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Registration form Form A

The STEAMhouse programme of support is provided by the Birmingham City University (BCU), to assist SMEs (small and medium sized enterprises, including micro businesses and sole traders) through the early stages of developing a new product or process. STEAMhouse is a partnership between Birmingham City University and Eastside Projects, supported by the European Regional Development Fund 2014-2020 programme (ERDF) and Arts Council England Creative Local Growth Fund.  

STEAMhouse is bound by State Aid and public funding rules, regulations and eligibility criteria. It is a condition of your participation in the STEAMhouse project that you agree to comply with requests to provide evidence of eligibility for the support, confirmation of support received and evidence of the impact of the support following completion. This will include a requirement for us to collect some data to measure the impact of the support on your business, which is based on changes in turnover, profitability, balance sheet value and number of employees.

Please read the prospectus – particularly pages 7 to 10 to find out more about

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the programme routes. Mark an ‘x’ in the box/es that most interest you.

STEAMlab Challenge RouteProduction SpaceSTEAMlab for businessGames@STEAMhouse

Please return your completed form to STEAMhouse@bcu.ac.uk by the end of the month!

Registration No:STEAMhouse/     (completed by STEAMhouse staff)

Your Ref (Optional):      

Registration undertaken by:       Registration Date:      

Section 1: Beneficiary DetailsEnterprise Name: Contact Name:

Trading Address:

Position: Nature of Business:Contact Number:Email:

Postcode: Website:

Section 2: Enterprise DetailsFor Sole Traders or Partnerships: For companies registered at

Companies House:HMRC UTR tax reference:

Company Registration number:

Vat Registration No:

Vat Registration No:

Number of Employees (FTE’s)

Number of Employees (FTEs)

Annual turnover (Please record even if NIL)

Annual turnover (Please record even if NIL)

How long has the enterprise been Trading?url for e:commerce website (if online trading)Do you trade from your address in

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Section 1?

Section 3: Eligibility Information1. Does the company have fewer than 250 employees? Yes

☐ No☐

2. Does the company have either an annual turnover not exceeding €50m (£43,090,000) or a balance sheet not exceeding €43m (£37,057,400).

Yes☐

No☐

Office use: Eligibility checks

Qualification as an SME for this project? Yes☐

No☐

Categorisation of RegionCategorisation of region?

More Developed☐

Transitional☐

GBS LEP Area?

Birmingham☐

Solihull☐

North Worcs☐

South Staffs☐

Smart spec?

Adv manfg☐

Health/ Life S☐

Digital/ Creative

☐

Low carbon☐

Section 4: How did you hear about STEAMhouse? (please mark all that apply)Other ERDF project – indicate which ☐

STEAMhouse website ☐

STEAMhouse Twitter ☐

STEAMhouse brochure ☐

STEAMhouse stand at event – which? ☐

Other University contact – who? ☐

Business or professional adviser – who? ☐

Gov.uk national helpline ☐

Internet search ☐

Word of Mouth ☐ Other (Please provide details) ☐

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Section 5: Nature of engagementPlease add detail here as to the nature of the engagement. E.g., STEAMlab Challenge workshop, Product or innovation idea, and the main aims and objectives sought.

Section 6: Agreed scope of supportScope of support to be provided via 12 hour assist to include a range of options including Product Route (includes IP advice, action planning, and technical support), Challenge Route (includes business support, IP advice, action planning, and technical support) Open Route (includes membership access to prototyping facilities), Grants, and Research Collaborations, as agreed with STEAMhouse advisor (to be completed by STEAMhouse Advisor):

Section 7: State Aid

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You are being offered assistance under the European General Block Exemption Regulations (GBER 28 section 2c: Innovation advisory and support services). Under World Trade Organisation agreements and European regulations, any assistance from the public sector towards trading operations must be strictly controlled and fall within agreed limits. The information provided in this declaration will help you to decide the activities to be included as part of the declaration.GBER harmonises the rules which previously existed across five separate EU Regulations, and enlarges the categories of State Aid covered by the exemption. The GBER sets out categories of state aid that have been declared compatible by the European Commission. GBER simplifies the procedures for aid granting authorities and allows a range of measures with horizontal objectives considered to be in the common interest. Member states are required to keep detailed records of aid schemes operating under GBER for 10 years from the date of granting each aid. The General Block Exemption makes certain types of aid lawful, without them having to be notified in advance to the Commission.To confirm that you are able to receive this assistance you must declare the full amount of aid, from any public source, and in any format, you have already received over the last 3 financial years. You must also declare under which exemption this was awarded. Please be explicit in your explanation of what the aid you received has been used for.The following is not a comprehensive list of the possible forms of aid. However it should give an indication of the most common forms of aid, which you may have been given over the past three years. Potentially any assistance from a public body might be an aid. Should you have any doubts on this matter, please contact the body from which the assistance was received. Grants from public bodies Loans from public bodies at favourable

rates Loan guarantees from public bodies Differential tax benefits Grants from an investment trust

