Building Adaptive Capacity through the Scaling-Up of Renewable Energy Technologies in Cambodia (S-RET)
Application Form: Testing and Roll-Out Grants
Applying for which Grant Window (tick box)Testing Grant / Roll-out Grant
Section 1: Applicant Details
1.1. Applicant name:
(Describe whether private company, NGO, community based organization, research institute, autonomous government agency)
1.2. Description of applicant (max 200 words):
(Describe history, mandate, vision and future strategy)
Address: / Contact person:
Telephone number: / Years operational(Please provide the last two years of audited financial statements):
Email: / Country of registration:
Website: / Type of legal entity(Please provide documentation on the legal registration of the applicant):
Section 2: Information on the RET
2.1. RET Category (tick box)
Solar / Micro/Pico-Hydro / Biomass / Biogas
Describe if other:
2.2. RET Application:
(Short description, including relevance of RET to smallholder agriculture e.g. household, farming, animal husbandry and/or food processing, postharvest handling etc. List multiple application if available)
2.3. Status of the technology:
(Prototype, pilot, implementation, commercialized for smallholder agriculture applications)
2.3.1. Is the technology already available (piloted/implemented) in Cambodia? (Yes/No) If no, state in which countries the technology has been piloted
2.3.2. If the technology is not available in Cambodia, where is it manufactured/assembled?
(Describe if self-built or installation by third party, include aspects of transportation costs, importation issues, competitive prices of local components, quality control systems)
2.4. Co-financing requirements:
(Describe how 10% co-financing will be provided under Testing Grants and 50% co-financing, of which half in cash expenditures,under Roll-out grants)
Section 3: Details of the Grant proposal
3.1. Institutional capacity of the applicant(Applicants should respond to be low questions and provide documentary evidence to substantiate the response for evaluation purposes)
3.1.1. Number of years with experience promoting RET:
(Provide details of past and present experiences. Please include documents to substantiate years operational)
3.1.2. Number of years experience working with poor rural residents in developing countries and/or in Cambodia:
3.1.3. Qualifications of leading staff member(s):
(Clearly articulate roles and responsibilities of the applicant’s team. Please include CVs of relevant staff members)
Section 3.2: Potential benefits for smallholder agriculture
3.2.1. Costs and financial aspects
Affordability and capital cost of equipment per farmer:
(Describe installation cost in USD per installation. Identify opportunities for consumer financing e.g. MFIs, subsidies, rental, mobile payment etc. The S-RET project provides a subsidy amount of US$150 for each IGRF member)
Level of operation and maintenance service required:
(Describe necessary knowledge required for its use e.g. level of education, days of training for proper operation and use, fuel and/or users’ time in operating the technology, repairs, ordinary maintenance etc.)
Lifespan of RET:
(Include any other documents such as technical briefs, manuals, brochures, details on certifications and warranties for the RET):
3.2.2. Expected benefits for household, community and environment
Which of the following benefits can the RET application lead to (tick box)
Cost savings: /
Time savings (in terms of walking long distances to collect firewood or water): /
Livelihood benefits additional or increased income (in terms of productivity or quality of product): /
Improved quality of life: /
Health and sanitation benefits: /
Rural youth employment: /
Other benefits: /
Provide narrative:
(Describe above and/or new features, in terms of quantifiable aspects where possible):
3.2.3. Environmental benefits:
(Compared to current practices/activities, what is the improvement in terms of the energy source e.g. switch to renewable energy and/or energy efficiency/savings, avoid/reduce chemical fertilizer use, conservation of forests, displacement of fossil fuel used for irrigation and other agricultural activities, reduced dependency on rainfall/weather, limit greenhouse gas emissions etc.) Provide quantifiable measures, indicators if available.
Does the RET substitute/improve existing practices/technologies? Yes/No
Does the RET introduce something completely new? Yes/No
Potential aspects (social, cultural, financial) hindering the adoption:
(Include aspects related to ownership and explain potential market size of proposed RET)
Section 3.3. Project Implementation plan:
(Provide a clear description of how each activity will be accomplished and a detailed cost table, expected outputs/impacts and proposed financing model.For Testing grants, include number of testing sitesestablished. Testing sites can be at one central location or in the 5 provinces. There is no minimum qualifying number of RET that need to be established.Please see scoring protocol in the application guidelines for details on specific criteria used for scoring the project implementation plan under Testing and Roll-out grants.
3.3.1. Field implementation capacity:
Describe the field implementation capacity to implement awareness programs, capacity building, training, monitoring and evaluation plan, provision of timely after-sales services. International companies not registered in Cambodia are required to provide information on potential local partnership strategies.
3.3.2. Implementation risks and sustainability of project activities
(Describe project level risks, success-stories and/or failures from the introduction of the proposed RET/application)
3.3.3. Other comments
I confirm that the information given in this form is true, complete and accurate and accept the terms and conditions of the S-RET Grant
Applicant signature: ______
Date: