Tyre Stewardship Research Fund - Round 1  · Web viewTYRE STEWARDSHIP AUSTRALIA. Tyre Stewardship...

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TYRE STEWARDSHIP AUSTRALIA Tyre Stewardship Research Fund - Round 1 Project Stream Guidelines and Expression of Interest Application Form Tyre Stewardship Australia Suite 6, Level 4, 372-376 Albert Street, East Melbourne, Vic 3002. Tel +61 3 9077 2791 ABN: 44 164 971 939

Transcript of Tyre Stewardship Research Fund - Round 1  · Web viewTYRE STEWARDSHIP AUSTRALIA. Tyre Stewardship...

TYRE STEWARDSHIP AUSTRALIA

Tyre Stewardship Research Fund - Round 1

Project Stream

Guidelines and Expression of Interest Application Form

Tyre Stewardship Australia

Suite 6, Level 4, 372-376 Albert Street,

East Melbourne, Vic 3002.

Tel +61 3 9077 2791

ABN: 44 164 971 939

This application, including attachments, must be submitted via email, with ‘Projects Stream’ in the subject line, to: [email protected]

1. About TSA

Australia generates a significant quantity of waste tyres every year, many of which are not managed in an environmentally sound manner. Poor practice by some operators has led to incidents of illegal dumping and dangerous stockpiling which poses a very real risk to environment and human health.

Tyre Stewardship Australia (TSA) is a not-for-profit company established to administer the national Tyre Product Stewardship Scheme (‘the scheme’), the objectives of which are to:

increase resource recovery and recycling and minimise the environmental, health and safety impacts of end-of-life tyres generated in Australia, and

develop Australia’s tyre recycling industry and markets for tyre-derived products.

The scheme provides an industry led and government supported framework to effectively reduce the environmental, health and safety impacts of the 52 million equivalent passenger units (EPU), which reach the end of their life in Australia each year.

TSA is supported by a 25 cent per EPU levy on new tyres coming into Australia and uses these funds to deliver a robust audit and compliance scheme and support research and development projects.

The Tyre Stewardship Research Fund (‘the fund’) is the primary mechanism for TSA to facilitate investment and support to develop Australia’s tyre recycling industry and markets for tyre derived products.

This document contains the guidelines and expression of interest form for Round 1 of the fund. Interested applicants are encouraged to read the guidelines in detail prior to lodging any application for funding.

For more information on TSA or the scheme please visit www.tyrestewardship.org.au

If you’d like to talk to someone about Round 1 of the Tyre Stewardship Research Fund, contact:

Liam O’Keefe - Market Development Manager E-mail: [email protected]

2. Tyre Stewardship Research Fund objectives

The Australian tyre recycling industry produces a number of tyre-derived products (TDP) such as crumb rubber and rubber granules that can be used in applications from road construction and playground surfacing to adhesives and binders, and even as an additive into explosives. However, at this point the market for these products is not large enough to absorb all of the waste tyres being created in Australia.

The TSA Board has therefore established the fund as a means of stimulating development of new products and new markets for TDP.

Put simply, the primary objective of the fund is to invest in projects that lead to higher sales of tyre derived product being made by Australian tyre recyclers and manufacturers.

The TSA Guidelines support this by noting the broad objectives of funding to be:

advance innovative technologies in Australia by supporting focused, collaborative research in high priority technologies;

retain local expertise in, and attract international expertise to, Australia in technologies related to end-of-life tyres;

support the growth of skills and capacity in Australia in technologies related to end of life tyres for the domestic and international markets; and

share the results of that research with the wider industry as appropriate whilst respecting intellectual property rights.

The fund is being delivered in two streams:

Project Stream – Funding to support research and development projects that will lead to increased uptake of tyre derived products (this document pertains to the Project Stream)

PhD Scholarship Stream – Specific PhD scholarships for students looking to investigate future technology and solutions that may transform markets for tyre recycling and tyre-derived products (guidelines and an application form for the PhD Scholarship Stream can be found here).

3. Why does TSA provide market development funding?

In order to minimise the environmental, health and safety impacts of end-of-life tyres, Australia needs diverse and sustainable markets for TDP. Stronger markets for TDP will mean more tyres get recycled rather than mishandled and stockpiled creating risk for the community. Stronger markets will reduce this risk by creating more value for waste tyres, driving more competition for material thereby supporting a more robust recycling market that feeds a more diverse and voracious TDP consuming manufacturing sector.