(including charities) which may themselves have received the funds from a public body

Investment from a part publicly funded venture capital fund

Publicly administered funds, even if the funds were originally not public such as the National Lottery

Landfill tax Waiving or deferral of fees or interest

normally due to a public body such as the waiving or deferral of rent or waiver of interest normally due on late payment of taxation or other costs to a public body

Monopoly licences or guarantees of market share

Advertising via a public channel such as a tourist board or state owned television

Consultancy advice provided either free or at a reduced rate

Training provided either free or at a reduced rate

Aid for investment in environmental projects

Provision of a free or reduced rate feasibility study for research and development or other assistance with research and development

Purchase of public land or property at a less than market rate

Benefiting from the provision of infrastructure where your organisation was pre-identified as a beneficiary

These types of aid may have been provided under De Minimis (as De Minimis aid) or under another State Aid regulation. If you are in any doubt which regulation aid was received or about its value, check with the providing organisation. If they are unable to say or there is any uncertainty, assume that it was De Minimis aid unless its value exceeded €200,000 (£172,360), in which case it cannot have been.

I declare that the amount of State Aid received by the

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company/organisation over the last three years is:

Fiscal Year and date aid was

grantedValue of the aid in Euros

From which organisation and

which scheme

What activity or item was the aid

given for

Section 8: Signatures (Beneficiary to mark each box to acknowledge each statement)1. The signatory on behalf of the Beneficiary confirms that he/she is authorised to sign on behalf

of the Beneficiary and understands that the assistance to be provided constitutes State Aid notified under GBER Article 28. The notional value of the State Aid to be provided through the work described in Section 7 ‘Agreed scope of support’ and provided through STEAMhouse is calculated to be £2,384 (€2766.00) for workshops, and £12,504 (€14,509) for open route facilities. The Beneficiary acknowledges that if they are found not to meet the eligibility requirements, the Beneficiary may become liable to repay the full price that would otherwise be payable in respect of the services received. ☐

2. I confirm that the Beneficiary would be unable to carry out the work described in Section 7 without the assistance of the STEAMhouse project. ☐

3. I confirm that the Beneficiary wishes to receive assistance through the STEAMhouse project and accepts the STEAMhouse terms and conditions, and that the Beneficiary is aware that this support is part funded by the European Regional Development Fund. ☐

4. Do you consider that participation in STEAMhouse activities will add value / additionality to the development of your product or service? Yes ☐ No ☐

5. I confirm that the Beneficiary is not a business “in difficulty” as defined at 2.1 of the Community Guidelines and State Aid for Rescuing and Restructuring Firms in Difficulty (2004/C22/02) at the date of this declaration. ☐

6. Data Protection The information you provide on this application form (Information) will be available to the Delivery Partners and also Project and Finance staff at BCU involved in the management of the STEAMhouse project to enable the management of the Project; Department for Communities and Local Government (DCLG) and its auditors, and auditors appointed by the European Commission to audit the Project. The Project Manager and Delivery Partner will store and process information both in physical files and electronically to assist with project management, record keeping, auditing, statistical and research purposes. To facilitate on going communication, information may be shared with the following partner organisations: European Commission, DCLG, Arts Council England, Eastside Projects, and agents working on each organisation’s behalf. We will not pass this Information on to any other organisations or third parties. I confirm that the Beneficiary agrees that the Information may be used to identify and advise us of other opportunities where there is potential benefit to us e.g. other opportunities for collaboration with the Delivery Partners and also for project evaluation purposes and to participate in any evaluation exercise carried out by the funding agencies or external consultants. ☐

7. On occasion we will use photography and film to document and publicise STEAMhouse activities. Please tick if you are happy for your image to be used. ☐

Signed on Position Signed Print

Date

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behalf of the STEAMhouse Project

Signed on behalf of the Beneficiary

Position Signed Print Date

Terms & ConditionsDefinitions1. Assist duration - a period of minimum 12 hours, and shall exclude any travelling time.

