The London Technology Fund - Investment Proposal Outline Form

Investment proposal outline

Please fill out the form below as fully as possible as this will be the basis of our initial decision on your proposal.

Please take note of fields with a maximum character length stipulated: the form cannot be submitted with over-full fields or with empty mandatory fields. Note that character counts include spaces and punctuation. The text will turn red to let you know if you have exceeded the maximum character limit.

Fields marked in bold with an asterisk* are mandatory.

Please carefully check the figures that you have inputted, particularly in the 'Valuation' field. If you do not know your valuation, please enter a zero. All figures should be entered WITHOUT decimal points or commas.

We will send an acknowledgement email to the address supplied when we receive your proposal.

NB: Please be sure to read our privacy statement.

Section 1: personal information Title*:
First Name*:
Last Name*:
Phone*:
Fax*:
Mobile*:
E-Mail*:
Role/Job Title*:

« Are you a shareholder, director or employee of the Company or an adviser to the Company?

Your firm*:

Section 2: company information Has a company been formed?*:
Company Name*:
Address Line 1*:
Address Line 2*:
Address Line 3*:
Postcode*:
Borough Company based in*:

« Using your postcode, you can look up your borough here (note: we are not responsible for the content of this external site).

The London Technology Fund can only invest in SME companies that are headquartered or have a significant part of their business within the Greater London area. If you are not in London, you may find there are similar government funding schemes for early stage technology businesses in your area. Refer to the "Useful Links and Glossary" page on our main website.

Website*:
Registered Company Number*:
Number of Employees*:

Have you had any of the following?* (Tick for Yes)
Research & Development Grant (formerly SMART)
SFLG scheme loan
R&D Tax Credits
University Challenge funding
Business Angel funding
Public Sector Proof of Concept funding
Corporate Investment

Is the business affiliated with a university or government research establishment ?: *

Who is TTO contact ? : *
TTO E-Mail address ? : *
TTO Phone Number ? : *
Do you intend to sell your business in the next 5-7 years?*:

Institutional Shareholders*:

« Do you have any institutional shareholders (e.g. venture capital funds)?

How did you find out about the Fund?*:

Please specify*:

What is the name of your introducer?*:

Next accounting year end date (dd/mm/yyyy)?*

Start of Company Trading* (mm/yyyy): /

Is this the first time the company has applied to the Fund?*:

Section 3: funding requirements Total Funding Required* (£):

Have you recieved offers of debt funding? * (£):

Funding required from the Fund* (£):

«This is that part of the total package of funding you are seeking (as specified above) for which you are applying to the Fund.

Do you have other funding for all/part of the balance?*

Have you had any offer from private sector investors for the entire amount of the funding that you require?*

For what will you use your funding?* (500 chars):

Valuation* (£):

« What valuation would you place on your business today?

Section 4: about your business and market/industry sector Technology Sector* :

« These sectors explained.

Stage of Venture*:

« These stages explained.

Business Description* (500 chars):

« What do you/will you produce and how? Who buys/will buy your products and why? How do you market and sell? Why is your business and/or business model better than your competitors?

Recent History* (500 chars):

« The key events and activities in your business that have brought you to your current position.

Market* (500 chars):

« How is your industry sector structured and what are the key changes which have created the opportunity for your business?

Management Team Information* (500 chars):

« Tell us about the people who will be making this business a success.

If your management team is incomplete what are your recruitment plans?* (500 chars):

Product Features* (750 chars):

« What are the principal features of the goods and services you sell?

Are your products fully developed?*:

When will your products be ready?*:
How much will full development cost?*:

What is the status of your IPR*:

« For information on patents and other forms of IPR protection consult the UK patent office www.patent.gov.uk.

Competitive Advantages* (500 chars):

« What do your products have that competing products lack?

Customer Needs* (500 chars):

« What customer needs do your products satisfy and why are customers going to buy them?

Month Sales Start (mm/yyyy)*:

« The month in which you made/will make your first sale.

/

Breakeven Month (mm/yyyy)*:

« The first month in which the Company made/will make a profit.

Section 5: financial projections

Note: The model should assume that the funding required goes into the company 4 months after the date of application. All figures in the financial fields should be in pounds sterling (£). All fields are mandatory. No decimal points or commas are permitted. If the company has not previously traded then leave the "Last Year" and "Current Year" columns zeroed as appropriate.

All figures in the Profit and Loss section should be entered as positive.

Financial Projection Model
	Last year £ (actual)	Current year £ (actual year to date)	Current year £ (projected total)	Next year £ (projected total)	Year 2 £ (projected total)	Year 3 £ (projected total)	Year 4 £ (projected total)	Year 5 £ (projected total)
Profit and Loss
Sales
Gross Profit
Overheads
Depreciation
Profit before interest & tax

Capital Expenditure
Balance Sheet (Enter assets as positive, liabilities as negative)
Fixed Assets - Net Book Value
Cash resources
Other current assets
Bank overdraft
Other loans
Other current liabilities
Long term loans
Share Capital
Reserves
Retained earnings/losses

Section 6: additional voluntary information

"The information requested in this section is not mandatory but, if you do provide the information requested it will be helpful in analysing entrepreneurship in London and providing information on the effectiveness of UK and European diversification policies. Your assistance is very much appreciated. Please note that this section of the form will in no way affect your likelihood of securing investment."

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6
Gender?
Founder?
Owner?	% of the company owned.	% of the company owned.	% of the company owned.	% of the company owned.	% of the company owned.	% of the company owned.
Amount invested
Invested as
Has this person previously founded a business?
Has this person previously managed a business?
Has this person invested as a Business Angel in other companies?
Director?
Full/Part Time?
Highest Academic Qualification?
Age Range?
Ethnic background?
Nationality?
Registered Disabled?

Are there any other Business Angels who have invested in this company?

Data Protection

Should your enquiry not meet our investment criteria, we may disclose your details to Gateway2Investment, Business Link or such other organisation who may contact you to offer further advice. If you do not wish your details to be made available, please tick the box below.

Please do not disclose my details

To submit your application to the London Technology Fund, click on the button below.

The London Technology Fund: Venture Capital (VC) investment for SMEs in Greater London, UK

Investment proposal outline

Data Protection