The intent of the fund is to enhance local market development and product development initiatives that demonstrate the value of new and enhanced applications for TDP. TSA believes that a focus on research projects (rather than recycling subsidies or infrastructure funding) is the best means of delivering market development outcomes for the tyre recycling industry. Our aim is to support research and development that brings together strong partnerships across industry, universities and governments to demonstrate both the technical and financial viability of new products and new applications.

Therefore, a significant portion of revenue collected from the TSA levy is directed to research and development and associated market development activities. This will act to support development of this evidence base and promote greater investment in new products and applications via the fund.

4. Funding

4.1 What will be funded?

It is the intention of the TSA Board that the fund evolve over time to ensure that we are targeting the most relevant and outcomes focused research. As such, the fund will be released in annual rounds, which may differ significantly in focus, priorities and process.

Round 1 of the fund will support projects that will lead to a direct increase in the local consumption of tyre-derived products that are currently on the market, such as crumb rubber, rubber granule and shredder tyre products.

Round 1 Priority Areas

TSA is interested in talking with any organisation with a legitimate interest in this field. However, to ensure assessment of applications can be done in a clear and transparent manner, TSA has set the following priorities to guide Round 1 of the fund:

Projects that have a construction engineering focus, such as those investigating applications for tyre-derived products in roads, rail and development

Projects that require research, development and/or testing for new or expanded products that have the potential to utilise significant volumes of tyre-derived products, such as new applications or for enhanced utilisation of rubber crumb, granule or shred

Fundamental laboratory based research, expert studies, testing or support for pilot or demonstration projects to utilise tyre-derived products where wider industry benefit can be shown

Partnerships

We are most interested in projects that can bring together industry, government and research organisations in partnership. TSA believes that having organisations that make products and buy products working closely with research bodies who can test and advance new products offers the best chance of long term success.

For example, a strong project proposal will most likely involve partnerships between:

an organisation that can evidence the beneficial applications for TDP such as a university or other research and development oriented organisations and;

a partner organisation that can realise the market potential of the identified application such as a manufacturer or customer that may purchase or sell the tyre-derived product.

Ideally, TSA is looking to work with organisations and partnerships that:

have a proven record of research and development related to tyre-derived products

have the capacity and capability to deliver outcomes to the industry

can demonstrate linkages with “end users” (i.e. those customers who may consume increased amounts of tyre derived products)

directly support industry in reaching the objective of improved markets for tyre-derived products

Activities

Within the project priorities and partnerships described above, TSA will fund:

Personnel (i.e. staff engaged in the project, but only for the time they are engaged with the project. Note that any time spent on the project by existing personnel will be considered as in-kind funding only)

Research / laboratory / testing costs

Use of equipment required for the project (TSA will consider purchase of specific new equipment for testing where there is likely to be a broader industry benefit)

Field testing to validate laboratory trials

Materials consumed (must use Australian TDP for any funded activities)

External consultants where required for specialist work, such as economic or feasibility analysis or market analysis for new products directly related to the project (these costs must not exceed more than 20% of the total project cost)

Other project costs where documented and justified

Whilst infrastructure development is not the focus of this fund (see following sections), TSA may consider the purchase and/or retrofit of infrastructure that has a direct impact on the uptake of tyre-derived products in Australia.

PLEASE NOTE: These guidelines are intended to assist potential applicants in developing strong proposals, however they should not be seen as “rules”. TSA will consider other models, partnerships and proposals, as long as they can demonstrably contribute to reaching TSAs desired outcomes and objectives. Therefore, if you have a project proposal, please contact TSA to discuss.

4.2 What will not be funded?

The priority for Round 1 of the fund is to find new or expanded markets for TDP currently being manufactured in Australia (for example crumb rubber or rubber granule).

Funding for alternative markets, applications and technologies may be more actively explored in future years.

Therefore, Round 1 of the fund will not support:

Projects related to the clean up of tyre stockpiles;

New vehicles, recycling infrastructure or infrastructure related to energy from waste facilities;

Feasibility studies or business cases for recycling or energy from waste facilities1

Start up or seed funding for new businesses;

Projects outside of Australia;

Projects related to the treatment or management of mining tyres2;

Activities that are being undertaken in order to comply with regulations / compliance;

Projects without matched funding from other parties (TSA aims to ensure all projects generate at least 1:1 funding with government, industry and other organisations);

Sunk costs of background technology, background intellectual property or retrospective research;

The construction of buildings and/or cost of purchasing or improving land unless specifically devoted to and required for the proposed project;

Management studies or efficiency surveys;

The making of donations;

Any activity that a local, State, Territory or Commonwealth government or agency thereof has the responsibility to undertake

5. ELIGIBLE APPLICANTS

To be an eligible applicant for the fund, applicants must:

be a registered Australian business, research institution or university that has the capability and capacity to undertake the project that is being proposed;

meet the requirements for co-contributions and be able to fund all costs of the project that are not met by TSA’s contribution to the total cost of the project;

have ownership of, access to or the beneficial use of any background intellectual property necessary to carry out the project; and

be accredited by TSA or be willing to seek accreditation if a tyre industry fund applicant (for example tyre recyclers, collectors, manufacturers etc.).

6. PROJECT FUNDING

1 Energy from waste projects are not a key focus of this round of funding, however TSA recognises a number of projects of this nature are currently in development. We would therefore be happy to discuss project concepts where alignment with the fund objectives may still be met (for example projects that are still focused on end markets rather than development of infrastructure)2 There are currently no mining companies contributing directly to the TSA levy and as such projects related to mining or OTR tyres may be the focus of future funding

TSA seeks to maximise the value of its funding through co-contributions and by setting funding levels. Round 1 funding levels are designed to ensure TSA can support a variety of relevant projects whilst at the same time managing any administrative burden.

6.1 Funding Levels

Ideally, TSA seeks projects where our cash contributions are between:

the minimum funding level $50,000 excluding GST

the maximum will be $200,000 excluding GST

TSA will use project milestones or gateways to ensure projects are delivering on expectations. We reserve the right to discontinue funding where outcomes and outputs are not being delivered.

6.2 Project Total Cost

The total costing of the project must identify all reasonable expenses associated with the project, including but not limited to:

Personnel: The cost for the time they are engaged in the project of staff engaged or to be engaged on the project.

Equipment: The cost of plant and equipment to be used on the project. For new plant and/or equipment that will be utilised on this project details are required on the cost to be charged to this project of that new plant and equipment.

Materials: The materials that will be consumed on this project and their cost (must use Australian TDP for all funded activities).

Subcontract: The costs of the engagement of subcontractors.

Travel: The costs for travel (please stipulate domestic and/or overseas) by project personnel that is directly associated with the project.

Other: Any other costs for the project which are not covered above. Of particular importance are technology adoption costs, i.e. any expected costs (including intellectual property protection costs) related to transferring the project results to, or to the next innovation stage towards, commercialisation.

6.3 Co-contributions

As is common practice, TSA seeks to maximise the value of its investment via co-contributions from other project partners. Ideally, TSA will look to support projects with a 1:2 ratio whereby $1 of TSA funding is matched by $2 from other project partners.

Whilst this is our desired outcome, TSA recognises that this will not be possible with all projects. At a minimum, TSA requires at least 1:1 funding whereby $1 of TSA funding is matched by $1 from other project partners. TSA will prioritise projects that offer a greater percentage of cash contributions versus in-kind support.

CASH AND INKIND SUPPORT

TSA will make a cash contribution, within the project funding limits set out above, to meeting the total costs of the project. Participants conducting the project may make cash and/or in-kind contributions to finance the balance of the total cost of the project.

A non‐monetary contribution will be an in‐kind contribution for the purposes of contributions to the funding of the total cost of the project if it meets the following criteria:

The contribution can be given a cash value (e.g. salaries and associated overheads of persons working on the project, access to and use of capital equipment made available for the project);

Imputed rent on buildings made available for use by the project, non‐salary project‐specific direct costs such as the cost of providing consumables, and other auditable costs necessary to enable project completion;

The contribution is an expense, for the direct and primary benefit of the project;

The contribution is directly attributable to the provider of the in‐kind support; and

The contribution could be reasonably verified by an independent auditor as an input to the total cost of the project (including overhead levels and/or formulae).

PLEASE NOTE: In line with the common practice of funding organisations similar to TSA, the salaries and associated full overheads of existing staff (adjusted for their proportionate time contribution to the project) must be considered as in‐kind contributions to the funding of the total cost of the project.

However, the gross salary + direct salary related on costs of new staff hires made by project participants specifically for the project (adjusted for their proportionate time contribution to the project) and contributed to the project may be considered as a cash contribution.

7. ASSESSMENT CRITERIA

This document relates to a competitive funding round and as such is a merit based application process.

Applications will be assessed on the ability to deliver tangible outcomes for the development or enhancement of tyre-derived products in Australia based upon assessment of the following project elements:

What – Project Description (20%). Describe the project, what research and development is involved, how developed is the methodology?

Who – About the organisations involved (20%). TSA encourages applications from partnerships that include research bodies, industry, government and potential end users. Describe the organisations involved, have you worked together in the past, what is your relationship? What is your organisations’ capacity to deliver the project?

Why – The need for the project (30%). Why do you need to conduct this project? How will the project deliver outcomes for TSA and the industry? What new or improved tyre-derived products will be developed and how might these be applied? What is the size of the potential market?

How – The project plan (30%). How will you implement the project? How will you ensure the project remains outcomes focused? How will you ensure long-term commercial success for the project?

Other criteria – Is there a likely payback for the project? How will this be achieved and to what level could TSA recoup its contribution if commercialisation is realised? How much will your project develop the market more broadly?

8. APPLICATION PROCESS

The market for research into applications for tyre-derived products has not been fully scoped. Therefore, round 1 of the fund is being undertaken as a two stages process:

1. First a call for Expressions of Interest (EOI) are made (this application)

2. This will be followed by an invitation to a shortlist of EOI applicants to submit full funding applications.

This approach is designed to give TSA the information it needs to shortlist potential projects whilst minimising the administrative burden of applicants who may not make it past the EOI stage.

9. ASSESSMENT PROCESS

In line with the TSA Guidelines, the TSA Board will engage a Research Advisory Committee (RAC) to assess project proposals at both stages of the process and make recommendations for prioritised funding.

The Research Advisory Committee is an advisory body specifically convened to provide additional support and technical expertise to the TSA Board on matters of research and development funding. It should be noted that whilst the RAC will provide recommendations and advice, it is the sole responsibility of the TSA Board to make final decisions regarding project funding.

All assessments by the RAC will be made using a weighted scoring system, with additional commentary for clarity and/or feedback. The RAC reserves the right to ask for supplementary information from any applicant.

EOIs will undergo a detailed review by the RAC, who will then provide advice to the TSA Board. Shortlisted proponents are then invited to submit full proposals.

Full proposals will undergo a detailed review by the RAC, with advice then provided to the TSA Board on the decision for funding. Each full proposal will be assessed against the merit criteria provided in the proforma assessment sheet for Full Proposals.

VALUE FOR MONEY

TSA is seeking projects that offer high value for contributions to the total cost of the project.

Notwithstanding this, a minimum 1:1 funding criterion is required for all projects, noting that value for money is an assessment criterion.

Participants’ contribution to the total cost of a project can comprise cash and/or in-kind components. The total contribution of the participant’s contribution cannot be in kind. That is, there must be some cash contribution from the applicant.

Those projects that have a higher component of cash to in kind ratio will be looked upon more favourably in the value for money section of the assessment process and therefore have more of a likelihood of success.

MANAGING CONFLICT OF INTEREST Any conflict of interest that arises in respect of TSA’s RAC or Board members will be managed carefully and appropriately to ensure that the relevant member(s) is not included in an application’s assessment or selection process.

Once finalised, details of RAC membership will be available on request and provided on the TSA website. Proponents will be given the opportunity to request that individual RAC members not assess their applications on the grounds of potential conflict of interest, if such a conflict can be reasonably justified.

THE EOI AND FULL SUBMISSION DOCUMENTS

This funding round is being undertaken in two stages – a call for Expressions of Interest (EOI) followed by an invitation to shortlisted EOI applicants to submit full funding proposals.

EOIs are submitted using this EOI template. Full proposals are to be submitted by following the full proposal template, which is provided separately to shortlisted EOI applicants.

EOIs and Full Proposals must address ALL questions in the templates and all requested information must be supplied. A failure to do so will result in the proposal not being considered for TSA funding. When necessary, additional expert advice may be sought as part of TSA’s assessment process. Any external assessor will be required to sign a confidentiality agreement before information about an application is released.

SELECTION OF SUCCESSFUL PROPOSALS The TSA Board will consider proposals and, based on the merit criteria assessments and advice provided to it by the Research Advisory Committee, it will select those of highest merit that contribute to TSA’s research investment objectives and Round 1 priorities. The Board reserves the right to not select any proposals for funding if the standard is not considered high enough.

