Annex 1: Application Template

Annex 1: Application Template

Project Identification Plate
Country and Location / Name of the Country and pilot site area (as specific as possible)
Name of the project
Applicant Organization / Name of organization:
Type of organization4:
Address:
Phone:
Fax:
E-mail:
Web page: (if exists)
Contact Person / Phone:
Fax:
E-mail:
Legal status of Applicant
Project Partners / Name of organization:
Type of organization[1]:
Address:
Web page: (if exists)
Required Budget (USD)
Co-financing (USD)
Duration of the project / How long will the project last? inc starting date
Number of communities (disaggregated by numbers of individuals) expected to benefit from sustainable access to safe water and/or sanitation services as a result of project interventions
How many m3 of water will be replenished to communities and nature(if applicable)[2]:
Number of communities (disaggregated by number of individuals) expected to benefit from the active healthy lifestyles interventions from the project activities
Number of communities (disaggregated by women and youth) expected to be empowered to improve education and receive job opportunities through project interventions
Project Area / A. Improved access to safe drinking water and sanitation services, climate change adaptation, improved water resources management
B. Supporting active lifestyles and diseases prevention for enhanced community wellbeing
C. Empowering women and youth through improved education and job creation
Abstract (Max 200 words) / Brief summary of the project objectives and activities
Estimated Impact / Impacts are the effect of the project on its wider environment, and its contribution to the wider objectives in the long run.
Please summarize the project’s likely impact to the target group(s), whether the project has a potential to replicate and/or scaling-up. If there is a dissemination or replication strategy proposed, please explain
Project Sustainability / Sustainability means the continuation of the project outputs and impacts after the closing of the New World Project. This section shall explain how the results and impact of the proposed project will continue after the conclusion of the Fund’s support. What characteristics of your project will help ensure that its results and development impact are sustainable? Please define how the proposal will secure the sustainability in financial, institutional, communal or policy levels. Describe any major challenges that your project may face to sustain its results
Steering committee comments

1.  What are the challenges/issues/opportunities in your community with regards to water, sanitation and/ or community wellbeing and /or women and youth empowerment and how is your project going to address them? (200 words max.)

2.  Who are the main stakeholders in your country in relevance to the issues discussed above?

i. Expected Results & Resources Framework

The expected results are the measurable changes which will have occurred by the end of the project as a result of the planned intervention.

INTENDED OUTPUTS / OUTPUT TARGETS[3] / INDICATIVE ACTIVITIES / RESPONSIBLE PARTIES / TIME FRAME /
Output 1:
Baseline[4]
Indicator[5]
Time Frame
Output 2:
Baseline
Indicator
Time Frame
Output (n):
Baseline
Indicator
Time Frame

ii. NEW WORLD GRANT INDICATIVE BUDGET FORMAT

General Category of Expenditures* / Budget (USD) / Description**
New World / Co-funding
Cash / In-kind
1 / Supplies, commodities and equipment
1.1 / Equipment (i.e. communications & audio visual equipments, IT equipments) and rental of equipment
1.2 / Materials, goods
1.3 / Supplies
1.4 / Other
2 / Personnel
2.1 / Project staff salaries
2.2 / Local consultants
2.3 / International consultants
2.4 / Travel
2.5 / Other
3 / Training of counterparts
3.1 / Meetings, Trainings (including travel, rental of premises etc.)
3.2 / Other
4 / Contracts (including sub-contracts to third parties)
4.1 / Institutional Contracts (Sub-contracts)
4.2 / Other
5 / Other Direct costs
5.1 / Audio visual & print production costs
5.2 / Translation
5.3 / Postal
5.4 / Rental & maintenance of premises/premises alterations (needs justification)
5.5 / Other
5.6 / Miscellaneous
6 / Total Funds Requested

* Any applicant should consider the project costs with the framework given on the budget template as applicable to its project. Any cost items which are covered under appropriate “Other” budget lines, the proposed / calculated expenditures shall be specified in the description for UNDP’s information.

** Please provide as much as detail and accurate information in “description” column as possible based on the necessary inputs (Section E of the New World Proposal Format) in order to justify the costs proposed.

iii. Annexes of New World Application:

Annex A: Partnership Statement and Description of the Partners

Annex B Declaration by the Applicant

Annex C: Supporting Document

Annex A: Partnership Statement and Description of the Partners

Important: This declaration must be provided by each partner. The PARTNERSHIP STATEMENT together with the DESCRIPTION OF THE PARTNERS shall be annexed to the New World Application Form.

