Ref no:
Please type in black in font 12, in black ink.
Project title:
SECTION I: BUSINESS DETAILS
1. BUSINESS DETAILS
Business name:
Full address:
Postcode:
Contact number:
(O)
(M)
Fax number:
Email address:
Website:
2. CONTACT DETAILS
Contact person’s name:
Full address:
Postcode:
Phone number:
(O)
(M)
Fax number:
Email address:
3. BUSINESS NATURE
Please describe the nature of your business (Maximum 100 words):ease describe the nature of
your business (maximum 100 words):
4. PRINCIPAL BUSINESS ACTIVITIES
Page 1 of 15
Which of the following are the principal business activities of your business?
System Integrator

Telecommunication Service Provider

Software Developer

Mobile Content Service Provider

Hardware Designer

Internet service reseller

Information and Computer Security
Service Provider
Website design and development
Service Provider

Distributor or reseller of IT software and
hardware


Internet based business

ICT Consultancy Service Provider

Multimedia and Animation content

ICT Training Service Provider


Other

Internet Service Provider (ISP)
If you ticked ‘Other’, please give details (in no more than 20 words):
5. BUSINESS TYPE
Tick one of the boxes below to describe your business status:
Sole Proprietorship

Limited Company

Firm/Partnership

Other

If you ticked ‘Other’ please describe (in no more than 10 words) your type of organization:
What year was your business registered/
incorporated?
Is your business incorporated in Brunei Darussalam
under the Companies Act [Cap. 39] or registered in
Brunei Darussalam under the Business Names Act
[Cap. 92]?
Yes

No

No

If yes, what is your incorporation/business
registration number?
6. AITI ACCREDITED BUSINESS (AAB) STATUS
Do you have AITI Accredited Business (AAB) status?
If yes, please state the date of issue of the AAB
certificate.
Page 2 of 15
Yes

7. ICT WINNING AWARD
Are you a winner of any recognized ICT-related
competitions?
Yes

No

If you are a limited company, are at least fifty per
cent (50%) of the shares in the company owned by
citizen(s) of Brunei Darussalam and/or permanent
resident(s) of Brunei Darussalam?
Yes

No

If you are a firm, are at least fifty per cent (50%) of
the registered partners in the business citizens of
Brunei Darussalam and/or permanent resident(s) of
Brunei Darussalam?
Yes

No

If yes, please state the name and year of competition.
8. LOCAL OWNERSHIP
9. IT SKILLED WORKFORCE
How many IT skilled work force (excluding administrative personnel) are you currently
employing on a full time basis and what qualifications and experience do they possess?
No
Name
Designation
Highest
Qualification
Experience
1
2
...
What percentage of your IT skilled work force (excluding administrative personnel) are citizens
of Brunei Darussalam and/or permanent residents of Brunei Darussalam?
Page 3 of 15
10. PROJECT TEAM
Kindly list out the names and I.C. numbers of the Project Team and the key staff for the Project
including their role in this Project? Kindly outline the Project Team’s professional experience
and any training the team members have that might be relevant to the Project, and describe the
degree of responsibility held by the individual team members on previous projects (please give
dates and locations):
No
Name
IC
Number
Role in project
Description of
professional
experience
and/or training
relevant to
proposed project
Description of
degree of
responsibility on
previous projects
including date
and locations
1
2
...
11. INCOME & EXPENDITURE
What was your business’ total local and foreign sales and net expenditure in the last three
years? (If you have not been operational for three (3) years kindly complete the years that you
have been operational for):
2010
Total Local Sales
Total Export Sales
Total Operational Expenditure
Page 4 of 15
2011
2012
SECTION II: THE PROJECT
12. TYPE OF GRANT APPLIED
What is/are the type(s) of GRANT that you are applying for and the amount of GRANT that you
are seeking?
Type of GRANT
Enhancement
Ownership
Marketing
Amount of GRANT Requested (B$)



13. PROJECT PROPOSAL
What are your Project expected start and
end dates: [Please see note (x) at page 14
Start date:
End date:
of this application form]
Please give us a brief description of the Project you are asking us to fund, and specify what is
the end product of the Project (e.g. software, hardware) and likely delivery timeframe
(Maximum 200 words):
Page 5 of 15
14. PRODUCT DEVELOPMENT OR PROTOTYPE
Please describe how your product or prototype have been developed earlier, the duration to
develop, and how the product or prototype is proven working (Maximum 200 words):
15. PLACE OF PROJECT BEING CARRIED OUT
Kindly inform us of the address and post code where the Project will be carried out in Brunei
Darussalam. If elements of the Project will take place abroad or components or expertise will be
utilised from abroad or part(s) of the Project are to be sub-contracted out, kindly provide full
details of the same:
16. TRAINING PROGRAM & TRANSFER OF KNOWLEDGE PLAN
Please describe how your Project will advance technology and Research and Development
(R&D) relating to the ICT industry in Brunei Darussalam, including the aims and objectives of
your Project (Maximum 300 words) and what training program you have in place to transfer
knowledge to Brunei citizens and/or permanent residents of Brunei Darussalam employed by
you:
Page 6 of 15
17. PRODUCT FOCUS
Please tick which of the following will your Project focuses on:
RFID solutions
Animation / Content Application
Communications Applications



