Please note that ABS are only contracted to provide NEIS in Western Australia.
Your name(s):*
Date of birth:*
Your address:*
Postal address:
Phone:*
Mobile:
Email:*
Which of the following income assistance are you receving: Newstart Parenting Disability Other
Can you work in your business on a full time basis (35 hours per week)?* Yes No
Do you have a partial work capacity restriction?* Yes No
Your Jobseeker ID:
Stream: ---1234
Business partner's name: (if applicable)
Partner's date of birth: (if applicable)
Is your business partner registered with Centrelink? Yes No (if applicable)
Which Centerlink are you registered with?
Who is your job services Australia provider?
Who is your contact at the JSA provider?
Are you an UNDISCHARGED Bankrupt?* Yes No
Have you previously received the NEIS allowance?* Yes No
Are you able to participate in Small Business Management training?* Yes No
Do you have an ABN now?* Yes No
If yes then please provide details.
Do you have any registered business names?* Yes No
Brief description of your proposed business:*
Will you operate as a Sole Trader (on your own), Partnership or Company?*
Have you ever operated you own business before?* Yes No
If yes then please provide details
Who will buy your product/service (your typical customer)?*
Have you undertaken any market research? (ie: trialled your product/service, confirmed market demand)* Yes No
How do you intend to market (ie: advertise/promote) your product?*
Who is your competition and how will you compare with them (include names & locations)?*
How will your product/service be better or different from other existing products/services?*
What price do you plan to charge for your product/service? How does it compare to other suppliers?*
Describe the equipment you will need for your business.
You already own*
Needs to be bought or leased*
NEIS does NOT provide loans, grants or any start up capital assistance. If you need initial funds and do not have the means to raise them yourself you need to discuss this with your NEIS Agent.
Will you need to borrow money to start your business?* Yes No
If yes, how much?
If you need funds, where do you expect to obtain these funds?
At what location will you be operating your business? e.g. shop, office, home, leased premises etc*
What training & education (formal qualifications) do you have that could be used in running your proposed business?*
What skills & experience do you (and your partner if applicable) have that is beneficial for the business?*
Your name:*