1.  PARTNERSHIP STATEMENT

A partnership is a relationship of substance between two or more organizations involving shared responsibilities in undertaking the action. To ensure that the action runs smoothly, the Contracting Authority requires all partners to acknowledge this by agreeing to the principles of good partnership practice set out below.

1.  All partners must have read the application form and understood what their role in the action will be before the application is submitted to the Contracting Authority.

2.  All partners must have read the standard New World Grant Agreement and understood what their respective obligations under the contract will be if the grant is awarded. They authorize the Lead Applicant to sign the contract with UNDP and represent them in all dealings with the Contracting Authority in the context of the project's implementation.

3.  The applicant must consult with his partners regularly and keep them fully informed of the progress of the action.

4.  All partners must receive copies of the reports - narrative and financial - made to the Contracting Authority.

5.  Proposals for substantial changes to the action (e.g. activities, partners, etc.) should be agreed by the partners before being submitted to the Contracting Authority. Where no such agreement can be reached, the applicant must indicate this when submitting changes for approval to the Contracting Authority.

6.  Where the Beneficiary does not have his headquarters in the country where the action is implemented, the partners must agree before the end of the action, on an equitable distribution of equipment, vehicles and supplies for the action purchased with the grant among local partners or the final beneficiaries of the action.

I have read and approved the contents of the proposal submitted to Contracting Authority (UNDP). I undertake to comply with the principles of good partnership practice.

Name:
Organization:
Position:
Signature:
Date and place:
This section must be completed for each partner organization within the meaning of section 2.1 of the Guidelines for Applicants.
Partner 1
Full legal name (business name)
Nationality
Legal status
Official address
Contact person
Telephone number
Fax number
E-mail address
Number of employees
Other relevant resources
Experience of similar actions, in relation to role in the implementation of the proposed action
History of cooperation with the applicant
Role and involvement in preparing the proposed action
Role and involvement in implementing the proposed action

Annex B: Declaration by the Applicant

DECLARATION BY THE APPLICANT

The Applicant, represented by the undersigned, being the authorized signatory of the Applicant, including every partner, hereby declares that:

 1. The Applicant has the sources of financing and professional competence and qualifications specified in Section 2.1. of the New World Project Application Guideline;

 2. The Applicant is directly responsible for the preparation, management and implementation of the action with its partners and is not acting as an intermediary;

 3. The Applicant and its Partners are not in any of the situations excluding them from participating in contracts which are listed in Section 2.1. of the New World Project Application Guideline. Furthermore, it is recognized and accepted that if the applicants participate in spite of being in any of these situations, it may be excluded from the New World Project;

 4. The Applicant undertakes to comply with the obligations foreseen in the partnership statement of the grant application form and with the principles of good partnership practice;

 5. If selected, the Applicant is in a position to deliver immediately, upon request, the supporting documents as requested by the Contracting Authority;

6. The Applicant and each partner (if any) are eligible in accordance with the criteria set out under section 2.1. of the New World Project Application Guideline;

 7. If recommended to be awarded a grant, the Applicant accepts the contractual conditions as laid down in the Standard Grant Agreement annexed to the Grant Application Guideline (Annex 7);

8. The applicant guarantees that none of the cost items stated in the Budget sheet annexed to this proposal have been financed or under contract to be financed by other local or international grant / support programmes.

Signed on behalf of the Applicant.

Name:
Position:
Signature:
Date and place:

Annex C: List of Supporting Documents[6]

Applicants shall provide the following supporting documents with their Applications. These documents are requested in order to allow the UNDP to verify the eligibility of the Applicants and their Partners. The supporting documents requested must be supplied in the form of originals or notarized photocopies of the said originals. Please keep in mind that UNDP has the right to ask clarification regarding the supporting documents or ask for additional documents.