Software Enhancement
Hardware Enhancement
Other



If you ticked ‘Other’ please describe (in no more than 30 words) the focus of your Project:
18. ‘BRUNEI-MADE’ ELEMENT
Please state what is the ‘Brunei-Made’ element and the estimated percentage of the ‘Bruneimade’ component [Brunei-Made is defined as products and/or solutions and/or applications
that are made, developed, created and/or assembled in Brunei by citizen(s) of Brunei
Darussalam and/or permanent resident(s) of Brunei Darussalam] of your Project:
Page 7 of 15
If any form part of the product or processes has been or shall be developed / created / complied
partially or fully by any party who is not a citizen of Brunei Darussalam and/or permanent
resident of Brunei Darussalam and / or by a party who is not the applicant, kindly provide full
details of that person / firm’s / company’s name and role in the project and in his / their role in
the development / creation / compilation of the product or processes:
19. RISK IDENTIFICATION & MANAGEMENT PLAN
Please describe what experience you have in managing similar projects, setting out the stage
which such projects have reached, whether the aims and objectives of the projects were
successfully obtained, what awards and recognition have been achieved by your business for
that project or within the last five (5) years (if any) and how you intend to manage this Project.
You should include risk identification and management plan of this Project (Maximum 200
words):
Page 8 of 15
20. TRACK RECORD
Kindly list out any projects that you have performed over the last five (5) years including on-going
projects:
Project Name
Project duration
(including date of completion)
Cost of Project
1.
2.
3.
4.
5.
21. PROJECT TARGET AUDIENCE/MARKET
Please identify your target market/audience (industries/sectors/sub-sectors/geography) that
you are seeking to reach and how you will do this, state the market size and growth opportunity
for the identified market/audience, any market research that you have conducted and how you
will market and promote the project (Maximum 200 words):
22. MEASURE OF SUCCESS
Please include details of how you will measure the success of your Project at all stages of its
progress and each of the milestone achieved (Maximum 300 words):
Page 9 of 15
SECTION III: FORECASTED FINANCIAL STATEMENT
23. PROJECT EXPENDITURE
Please provide a detailed estimated funding for each milestone of your Project as mentioned in
Box twenty (22) above and for the duration up to eighteen (18) months only using the format
provided in Annex 1 that can be downloaded from www.aiti.gov.bn/AITIGRANT
24. PROJECT COMMERCIALITY
Kindly provide detailed forecasted profit/revenue of the Project for a period of three (3) years
after completion of the Project.
Items
Year 1
Year 2
Year 3
B$
B$
B$
Forecasted Profit/Revenue (please provide detailed
breakdown on a separate sheet)
SECTION IV: OTHER TYPES OF FUNDING/LOANS RECEIVED
25. FUNDING/LOANS RECEIVED
Have you received funding or grants or loans in the last three
(3) years from AITI or any other organization/ body/
corporation?
If yes, kindly provide full details including the amount:
Page 10 of 15
Yes

No

SECTION V: DEBTS AND LIABILITIES
26. LEGAL/BANKRUPTCY/WINDING-UP PROCEESINGS
Have you received a letter of demand before action or had any
legal proceedings commenced against you or bankruptcy
proceedings or winding-up proceedings issued against you
within the last two (2) years?
Yes

No

No

If yes, kindly provide full details:
Have you received a letter of demand before action or had any
legal proceedings commenced against you or bankruptcy
proceedings or winding-up proceedings issued against you
within the last six (6) years?
If yes, kindly provide full details:
Page 11 of 15
Yes

SECTION VI: STATEMENT BY APPLICANT
SOLE PROPRIETOR
I hereby confirm that, as far as I know, the information in this application is true and correct.
Your signature:
Name: (Use CAPITAL letters)
Date:
FIRM/PARTNERSHIP
I hereby confirm that, I am duly authorised by all the registered owners of the firm to sign this
application on their behalf and that of the firm, and as far as I know, the information in this
application is true and correct.
Your signature:
(Please also apply company
seal/chop)
Name: (Use CAPITAL letters)
Date:
LIMITED COMPANY
I confirm that the company named on this application has given me the authority to sign this
application on their behalf. I confirm that the activity in the application falls within the powers of
the Company’s Memorandum of Association. I confirm that, as far as I know, the information in
this application is true and correct.
Your signature:
(Please also apply company
seal/chop)
Name: (Use CAPITAL letters)
Position:
Date:
Page 12 of 15
CHECKLIST
Prior to sending in your form kindly check that:
You have filled in all relevant questions in the application form.

