Page 1 of Screen Tasmania Application Form 2.2 Factual and Light Entertainment Fund SECTION A : GENERAL INFORMATION Applicants must make contact with a Screen Tasmania project officer prior to submitting applications. The allocation of project officers is subject to availability and workload. This application form should be completed in compliance with Screen Tasmania’s 2.2 Factual Entertainment Initiative Guidelines , General Guidelines and Terms of Trade . Please refer to these guidelines for the specific requirements of your application. For factual entertainment projects with the majority of marketplace finance in place and seeking more than $20 000 in production investment, please see 2.1 Production Investment Fund Application Form. Please provide the name of the Screen Tasmania Project Officer with whom you have discussed your application. Applicant Details Applicant type Individual Company Partnership Other (please specify) ................................................ ...................... (* to check boxes, double click in the box you wish to select, this opens a dialogue box and under default value, select ‘checked’ and hit ok) Applicant name (Contracting entity) 1. Individual name Titl e: First Name: Surname :
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Screen TasmaniaApplication Form2.2 Factual and Light
Entertainment Fund
SECTION A : GENERAL INFORMATIONApplicants must make contact with a Screen Tasmania project officer prior to submitting applications. The allocation of project officers is subject to availability and workload.This application form should be completed in compliance with Screen Tasmania’s 2.2 Factual Entertainment Initiative Guidelines , General Guidelines and Terms of Trade. Please refer to these guidelines for the specific requirements of your application.For factual entertainment projects with the majority of marketplace finance in place and seeking more than $20 000 in production investment, please see 2.1 Production Investment Fund Application Form.
Please provide the name of the Screen Tasmania Project Officer with whom you have discussed your application.
Applicant Details
Applicant type Individual Company Partnership
Other (please specify) ......................................................................(* to check boxes, double click in the box you wish to select, this opens a dialogue box and under default value, select ‘checked’ and hit ok)
Applicant name (Contracting entity)
1. Individual name Title: First Name:
Surname:
or 2. Company / Partnership name
Is the applicant a Tasmanian resident/Tasmanian resident production company
Yes No
Applicant/Contracting entity’s ABN
Is the applicant/contracting entity registered for GST Yes No
Screen TasmaniaApplication Form2.2 Factual and Light
Entertainment Fund
Postal address Postcode
Street address Postcode
Contact phone Mobile
Email Website
Contact person 1: same as applicant (if Individual) Yes No
If no, please provide the following:
Contact 1 Title: First Name:
Surname:
Contact phone Mobile
Email
Contact phone Mobile
Contact 2 Title: First Name:
Surname:
Email
Primary contact Contact 1 Contact 2
Professional LevelSee General Guidelines for definitionsFor individual applicants only.Please indicate your professional level by placing a tick in the relevant box below (i.e. entry level/emerging/experienced).
Project synopsis (this section must be completed - maximum of 4 lines)
Which stage are you applying for? Pitching Documents Trailer Pilot
Please provide a brief description/rationale of the development stage you are applying for and your specific marketing objectives
Estimated time to complete the next stage of development
Proposed deliverables for next stage
Project type (tick one or more)
Lifestyle Comedy or Light Entertainment
Reality
Talk Show Game show Other
Delivery platform (tick one or more)
FTA Television Broadcast Subscription Television
Interactive television
Website DVD Wireless / mobile
Other (please specify)
Number of episodes Duration
(minutes)
Genre
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Setting
Indigenous story content (if yes, an additional copy of the script is required)
Yes No
Please indicate the censorship rating you aim to obtain for the project
Television P C G PG M MA 15+ AV 15+
Who is the audience for your project?
Intended timeslot and/or online platform
Do you have any marketplace attachment or interest
Please list the items to be delivered for this stage
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SECTION C : CREATIVE TEAMPlease specify the names of the team applicable and place of residence (state or country) and indicate whether proposed (P) or confirmed (C)
Role Name Residence Proposed/Confirmed
Executive producer P C
Producer P C
Concept by
Series writer P C
Writer(s) P C
Director P C
Production manager P C
Director of photography
P C
Production designer
P C
Editor P C
Composer P C
Sound designer P C
Principal Host(s) P C
Guest(s) P C
P C
Does this project involve a key host(s) or subject(s)? Yes No
If so, please attach written evidence of their commitment and/or permissions and clearances
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SECTION C : CREATIVE TEAM cont’d
Please list recent produced credits for Key Creative 1
Project Name Role Type Duration Year
Please list recent produced credits for Key Creative 2
Project Name Role Type Duration Year
Please list recent produced credits for Key Creative 3
Project Name Role Type Duration Year
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SECTION D : FINANCIAL INFORMATIONEstimated series production budget $
Estimated budget for this stage of development $
Amount sought from Screen Tasmania $
Has this project been considered by Screen Tasmania previously? Yes No
If yes, please provide detailsDate Stage Project Title Amount
requested/funded
Funded
$ Yes No
Have other funding bodies or broadcasters provided money for development?
Yes No
If yes, provide details
Date Name of entity
Amount requested/fund
ed Status
$
$
$
Applicant track record Please provide details of previous projects produced
Title and format Distributor Year Total budget
Gross returnsto date
$ $
$ $
$ $
$ $
$ $
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SECTION D: FINANCIAL INFORMATION cont’dCopyright informationThe applicant must be the originator of the concept, script or treatment concerned, or the holder of the copyright, or have an option to the rights in any and all works on which the project is to be based. Evidence of copyright must be submitted with this application. Screen Tasmania will only contract with copyright holders of the works.
Name(s) of originator
Is the work an original idea of yours (the applicant)? Yes No
If yes, please provide statement of copyright
If no, have you (the applicant) acquired all rights from the copyright owner/co-writers?
