3

n° FARO/___

Description form for projects applying

for the seed capital, development and orientation fund

Project leader

Name of the organisation:

Type: Company Professional association Research Centre Laboratory

(Tick or delete as appropriate)

Headcount:

Registration no:

Address:

Website: http://

Contact

Last Name: First Name:

Phone: Email:

Please fill and send this form to mail to

Partnership

Identified partners

Name / Country / Website / Role in the project

Targeted partnerships

Type of partner targeted (names if possible) / Country / Role in the project

Need

Value of the requested loan: ……………USD

Have you ever applied for a loan for the development of your project?

Yes No

If yes, please specify the year and the organization?

…………………………………………………………………………………………………………………………………………………………………………….

Have you ever received financial support for the development of the project that you submit to Faro? Yes No

If yes, please specify the amount, the tenor and the organization?

…………………………………………………………………………………………………………………………………………………………………………….

Has your company already received financial assistance from a public organization? Yes No

If yes, please specify the amount(s) and the source(s):

……………………………………………………………………………………………..

Description of your project[1]

·  Description of your project (maximum 15 lines):

·  Studies / work to be conducted in the scope of the Faro (maximum 15 lines):

·  Description of the innovative nature of your project (maximum 15 lines):

·  Economic viability of your project (maximum 20 lines). Please also provide detailed business plan and financial projection :

·  Short description of your total budget (in USD):

Expenses incurred for human resources:

Expenses incurred for travel:

Expenses incurred for external expertise:

Other expenses:

Total:

Confidentiality

(Please sign and send this document to EDC/CCIABML 1 Justinien Street, Sanayeh P.O.BOX 11-1801 Beirut, Lebanon)

Do you authorise CCIABML to communicate your business information (name, internet address, partners, etc.) and your project (description) on the Faro's website as soon as the subsidy is granted? Yes No

Please write below a non-confidential summary that we could publish:

How did you hear about the Faro fund ?

…………………………………………………………………………………………………………………………………………………………………………….

Date: Signature:

www.ccib.org.lb

[1] Please feel free to attach appendices to the description of your project.