If you are a sole proprietor or firm that you have enclosed a certified true copy of your
latest Business Registration Certificate (Section 16 & 17 of the Business Names Act).

If you are a limited company that you have enclosed certified true copy of your Certificate
of Incorporation, latest Annual Return, Form X and List of Directors and Memorandum of
Association.

If you are a sole proprietor or partnership that you have enclosed a copy of your latest
Management accounts.

If you are a limited company, that you have enclosed a certified true copy of your latest
audited accounts and a copy of the Form of Annual Return of a Company Having Share
Capital (Companies Act, Fifth Schedule).

You have enclosed a detailed project proposal and a product or solution business plan.

You have submitted soft copies of the application form, project proposal and business plan
online via email to farihah.said@aiti.gov.bn with the subject titled ‘GRANT APPLICATION
2013/2014’.

Notes:
i.
Applicants are strongly advised to read the GRANT for development of local ICT & Digital
Media industries Manual carefully to ensure that they are eligible to apply for this GRANT
and that they have complied with and understand the basis upon which this GRANT will be
awarded.
ii.
All applications must be delivered by hand in a sealed envelope marked ‘GRANT
APPLICATION 2014/2015’ and be delivered to the:
Authority for Info-communications Technology Industry
Block B-14, Simpang 32-5, Kg Anggerek Desa
Jalan Berakas BB 3713
Bandar Seri Begawan
Brunei Darussalam
iii.
All applications must also be submitted online via email to farihah.said@aiti.gov.bn with
the subject titled ‘GRANT APPLICATION 2014/2015’.
iv.
All applications for the GRANT must be submitted on or before the closing date as publicly
announced from time to time. Any application received after the closing date or which is
incomplete or not delivered by hand and via email may either be rejected or considered by
AITI in their ultimate discretion.
Page 13 of 15
v.
All decisions of AITI and/or the Evaluation and Approval Committee are final and are not
subject to appeal or review by the applicant.
vi.
If AITI requests for any further information from you, you must supply such information to
AITI by the date stated in the letter requesting such further information failing which the
application will not be considered.
vii.
All applicants are reminded that if there is any change in the information provided to AITI
under the GRANT (for example, change in personnel, change of ownership of the business
or any step or legal proceedings has been taken or threatened to sue/dissolve/wind-up or
bankruptcy proceedings against the applicant) you must inform AITI immediately.
viii.
All awards are subject to the applicant’s acceptance of the Acceptance Form and our
standard terms and conditions of contract (a copy of which is available upon request).
ix.
The term ‘permanent resident’ shall be deemed to also mean holders of Brunei Entry
Permits.
x.
That all Projects must be completed within the timeframe(s) stated in the duration column
of the ’classification of types of GRANT’ table set out in paragraph 4 of the GRANT Manual.
xi.
If there is insufficient space in any of the above boxes to complete your answers kindly
continue on a separate piece of paper and securely attach the paper to your application
form.
Page 14 of 15
ANNEX 1
PROJECT MILESTONES AND FUNDING BREAKDOWN
1
2
3
4
5
Expenses 1
Sub-expense
Sub-expense
Sub-expense
Sub-expense
Sub-expense
Expenses 2
Sub-expense
Sub-expense
Sub-expense
Expense 3
Sub-expense
Sub-expense
Sub-expense
Expense 4
Sub-expense
Sub-expense
Sub-expense
Expense 5
Sub-expense
Sub-expense
Sub-expense
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 15 of 15
Month-18
BND
Month-17
BND
MILESTONE
5 (NAME
OF
MILESTONE
)
Month-16
BND
Month-15
BND
Month-14
BND
MILESTONE
4 (NAME
OF
MILESTONE
)
Month-13
BND
Month-12
BND
Month-11
BND
MILESTONE
3 (NAME
OF
MILESTONE
)
Month-10
BND
Month-9
BND
Month-8
BND
MILESTONE
2 (NAME
OF
MILESTON
E)
Month-7
BND
Month-6
BND
Month-5
BND
MILESTONE
1 (NAME
OF
MILESTONE
)
Month-4
BND
Month-3
BND
% OF GRANT
REQUESTED MOBILIZATIO
OVER TOTAL
N
PROJECT COST
AITI GRANT
FUNDING
BND
Month-2
BND
% OF COST
TOTAL
OVER TOTAL SELF-FUNDING
PROJECT COST
PROJECT
BND
BND
COST
DESCRIPTION
Month-1
BND
The template below can be downloaded from www.aiti.gov.bn/AITIGRANT. Please read the instructions carefully prior to filling in the sheet.
MILESTONE
6 (NAME
OF
MILESTON
E)
E
N
D
O
F
P
R
O
J
E
C
T