EIF version 10 (July 2009)

• Please read the EIF Guidelines for Applicants For office use only
carefully before you complete this form.
• All information required in the application form must Date received
be given.
• Your application form must not be more than 15
pages excluding appendices. Reference

Project Officer

ALL INFORMATION PROVIDED IN THIS APPLICATION

WILL BE TREATED AS CONFIDENTIAL

Ministry of Science, Technology and Innovation (MOSTI)

Fund Section, Planning Division,
Level 3, Block C5, Complex C, Federal Government Administrative Centre
626621Putrajaya
 EIF version 10 (July 2009)

I am / we are currently:
Please mark (X) in appropriate box
Individual
Sole Proprietor
Micro Enterprise

Small Enterprise

PART 1: APPLICANT PARTICULARS

Section A: Individual

1.1 Applicant Name 1.2 IC No

*Please enclose CV

1.4 Designation
1.3 Occupation

1.6 Telephone No.

1.5 Address
Mobile:
House :
Postcode

1.7 Fax No. 1.8 Email Address

Section B: Sole Proprietor, Micro & Small Enterprise

1.1 Company Name 1.2 Company Registration Number

* Please enclose a copy of Certificate Of Registration

(Form D) or Certificate of Incorporation (Form 9)
1.3 Date of Incorporation
1.4 Company Address

1.5 Telephone No.

Postcode
Mobile :
Office : 1.6 Fax No.

1.7 Email Address

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 EIF version 10 (July 2009)

PART 2: BUSINESS DETAILS

(Note: For Micro and Small Enterprises only)

Section A: Capital Structure

2.1 Authorised Capital 2.2 Paid Up Capital

2.3 Structure of Shareholding

RM %
Bumiputera
Non-Bumiputera
Total
* Please enclose copies of Return of Allotment of Shares
(Form 24) and Memorandum and Articles of Association

Section B: Manpower Structure (Full Time Employees

Only)

No. of No. of Non-

2.4 Sector
Bumiputera Bumiputera
Total

1. Managerial
Technical &
2.
Supervisory
Support
3.
Staff
Total
* Please enclose copies of Form 49 and Latest EPF Statement

Section C: Company Turnover

2.5 Turnover (In your most recent annual accounts) 2.6 Balance Sheet (Total assets net of depreciation)

* Please provide copy of latest company’s audited accounts

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 EIF version 10 (July 2009)

PART 3: PROJECT DETAILS • Waste to Wealth

• Processing Technology
Type of Innovation
3.1
Please mark (X) in appropriate box • Engineering Development
• Environment
Recombination / Fusion / Integration of
technologies that lead to new products /
processes and services
Replication / Refinement of technologies
that improve quality or reduce the cost of
existing products / processes / services

Technology Cluster
3.3
Please mark (X) in appropriate box

Biotechnology
• Plant
• Animal
• Food
• Biopharmacy
• Molecular Biology
• Medical Biotechnology
• Industrial/Environmental
Biotechnology
ICT
• Information System
• ICT Infrastructure
• Software
• Emerging IT
• Communication
• Security System
• Signal Processing
• Database Technology
• ICT Application
Industry
• Advanced Materials
• Advanced Manufacturing
• Nanotechnology
• Alternative Energy

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 EIF version 10 (July 2009)

At the designing stage

At the development stage
Innovation Stage
3.2 Have a functional model or prototype
Please mark (X) in appropriate box
which needs some improvements
I / We currently: Have prototype for product testing
Have initial idea or concept

3.4 Project Overview

3.4.1 Project Title

3.4.2 Executive Summary

A brief description not more than 1 page which includes the following:-

i) Objectives
ii) Methodology
iii) Project Milestones
iv) Technology used
v) Output expected / Deliverables
vi) Total Project Cost

* Please attach full project proposal

3.4.3 Proposed Start Date:

3.4.4 Project Duration :

(max. 18 months for Small Enterprise; 12 months for Individual / Sole Proprietor & Micro Enterprise):

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 EIF version 10 (July 2009)

3.4.5 Eligible Project Funding

( Please detail out the cost for each component )
Component (where applicable) RM
Consumables / materials
• _________________________________
• _________________________________

Sub Total
Equipment (not more than 40% of total amount requested)
• _________________________________
• _________________________________

Sub Total
Expenditure for services (consultancy and testing)
• _________________________________
• _________________________________

Sub Total
Project documentation
• ____________________________
• ____________________________

Sub Total
Regulatory and standard compliance
• ____________________________
• ____________________________

Sub Total
Product testing (including samples, fees and documentation)
• ____________________________
• ____________________________

Sub Total
Grand Total

Note: The quantum and duration of funding approved under EIF will be based on the merits of each application as listed below:

Quantum Maximum Duration

Category
(Maximum) (Months)

Individual RM 50,000.00 12

Other RM 300,000.00 12

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 EIF version 10 (July 2009)

3.5 Innovation Aspects

Please elaborate on the following:

(a) How is your proposed product, service or process innovative?

