EXPRESSION OF INTEREST FORM Invest to Grow Office Use Only Reference Number Invest to Grow Appraisal Officer Date EOI Received Date Assessment Completed Decision Name of Company Postal Address Post Code Legal Status (including Company Registration No. if applicable) Principal Activities Invest to Grow Office Use Only Appraiser’s Comments 1 of 5 Contact Details Name Position Telephone Number Mobile Fax Email Address Postal Address (If different from above) Post Code Number of Employees Worldwide Current Annual Turnover £ Date of last Accounts Name of Project Location of Project (Town/Village) Post Code Description of Project Describe in general terms the nature of the investment, its purpose and the benefits it will bring to the business in terms of capability (including with respect to R&D and innovation), markets, turnover, profitability and job creation. Describe any Planning Consents that you may require or have obtained. 2 of 5 Anticipated Start Date Anticipated Completion Date When do you expect to (DD/MM/YY) complete expenditure on your Project? Invest to Grow Office Use Only Appraiser’s Comments: Summary of Project Costs Description Costs Total Project Cost £ Will the project create new jobs that will be sustained for at least 3 years? Number of New Jobs Please delete as appropriate. YES / NO Describe how the project will create new jobs 3 of 5 Level of £ Funding How much funding do you think you need? What will it pay for? Need for RGF support The Invest to Grow programme is a combination of loan and grant funding and is a fund of last resort. Please outline why you need support. The Strategic Investment Panel which makes funding decisions will determine whether a company is offered a loan or grant, or a blend of both. The Fund is intended to be a recirculating finance scheme to ensure sustainability beyond the duration of Regional Growth Fund. Therefore applications for loans will be judged favourably compared to grants. Expression of Interest Eligibility checklist Is your project and the jobs to be created located in the East Midlands? Yes No Is the amount requested over £15,000 and is your overall project cost over £50,000? Yes No Have you secured the match funding required? Yes No Are you an SME? i.e. with less than 250 employees and with turnover of less than or equal to 50m Euro? Yes No Signature If completing electronically a name will suffice. Date Form Completed 4 of 5 Invest to Grow Office Use Only Appraiser’s Comments: Decision Date: We would like to share your application with University Colleagues and Partner Organisations to determine whether there is other support, aside from Invest to Grow funding, we could offer your company. Please tick here if you would prefer your information not to be shared. We will not disclose any financial or commercially sensitive information without your prior agreement. 5 of 5