Yes No
If yes, please attach evidence of chain of title documentation
Development budget breakdown It is not necessary to complete all sections, only those relevant to your project and its
particular stage of development Applicants should provide budgets exclusive of GST Screen Tasmania reserves the right to negotiate amendments to the budget as a
condition of the provision of funds Screen Tasmania does not fund retrospectively.
Category
Screen Tasmania Funding
Applicant’s
contribution *
Other funding ^
Previous$
Requested$
Amount$
Source$
Amount$
Option on rights n/a n/aPurchase of rights n/a n/aConcept fee n/a n/aSeries writers feeCo-writer’s feeExecutive Producer’s FeeProducer’s Fee
Legal fees n/a n/aOffice overheadsTrailer below the line production costs Pilot below the line production costs Pitch materialsOther – please specify:# Please attach separate breakdown sheet and narrative description Please also attach a complete estimated budget cost breakdown using Screen Australia’s A-Z
Budget format and detailed shooting schedule* Applicant contribution (deferrals, production company investment)^ Other funding (broadcasters / government funding agencies)
Please submit one electronic copy and two hard copies of the following: a completed application form a logline a one page synopsis a four to 10 page treatment outlining:
o concept and formato target audience, time sloto web strategy (if relevant)
a completed project history, market strategy and next stage notes a statement of copyright and chain of title documents (if the work is based on an
underlying work by a person other than the applicant) a statement articulating the economic and cultural benefits of the project to
Tasmania the curriculum vitae of the applicants and key creative.
Production of teaser/ trailer
Please submit one electronic copy and two hard copies of the following: a completed application form a logline a one page synopsis a shooting script a shooting schedule and A-Z budget proposed cast a four to 10 page treatment outlining;
o concept and formato target audience, time sloto web strategy (if relevant)
a draft script (if available) a completed project history, market strategy and next stage notes a statement of copyright and chain of title documents (if the work is based on an
underlying work by a person other than the applicant) a statement articulating the economic and cultural benefits of the project to
Tasmania the curriculum vitae of applicants and key creative.
SECTION F : CHECKLISTS cont’d
Production of pilot
Please submit one electronic copy and two hard copies of the following: a completed application form evidence of marketplace interest a logline a one page synopsis a shooting script a shooting schedule and budget proposed cast a four to 10 page treatment outlining:
o concepto target audience, time sloto web strategy (if relevant)
a completed project history a detailed market strategy a statement of copyright and chain of title documents (if the work is based on an
underlying work by a person other than the applicant) a statement articulating the economic and cultural benefits of the project to
Tasmania the curriculum vitae of applicants and key creative.
In addition to the requirements outlined in the Application Form, detailed concept documents must outline the project in a way that clearly demonstrates its market potential and appeal. See the Application Form for more details.
SECTION G : DECLARATION & SIGNATUREPublicity of AssistanceUnlike private sector financial organisations, the Department of Economic Development, Tourism and the Arts (the department) disburses public funds and is therefore accountable for the distribution of those funds. As part of the accountability process, the department may publicise the level of its financial assistance including the terms and conditions of the financial assistance as provided in the confidentiality requirements set out in the legal documentation entered into with you.Right to InformationYou should also be aware that information you provide to the department, and details of any financial assistance package, may be subject to requests for public disclosure under the Right to Information Act 2009 provided that information is not subject to the confidentiality requirements set out in the legal documentation entered into with you.Personal Information Protection Personal information will be collected from you for the purpose of undertaking the department’s activities. Your personal information will be used for the primary purpose for which it is collected and may be used for other purposes permitted by the Tasmanian Development Act 1983 and may be disclosed to contractors and agents of the department or affiliated bodies, and other organisations authorised to collect it. Your basic personal information may be disclosed to other public sector bodies where necessary for the efficient storage and use of the information. Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to the department’s personal information protection officer on (03) 6233 5888. You may be charged a fee for this service.
Have you read and understood the confidentiality regulations above? Yes No
Screen Tasmania is required to identify all relevant financial or personal interests that may exist between board members or employees of Screen Tasmania and applicants. This is to ensure that measures can be introduced to prevent a conflict of interest arising between those persons assessing the application for Screen Tasmania and such applicant. For these purposes please select the relevant statement below:
‘I (the applicant and my colleagues on the project) do not have a financial and/or close personal relationship with a board member or employee of Screen Tasmania.
I (the applicant and my colleagues on the project) do have a financial and/or close personal relationship with a board member or employee of Screen Tasmania. The nature of such relationship is:
I/we acknowledge this submission in no way inhibits or prejudices Screen Tasmania from becoming involved in or developing other projects which may or may not have various similarities with my project.
No agreement, arrangement or obligation shall be deemed to exist between Screen Tasmania and myself/us unless and until a formal contract is made between us.
SECTION G : DECLARATION & SIGNATURE cont’d
I/we are aware that in the event of this application being approved, no contracting will occur until Screen Tasmania has been provided with copies of executed documents giving the contracting party the right to exploit the material being the subject of the application either by way of assignment of copyright or an opinion.
I/we state the details provided in this application are true and correct.
Signature Print name
Signature Print name
Witness Print name
Date ……..…/……..…/……..…
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SECTION H : STATISTICAL DATA
Screen Tasmania is compiling statistics on applications for its funding programs. To assist us, we appreciate the completion of the form below and return it with your application.This information is removed prior to processing of applications and is only used to generate aggregated statistics.
Date of application ……..…/……..…/……..…
Gender Female Male
Country of birth
If you are a Tasmanian resident, what area of the state do you reside in?
Are you of Aboriginal or Torres Strait Islander descent? Yes No
Do you speak a language other than English at home? Yes No