(b) How does your proposed product / service / process improve value, enhance efficiency or reduce cost?
(c) Is there an existing IP for the proposed product, service or process?(Please attach results of IP search if any)

3.6 Commercial / Business Potential

3.6.1 For Micro and Small Enterprise

Please elaborate on the following:

(a) Market Size & Demand

(b) Market & Financial Risks
(c) Product Competitiveness (Quality, Pricing)
(d) Potential Revenue Generated
(e) Business / Commercialisation Plan (Financial projections, assumptions and projected cash flow)

3.6.2 For Individual / Sole Proprietor

Please elaborate on the following:

(a) Market Size & Demand

(b) Product Competitiveness (Quality, Pricing)
(c) Potential Revenue Generated

How do you plan to fund the portion of the project costs not funded under EIF?
3.7
Please provide evidence (e.g. bank statement, bank facility / OD)

Have you been awarded any Government grants or funds? If yes, please provide details and
3.8
amount of grant / fund awarded

(a) Project Title

(b) Name of Grant / Fund Received
(c) Funding Agency
(d) Amount Approved
(e) Duration Approved
(f) Status ( completed / on-going / terminated )

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 EIF version 10 (July 2009)

PART 4: REFEREE (For Individual Only)

4.1 Name 4.2 IC Number

4.3 Address 4.4 Mobile No.

Postcode
4.6 Occupation / Designation
4.5 Email Address

4.8 Office Telephone No.

4.7 Office Address

* Referee must be a Government officer from the Management and

Professional Group ( Grade 41 and above )

Postcode

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 EIF version 10 (July 2009)

PART 5: DECLARATION

5.1 Declaration

I hereby declare that the particulars furnished in this form including attachments are correct and true to the best of my
knowledge.

Name

I/C Number

Signature (Digital/Scanned)

Date

Please complete this application form and email to MOSTI via innofund@mosti.gov.my
or post the form ( in both hardcopy and softcopy) to the following address:

Innofund Secretariat
Fund Section, Planning Division,
Ministry of Science, Technology and Innovation
Level 3 Block C5, Complex C
Federal Government Administrative Centre
62662 PUTRAJAYA

MOSTI reserves the right to withdraw approval based on false information submitted by applicants.

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 EIF version 10 (July 2009)

APPLICATION CHECKLIST
(For Micro And Small Enterprises)

Please ensure that the relevant supporting documents are attached to the application form.
(Please tick [ √ ] in appropriate box)

1) Completed Application Form

2) Full project proposal which includes the following:

• Project Title
- Provide project title

• Project Objectives
- Describe the measurable objectives of the project

• Project Description
- Provide a detailed description of the project in terms of:

The technology to be used

The methodology that will be used

How you expect the project to achieve its goals

The innovativeness of the product, process or service that you propose to develop compared to the
technology currently available

The deliverables

Market opportunity

Immediate and long term benefits

• Project Milestones
- List the milestones and activities in the format provided below:

No Milestones Activities Completion Date

• Total Project Cost

- Provide the detailed costs involved in developing the project
- Include breakdowns for each component

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 EIF version 10 (July 2009)

• Total Amount Requested From EIF

- Provide the detailed costs for each component requested
- Attach quotation for the items to be purchased especially equipment

• Project Timeline
- Provide a Gantt Chart to show the implementation schedule of your proposed project

Month
No Activities 1 2 3 4 5 6
1
2
3
4

• Project Team
- Please provide full CVs of all personnel involved in the project: -

Name

Position

Qualification

Experience

Achievement

• Technology Benchmark
- Comparison between the proposed technology used with the existing or similar technologies
in the market.

• Project Risk
- Please identify and describe the technical risks in the project and how these risks will
be managed

3) Copy of Certification of Incorporation (Form 9)

4) Copy of Return of Allotment of Shares (Form 24)

5) Copy of Return Giving Particulars in Register of Directors, Managers and Secretaries and
Changes of Shares (Form 49)

6) Copy of Memorandum and Articles of Association

7) Company’s organization chart

8) Copy of Latest Company’s Audited Accounts

9) Copy of Latest EPF Statement

10) Soft copy of Application Form and Full Project proposal if submitted through post

11) Results of Intellectual Property Search (if Applicable)

12) Additional Supporting Documents (if Applicable)

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 EIF version 10 (July 2009)

APPLICATION CHECKLIST
(For Individual And Sole Proprietor)

Please ensure that the relevant supporting documents are attached to the application form.
(Please tick [ √ ] in appropriate box)

1) Completed Application Form

2) Full project proposal which includes:

• Project Title
- Provide project title

• Project Objectives
- Describe the measurable objectives of the project

• Project Description
- Provide a detailed description of the project in terms of:

The technology to be used

The methodology that will be used

How you expect the project to achieve its goals

The innovativeness of the product, process or service that you propose to develop compared to the
technology currently available

The deliverables

Market opportunity

Immediate and long term benefits

• Project Milestones
- List the milestones and activities in the format provided below:

No Milestones Activities Completion Date

• Total Project Cost

- Provide the detailed costs involved in developing the project
- Include breakdowns for each component
• Total Amount Requested From EIF

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 EIF version 10 (July 2009)

- Provide the detailed costs for each component requested

- Attach quotation for the items to be purchased especially equipment

• Project Timeline
- Provide a Gantt Chart to show the implementation schedule of your proposed project

Month
No Activities 1 2 3 4 5 6
1
2
3
4

• Project Team
- Please provide full CVs of all personnel involved in the project: -

Name

Position

Qualification

Experience

Achievement

• Technology Benchmark
- Comparison between the proposed technology used with the existing or similar
technologies in the market.

• Project Risk
- Please identify and describe the technical risks in the project and how these risks will
be managed

3) Copy of Certification of Registration (Form D) (for Sole Proprietor only)

4) Copy of Latest Account/Bank Statement

5) Soft copy of Application Form and Full Project proposal if submitted through post

6) Results of Intellectual Property Search (if Applicable)

7) Additional Supporting Documents (if Applicable)

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