NEIS (New Enterprise Incentive Scheme) - Application Form

Complete all sections of this application and submit it to your nearest NEIS office. This form is key to your acceptance to the program, and all required entries have to be filled in. If you feel you need help filling it in, contact us before submitting your application - an incomplete form may not be accepted.

Privacy: All information provided will be treated as strictly confidential and will not be passed on to other agencies without your written approval.

* Denotes Required Fields

Your First Name *

Your Surname *

Your Date of Birth *

Partner's Name (if applicable)

Partner's Date of Birth

Your Job Seekers ID or Centrelink Reference Number(if applicable)

Partner's Job Seekers ID or Centrelink Reference Number (if applicable)

Address *

Phone *

Mobile *

Email *

Designated Job Services Australia Provider(if applicable)

Are you an undischarged bankruptcy?

Summary of Business Idea *

Structure:

1. Why have you chosen this specific business? *

2. What research have you done so far, and what have you found out? *

3. How will your product/service be better, different, or meeting an unmet demand? *

4. Who will be your typical customer? What makes you say so? *

5. How do you plan to market your product/service? Please give specific examples. *

6. Where will you be based? How far will you, or your clients, travel? *

7. What equipment do you already own and what is its worth? *

Total Cost *

8. What do you still need to purchase for the business, and what does it cost? Will you need to borrow money? If you do, you must give us proof that you can obtain it. *

Total Cost *

9. Have you trialled the business in any way (e.g. selling your product or service)? *
Please provide details of the trials and the results (e.g. how much did you sell).

10. Provide an estimate (or a guess) of your financial expectations in your first year.

Sales Income (specify the type and quantity of units sold): *

Total Income *

Business Expenses (do not include personal expenses): *

Total Expense *

Other Income (e.g. a part time job - please specify): *

11. Have you operated your own business before or worked with someone that has? If so...

(a) what was it's nature

(b) is it still operating (and if it isn't, why did it cease)

(c) was government support obtained in establishing it?

12. Overall, what training, education, skills or experience do you (and your partner/s) have that could be used, directly or indirectly, in running the proposed business? *

13. Any further comments you would like to make to support your application? *

14. Has anyone helped you out with this form? If yes, who and why? *

Mission Australia makes available its NEIS consulting and advisory services on a gratuitous basis and on the understanding that neither Mission Australia, its management, staff or volunteers are responsible for any liability or loss resulting from any of their actions, recommendations or advice, or from any failure to take action, recommendations or give advice.

Mission Australia, its management, staff and volunteers hereby expressly disclaim all and any liability whatsoever, to the full extent allowed by law to any person, arising out of or connected in any way to the services provided by each and any of them, including any liability for negligence.