no stage is divulged to any third party or government department. QRAA NDA Non-Profit Application Form - pg 7 of 11

8 Application & cash flow guidance General Guidance QRAA has Client Liaison Officers based in Bundaberg, Innisfail, Kingaroy, Longreach, Mackay, Rockhampton, Roma and Toowoomba who can assist you with any questions. To speak to your local Client Liaison Officer, please contact QRAA on Freecall Please complete each section in the application form and forward it to QRAA with the required attachments (listed on page 7). Incomplete applications or missing attachments are likely to cause delays in assessing your application and may result in the application being declined. Cashflow Guidance The cashflow forms should be completed by those who understand the business best. This is usually the owners and operators of the business. Your Accountant or Financial Advisor may be able to assist, if needed. A projected cashflow, in which you estimate as accurately as you can the income and expenses for a current/future period, is probably the most important tool your business can have. You should base your projections on your historical results (past financials) and your knowledge of what might be different this year and the following year. The ability to check your actual results with what you expected will assist you to make critical decisions about your business. QRAA requires a monthly cashflow for the current year, plus the next full financial year. Microsoft Excel versions of the cashflow form are available to download from the QRAA website, If you utilise the Excel cashflow, the totals will automatically calculate and you may find it is easier to complete. If you have your own computer prepared cashflows, please feel free to send them instead. Completing a Cashflow The steps below outline how to complete a QRAA application cashflow: 1. Fill in your name and QRAA Client Identification Number (if known) at the top of the form and complete the relevant year. 2. Revenue All revenue should be shown, including interest and dividends from investments, rents from properties and government assistance. Use your historical records to estimate when income will be received. Do not include the QRAA loan amount you are applying for. 3. Expenses 4. Purchases Please refer to your past financials for suitable headings for your organisation (the headings shown can be used as a basic guide). These will also assist you with the timing of payments. Do not include non-cash items such as Depreciation or Bad Debts in your cashflow. Include all your stock purchases (if applicable) in the months when you expect to pay for them. Capital purchases would include major items such as vehicles or equipment (the cash amount paid excluding lease/hp etc), major renovations or improvements, new equipment etc. Please make a note of the type of capital purchase. Include in this section the costs to restore your organisation s operations from Section 5 (page 3). 5. Other Expenses Please list all your: - lease, hire purchase or chattel mortgage payments - interest on overdraft or similar type of non reducing facility, and - total repayments on term loans, housing loans and credit cards. 6. Surplus or (Deficit) This total will be automatically calculated if you are using the Microsoft Excel version of this form from the QRAA website. If you are completing the form manually, please calculate the difference between Income and Expenses. If income is greater, you have made a surplus. If Expenses are greater, you have made a (deficit) or loss. 7. Note your Opening and Closing Bank Balances. If completing the cash flow for the current year, the opening bank balance of your overdraft or operating account for July should be taken from your bank statement and adjusted if necessary for outstanding cheques. If completing the cash flow for the following or subsequent years, the opening bank balance will be the closing bank balance from the previous year s cash flow which you have completed. The purpose of this calculation is to provide an estimate of your bank balance (the closing balance) at the end of each month, and indicate your peak debt or credit. The closing balance is calculated by adding the opening balance to the monthly surplus or (deficit), which then becomes the opening balance for the next month. QRAA NDA Non-Profit Application Form - pg 8 of 11

9 Monthly cashflow for CURRENT financial year (Period 1 July... to 30 June... ) QRAA Client ID (if known) REVENUE Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun TOTAL Sales Donations Membership fees Grants Other Wages/Salary Contracting GST & Tax Refunds Asset sales (detail) TOTAL REVENUE EXPENSES - FIXED & VARIABLE (amend, add or delete headings as necessary to suit your organisation - refer to your past financials) Account/Admin fees Bank charges Electricity & Gas Insurance Licences Phone & Internet Postage & Stationary Rates & Rent Subscriptions Advertising Fuel & Oil Motor Vehicle Expenses Plant & Equip Hire Repairs & Maintenance Salaries & Wages Sundry Superannuation Travel & Accomm Workers Compensation PURCHASES Stock Disaster Costs Capital OTHER EXPENSES Lease/HP/Chattel Mort Interest Loan Repayments TOTAL EXPENSES SURPLUS (DEFICIT) Opening Bank Balance Closing Bank Balance QRAA NDA Non-Profit Application Form - pg 9 of 11

10 Monthly cashflow for NEXT financial year (Period 1 July... to 30 June... ) QRAA Client ID (if known) REVENUE Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun TOTAL Sales Donations Membership fees Grants Other Wages/Salary Contracting GST & Tax Refunds Asset sales (detail) TOTAL REVENUE EXPENSES - FIXED & VARIABLE (amend, add or delete headings as necessary to suit your organisation - refer to your past financials) Account/Admin fees Bank charges Electricity & Gas Insurance Licences Phone & Internet Postage & Stationary Rates & Rent Subscriptions Advertising Fuel & Oil Motor Vehicle Expenses Plant & Equip Hire Repairs & Maintenance Salaries & Wages Sundry Superannuation Travel & Accomm Workers Compensation PURCHASES Stock Disaster Costs Capital OTHER EXPENSES Lease/HP/Chattel Mort Interest Loan Repayments TOTAL EXPENSES SURPLUS (DEFICIT) Opening Bank Balance Closing Bank Balance QRAA NDA Non-Profit Application Form - pg 10 of 11

11 QRAA - GPO Box 211 BRISBANE QLD 4001 Telephone: (07) Freecall: Facsimile: (07) Website: ABN: A separate copy of this form is to be completed by each of your lenders. Please arrange for your lenders to return this form to you before submitting your completed review to QRAA. (Includes banks, finance companies, building societies, credit unions and private lenders. For applicants and all related entities) To: (Bank/Financier ) Please list below details of all my/our accounts held with your company and return this form to me/us according to the Return Instructions (shown to the right of this form). You are also authorised to discuss my/our accounts with QRAA and provide any information QRAA may request regarding my/our accounts. /Company/Firm Applicant s Signature /Director/Partner Schedule of Account Details Consent and Authorisation Applicant s Signature Return Instructions Please return this form to me/us by: Fax ( ) Post OFFICE USE ONLY Client ID No: QRAA V.8 08/01/15 Loan Accounts, Equipment Finance & other Borrowings (Debit Accounts) Account Account BSB & Number Facility Type Balance Limit Interest Rate Expiry Date Repayment Amount Repayment Frequency Balloon or Residual Arrears Contingent Liabilities: Savings Accounts, Term Deposits, Investment Accounts & other Asset Accounts (Credit Accounts) Account Accounts BSB & Number Account Type Balance Certification I/we confirm the above information is correct and the account holder currently has the lender s support. Requests for additional funding and / or continued support will be considered in line with conditions prevailing at the time of any such request and the lender s usual credit requirements. Branch Address/Stamp Manager Address QRAA NDA Non-Profit Application Form - pg 11 of 11 Manager Signature Phone Number An additional Schedule of Account Details form is available on QRAA s website. Date Fax Number Great state. Great opportunity.

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