The required supporting documents are as follows:

1.  The statutes or articles of association of each partner organization;

2.  Certificate of the legal registration of each partner organization (notarized photocopy);

3.  Certificate of the registration with the tax authorities (certified photocopy) , of each partner organization;

4.  Copy of the applicant’s latest accounts (the profit and loss account and the balance sheet for the previous financial year for which the accounts have been closed);

5.  Evidence on the fulfillment of obligations related to the social security contributions and payment of taxes as per the submission date (original) and/or a Declaration by the Applicant (Annex B to this Application Form) and, where appropriate, by each partner organization;

6.  Authorization or other licenses necessary for the implementation of the project, if required by the Law (photocopy);

7.  CVs of the key staff with the role specified that will be involved in the project.

8.  Power of Attorney of the Applicant Organization and partners who will sign the application form and associated documents.

Annex 2: Interim/ Final Report Template

New World Interim/ Final Report

Recipient Institution:
Project Title:
Project Number:
Country:
Interim report #/ Final Report
Period covered by the report: / From: / To:
Submission date:
I, <name of the authorized person (signatory)>, acting as the Authorized Person of the <name of the Recipient Institute> confirm and certify that the information contained in this Interim/Final Progress Report is correct and accurate to the best of my knowledge.
Name and signature / Date
Prepared by:
Summary of results achieved during the reporting period (200 words/ 500 words in case of final report)
Implementation schedule (if applicable). Indicate percentage completed by end of:
2014:
2015:
Project Funding (USD) In the table below; please indicate the amount of funding from each partner. Include the New World funding contributions as well as external funding partners and contributions by implementing partners, communities, and others.
Partner Name / Role / Financial Contribution / In-Kind Contribution

Main activities planned and achievements for the Reporting Period as compared to the Results and Resource Framework (Please complement the activities with dates and venue as possible)

Outputs / Planned Date / Realized Date / Direct Beneficiaries / Indirect Beneficiaries / Progress on the output targets[7], [8], [9] / Current status
Output 1.
Output 2.
Output ….
Current and anticipated implementation problems/risks, including planned remedial actions and lessons learned from addressing these problems (if any)
Forthcoming activities to achieve the project targets (max 150 words)

IMPORTANT: Please provide also Project Related Photos/ Publications/ Promotional materials/ Social media coverage etc.

Financial Report

General Category of Expenditures / Total budget (USD) / Expenditures / Balance
1 / Supplies, commodities and equipment / New World / Co-funding / New World / Co-funding / New World / Co-funding
1.1 / Equipment (i.e. communications & audio visual equipment, IT equip.) and rental of equipment
1.2 / Materials, goods
1.3 / Supplies
1.4 / Other
2 / Personnel
2.1 / Project staff salaries (max 15% of the project budget)
2.2 / Local consultants
2.3 / International consultants
2.4 / Travel
2.5 / Other
3 / Training of counterparts
3.1 / Meetings, Trainings (including travel, rental of premises etc.)
3.2 / Other
4 / Contracts (including sub-contracts to third parties)
4.1 / Institutional Contracts (Subcontracts)
4.2 / Other
5 / Other Direct costs
5.1 / Audio visual & print production costs
5.2 / Translation
5.3 / Postal
5.4 / Rental & maintenance of premises/premises alterations (needs justification)
5.5 / Other
5.6 / Miscellaneous
6 / Total Direct Costs
7 / Total

Total Budget approved:...... New World Project Funds already advanced:......

Amount of expenditures:...... New World Project Funds requested:......

Balance (if it exists):...... Certified by:______

Name and signature of the Representative of the Grantee

The Grantee is responsible for compiling and providing all supporting documentation or information related to this report at the request of UNDP.

[1] Type of Applicant/ Partner Organization (for more information please refer to Guideline Section 2.1):

[2] Applicants will be encouraged to calculate water replenishment levels based on the Replenish Benefit Quantification Methodology used by TCCC (details to be obtained from the New World project Coordinator).

[3] To be achieved by the end of the project

[4] Baseline describes the pre-project condition

[5] Indicator is the measurable variable of the impact of the projects. Eg. Types and numbers of people served.

[6] Applicable only to external partners, is not applicable to the UNDP CO’s application

[7] Number of communities (disaggregated by numbers of individuals) expected to benefit from sustainable access to safe water and/or sanitation services as a result of project interventions

[8] Number of communities (disaggregated by number of individuals) expected to benefit from the active healthy lifestyles interventions from the project activities

[9] Number of communities (disaggregated by women and youth) empowered to improve education and generate job opportunities through project interventions