POST SELECTION FEEDBACK Unsuccessful applicants for funding may seek feedback from TSA management – but detailed scoring information will NOT be provided. TSA management will provide qualitative feedback on why a proposal was not successful using the assessment criteria described earlier. Unsuccessful applicants may re-submit their proposals in subsequent funding rounds.

CONFIDENTIALITYTSA treats all information that it receives confidentially.

10. KEY DATES

The following are the target dates but these are subject to change at the discretion of the TSA:

October 23: Round 1 launched with invitation for submission of Expressions of Interest (EOI) (ie. this document)

October 23 – December 16: Round 1 open period. TSA will engage with interested parties across Australia and provide support and guidance where appropriate.

5pm, Wednesday December 16, 2015: Closing date for receipt of EOIs January 2016: Assessment, ranking and recommendation to Board by RAC of the EOIs

February 2016: Applicants advised of EOI outcome

March 2016: Closing date for receipt of full applications from shortlisted EOI applicants

April 2016: Assessment by the RAC and selection by TSA’s Board – based on merit criteria rankings by the RAC and the advice of TSA management – of successful projects

Applications close 5pm Wednesday December 2015 TSA will provide applicants with updates about the progress of applications as much as possible, but is unable to provide a definite approval /announcement date.

We thank you for your co-operation and understanding on this and will endeavour to advise you if we expect any unforeseen delays.

11. ADDITIONAL INFORMATION

TSA recognises that this is a new fund with new objectives and it is our intent to work closely with potential applicants to provide adequate guidance. TSA is available to answer questions from applicants over the phone and by email during the preparation of EOIs and full proposals.

Where appropriate, TSA may be able to assist potential applicants in linking up with relevant industry partners and/or tyre recyclers.

If you have any queries regarding this process, please contact TSA:Email: [email protected]

Disclaimer: Information in this document is current as of October 2015. While all professional care has been taken in preparing this document, Tyre Stewardship Australia accepts no liability for loss or damages incurred as a result of reliance upon its content.

Application Form

Section 1 – Contact Information Fields marked (*) are mandatory

Part A: Lead Applicant Details

* Name of Applicant:      

* Main Street Address:      

* Town / Suburb:       * Postcode:       * State:      

Postal Address (if different from above):

Postal Address:      

Town / Suburb:       Postcode:      State:      

Authorised person (This is the person who is authorised to make the application on behalf of the Applicant)

* Title:       * First name:      

* Last name:       Position:      

* Telephone:       Mobile:      

Fax:       Email:      

* Type of Applicant

Type of entity: Company Incorporated Association Co-operative Trust (if so, name of applicant above must specify both the name of the trust and the trustee company) Partnership Individual

Type of business: Commercial/for profit business Local Government Other Government Not for profit organisation Tertiary education institution Other (please specify)      

Applicant’s Australian Business Number (ABN) and Australian Company Number (ACN)

ABN:       ACN:      

Please note that where an applicant is not a registered company, only an ABN is required

Applicant’s Incorporation Number, if you have one:      

Part B: Contact Details for Project ManagerTitle:       First name:      

Last name:      

Postal address:      

Town / Suburb:       Postcode:       State:      

Telephone:       Mobile:      

Fax:       Email:      

Part C: Partner Organisations

List industry / research / government / other project partners in the table below:

Name of organisation Outline their role in the project Contact name and email

The Research Advisory Committee requires Partner Organisations to provide letters of commitment or support for the application outlining their involvement in the project and the importance of the research to organisational objectives.

Section 2 – Project Overview* Project name We will use this name on all correspondence. Please use 10 words or less.

     

* Project summaryPlease provide a short synopsis of the project in no more than 3 paragraphs.

This project will (provide three key outcomes):

* Where will your project be located?

Please provide the address of where most of your planned activity will take place including town / suburb and postcode.

Address:      

* What are your project timelines?

How long will it take to complete the project? * Anticipated project start date:      

* Anticipated project completion date:      

Section 3 – Project Details

This section allows you to provide details about your project and what it aims to achieve. You should consider the objectives of TSA funding as outlined above when developing your project.

What are you going to do? (20% weighting)

Describe the project, what it involves and what it aims to achieve (750-word limit – note you may attach supplementary information above this word count but excessive additional information will not be considered by the Research Advisory Committee)

What are the anticipated benefits of the project and how might these be quantified? (E.g. TDP consumed, new products created, new market, jobs, exports etc).

