Annex 2: Expression of Interest (EoI) Application Form for the Indigenous Knowledge SystemsInnovation Call

CONTRACTING AUTHORITIES:SANBio / BIH

REFERENCE: SANBio / BIH / 2017

DEADLINE FOR SUBMISSIONS:18 May 2017 at 00.00

INSTRUCTIONS:
This template must be used for this Grant application. The applicants must ensure that the text:

  1. Does not exceed 5 pages (A4 size) of Arial 10 characters, single line spacing with 2 cm margins. Information provided on any additional pages will not be considered;
  2. Provides the information requested under the headings below in the order in which it is requested and in proportion to its relative performance.

GENERAL INFORMATION OF THE APPLICANTS:

Name of lead applicant
Name of the company/institution
Registration number / <private companies provide the registration number, for statutory institution provide the Act number>
Postal address
Telephone number
Contact person’s e-mail
Web page of lead applicant
Name of co-applicant
Name of the company/institution
Registration number / <private companies provide the registration number, for statutory institution provide the Act number>
Postal address
Telephone number
Contact person’s e-mail
Web page of co applicant

SUMMARY OF THE PROJECT

Title of the project / <The title must not exceed 15 words and should capture the essence of the project in a concise manner>
Objectives of the project / <Maximum 50 words>
Product developed / <Recommended 50 words>
Thematic area
Grant amount requested (ZAR)
Cash contribution from applicants (ZAR)
Costed in-kind contribution from applicants (ZAR)
Total project cost (ZAR)
Duration of the Projects (months) / (Must not exceed 12 months)

PROJECT DETAILS:

Project introduction / < Recommended 200 words. Briefly describe and explain the key features and main concept/rationale of the project and current status. Include a brief outline of prior research and development. This section should explain how the project links with SADC priorities in IKS
Introduction and background of participants / <Provide a brief introduction of the Lead and Co-applicant and explain the nature of their operations>
Problem being addressed / Recommended 150 words. Clearly defined market need as well as the value of the solution to the end-user
Target market/customer segment / <Define the target market for the product developed>
Solution proposed / <Recommended 150 words. Clearly define the solution proposed to address the problem and the potential impact that the solution will have to the end-user or on the market , and competitive advantage of solution
Planned activities and targeted outputs / <List the main activities needed to produce the project outputs and main outcomes. Check that the activities are practical, realistic, feasible and coherent
Illustration of how the activities will lead to marketable products / <Recommended 150 words. Explain how the planned activities will lead to a product>
Intellectual property / <What are the unique features of your technology/product/services when compared to those of competition? Did you conduct any prior art searches to establish if your technology/product is new? Explain also what steps have your taken to protect your technology/product/service?>

TEAM

Lead innovator with proven track record – short CV, please indicate the gender
Other relevant experts with proven track record – short CV, please indicate the gender
Business expert with proven track record – short CV, please indicate the gender
Industrial partnership / <Recommended 100 words. State the industrial partner and their role in the implementing the project

DECLARATION

I certify that the information shared in this application is true and correct
Lead applicant’s signature / signature> / name printed> / date>
Co-applicant’s signature / signature> / name printed> / date>

CHECKLIST FOR THE EXPRESSION OF INTEREST:

Before sending your proposal, please check that each of the criteria below have been met in full and tick them off / Tick the items off below
Title of the proposal / Yes / No
Part 1 Administrative
  1. Has the application form been completed in full

  1. Has the form been signed by both the lead applicant and the co-applicant

  1. Does the project have at least 10% cash contribution (R142857)?

  1. Are at least 2 countries in the SANBio Member States[1] involved in implementing the project and one of them being Botswana?

Part 2. Eligibility
  1. Does the project have proof of concept of a prototype?

  1. Is the project duration at most 12 months

  1. Is the requested contribution in line with the maximum allowed (both in kind and cash contributions)

  1. Does the project have an industrial partner?

Additional information (This does not affect the above checklist)
May the SANBioBioFISA II Programme publish the tile of your project and the names of the institutions involved on the SANBioBIH websites should you be shortlisted?

LATE AND INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED

1

[1]Any of the 13 SADC Member States that the SANBio Network is currently working in, namely, Angola, Mozambique, South Africa, Lesotho, Swaziland, Malawi, Namibia, Mauritius, Botswana, Zimbabwe, Seychelles, Madagascar and Zambia