For the Open Route it assumes one year in the facility.2. Advisor – the representative of the Delivery Partner selected to assist the Beneficiary.3. Grants – up to the value of £2,500 (€2,900) for capital expenditure for prototyping £1,500

(€1,740) and business support £1,000 (€1,160). 4. Routes: Product Route (product development workshops), Challenge (challenge event

workshops), and Open Route (prototyping facilities)5. Beneficiary – means the SME applicant identified in Section 1 of this form6. Project Manager –BCU acts as Project Manager for the STEAMhouse Project7. Delivery Partner – Eastside Projects allocated by the STEAMhouse Project to assist the

Beneficiary for the Open Route 8. STEAMhouse Assist – concept diagnostic work, advice, learning, research

cooperations, financing, recommendations and any further support provided to the Beneficiary by the Delivery Partner through the STEAMhouse Project. Includes a diagnostic of the innovation concept, recommendations for business and/or prototype development, and a summary of any further work by the Advisor

9. ERDF - means European Regional Development Fund10. SME - Small to Medium Enterprise - Enterprises qualify as micro, small, and medium-

sized enterprises if they fulfil the criteria set by the European Commission, which are summarized in the table below. In addition to the staff headcount ceiling, an enterprise qualifies as an SME if it meets either the turnover ceiling or the balance sheet ceiling, but not necessarily both.

Enterprise Category

Headcount

Turnovero Balance

Sheet Total

Medium-sized < 250≤ € 50 million≤ £43,090,000

≤ € 43 million≤ £37,057,400

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Small < 50≤ € 10 million≤ £8,618,000

≤ € 10 million≤ £ 8,618,000

Micro < 10≤ € 2 million≤ £1,723,600

≤ € 2 million≤ £ 1,723,600

11. State Aid - A subsidy (also known as a subvention) is a form of financial assistance paid to a business or economic sector by government or any other public source.

12. Data Protection - The STEAMhouse Project complies with the requirements of the Data Protection Acts as amended. The Project Manager and Delivery Partner will store and process information both in physical files and electronically to assist with record keeping, statistical and research purposes. To facilitate on going communication, information may be shared with the following partner organisations: European Commission, DCLG, Arts Council England, Eastside Projects, and agents working on each organisation’s behalf.

13. State aid - The STEAMhouse Project is part-funded by the ERDF and as a result we are obliged to notify you that the support you are being offered falls under what is technically known as Article 28 of the General Block Exemption Regulations (GBER) and that it has a nominal value of £2,384 (€2,766) for workshops, and £12,504 (€14,509) for open route annual membership. Under the GBER regulations you are legally obliged to provide the Project Manager with details of any State Aid, (including De Minimis or other exempt aid) you have received in this and the previous 2 fiscal years to enable the Project Manager to assess your eligibility for STEAMhouse Project support.

14. Limitation of liability - The Project Manager and Delivery Partner will not be liable to the Beneficiary under any circumstances for any loss, damage, liability or proceeding arising out of any project advice or services provided through the STEAMhouse Project.

PRIVATE & CONFIDENTIAL - EQUAL OPPORTUNITIES MONITORING FORM

Birmingham City University is committed to promoting Equal Opportunities. By completing all sections of this form you will help us to monitor the effectiveness of our process.

First Name(s): Surname:

1. Please tick here if you do not wish to complete this section.

2. Are you: Male Female Prefer not to state (Please tick)

3. Age: 16-24 25-29 30- 34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Prefer not to say

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4. From which of the following ethnic/racial groups do you feel that you or your family originate?

White:White BritishWhite IrishOther White Background (Please specify) ………………………………………

Black or Black BritishBlack or Black British – CaribbeanBlack or Black British – AfricanOther Black background (Please specify) ………………………………………

Asian or Asian BritishAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - BangladeshiChineseOther Asian background (Please specify) ………………………………………

Mixed:Mixed - White and Black CaribbeanMixed - White and Black AfricanMixed - White and AsianOther Mixed background (Please specify) …………………………………

Other:

Other Ethnic background (Please specify) Not knownInformation refused

4. What is your Nationality? …………………………………………………...

THE DISABILITY DISCRIMINATION ACT 1995

The Disability Discrimination Act 1995 defines disability to include those who currently have a disability and those who have had a disability in the past. This can include a physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities. Long term is taken to mean lasting for a period greater than 12 months. You may if you wish, supply further details relating to your disability, which may help Birmingham City University to provide adequate support for your needs.

Please complete the questions below.

1. Under the definition within the Disability Discrimination Act 1995, which type of disability do or did you have? (Please tick as appropriate).

Blind/Partially Sighted Deaf/Hearing Impairment Wheelchair Use

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Other Mobility Problems Mental Health Difficulties Dyslexia

Unseen Disability (i.e. diabetes, epilepsy)

Two or More Disabilities – Please specify: ………………………………………………………………………

………………………………………………………………………………………………………………………………………………………

2. Do you need any equipment or support because of your disability in order to carry out the duties described in the job description for this post? (Please tick as appropriate).

Yes No

If yes, please specify: …………………………………………………………………………………………………………………

…………………………………………………………………………………………………………

3. Do you need any special consideration for access? (Please tick as appropriate).

Yes No

If yes, please specify: ………………………………………………………………………………………………………………..

…………………………………………………………………………………………

Please return your form to STEAMhouse@bcu.ac.uk by the end of the month!

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