What knowledge, research and other evidence is already available in this area and how are you leveraging from it? (previous research, existing markets or products)

Will any intellectual property will be developed as part of the project?

What resources (eg human resources, laboratories, equipment) will be required and where will these resources come from?

Who will be involved in the project and what is their capability and capacity to ensure success? (20% weighting)

Describe your organization

Describe your team’s ability to deliver the project: both capability (skills) and capacity (resources)

Who are your project partners and stakeholders? What is their contribution to the project? Demonstrate their commitment to the project and how they will add value.

Provide relevant examples of similar projects that you and/or your team have delivered.

Why is this project important and why should it happen now? (30% weighting)

Why is this project necessary, what problem is it looking to address or opportunity will it realise? If possible describe this in terms of any market failures/opportunities and how they may be addressed by the project.

What will be the impact of the project on the market for tyre-derived products (i.e. How will this open new opportunity for tyre recyclers and their products)?

What is the size of the potential market/opportunity and can this be quantified (at least indicatively) (for example for road surfacing projects this may be Xkm roads x Ythickness x Z% of crumb rubber per annum or a new product may consume X tons per year of TDP)

How does the project demonstrate good value for money?

What will be the outputs of the project (ie a specification, research reports, journal articles, a new product etc)

How will the economics of the project be tested and developed? TSA believes strongly that projects must show an understanding of the economics of the current market for tyre-derived products. We would encourage some level of financial / economic skills to be included in the project team as commercial viability of products is a key success factor.

How will the project be implemented and evaluated? (30% weighting)Please provide an implementation plan and timeline (either below [delete if table not required] or attach)

Activity Start date

End date

Output or Outcome Budget

What steps will be taken to ensure the project is delivered on time and on budget?

What experience does the project manager have in delivering similar projects?

How will the project be evaluated and what gateways will be used along the way to ensure the project has ongoing relevance and viability?

Project BudgetPlease provide an indication of income and expenditure for your project, excluding GST. Note that the total income must equal total expenditure.Please include in-kind and co-contributions that are relevant to the project budget and the amount of funding sought from TSA – use attachments if a project budget already exists.

Project Income Project Expenditure (please detail in-kind vs cash)

Amount Requested from TSA $      Project Management incl. salaries $     

Your cash contribution $      Please detail other costs: $     

Your in-kind contribution $      $     

Other contributions $      $     

TOTAL INCOME $      TOTAL EXPENDITURE $     

Section 5 – Insurance and checklistAll applicants must answer section 5. Please enter the details of insurances held. Certificates of Currency will need to be provided if your grant application is successful. This need only be provided for the lead project partner, not all project partners.

Name of insurance company

Insurance type Public Liability

Policy number/s

Expiry dates

Policy amount

Name of insurance company

Insurance type Professional Indemnity

Policy number/s

Expiry dates

Policy amount

Ethical conduct statementI/We confirm that the project will be delivered in line with relevant standards and legislation (such as occupational health and safety requirements, workplace relations requirements etc).

Yes

No

Conflict of Interest(Conflict of Interest means any matter, circumstance, interest or activity affecting the applicant or it’s Related Persons which may or may appear to impair the ability of the applicant to undertake the Project diligently and independently, or perform its obligations under any funding agreement with TSA in relation to the Project.)

No current or potential conflict of interest exists

We disclose the following conflict/s of interest and indicate below how we propose to manage it/them.

Details:      

Checklist:

Please ensure all boxes are checked and relevant information is attached before sending your application.

My organisation is eligible to submit an Application.

I have read the guidelines carefully and my project addresses the priorities established in the guidelines.

I have completed all questions and addressed all criteria set out in the questions.

I have attached all relevant documents

The Declaration is signed by the officer authorised to make this application on behalf of my organisation.

Declaration(This page is to be printed, signed, scanned and returned with the email submission)

I state that:

The information in this application and attachments is to the best of my knowledge true and correct and agree to the application conditions. I will notify TSA of any changes to this information and any circumstances that may affect this application.

I acknowledge that TSA may refer this application to external experts or other Government Departments for assessment, reporting, advice, comment or for discussions.

* Signature: * Date:

* Print name: * Position:

This application, including attachments, must be submitted via email, with ‘Projects Stream’ in the subject line, to: [email protected]