Undap Coop Challenge Fund

UNDAP COOP CHALLENGE FUND

APPLICATION FORM

For Office Use
Reference number:

Please fill in every field and note that incomplete formsor forms containing incomplete information will not be considered.

SECTION 1: SUMMARY PROJECT DATA
1.1 / Title of the Project
1.2 / Region targeted
1.3 / Name of applicant organisation
1.4 / Partner organization/s
1.5 / Project duration / (7 months maximum)
1.6 / Proposed start and end dates[1]
1.7 / Project budget
(in USD) / Total Budget:
UNDAPCOOP Contribution requested:
1.8 / Please describe in 2-3 sentences your work with farmers’ organisations (e.g. cooperatives, associations, community-based organisations)
1.10 / How did you learn about UNDAP COOP Challenge Fund? / Please specify______
1.11 / Please give a brief description of your project
(specifying the development objective, immediate objective and results as listed in section 5.1 and the target group disaggregated by sex) / (300 words max)
SECTION 2: INFORMATION ABOUT THE APPLICANT
2.1 / Organisation Name
2.2 / Physical Address
2.3 / Website Address (if any)
2.4 / General Telephone / Tel:
2.5 / Main Contact Person / Name:
Position:
Email:
Tel:
Mobile:
Fax:
2.6 / Second Contact Person / Name:
Position:
Email:
Tel:
Mobile:
Fax:
2.7 / Most recent annual income of your organisation (USD)
2.8 / Source of income
(Membership fee, government, external donor, etc.)
2.9 / Category of organisation / Savings and Credit Cooperative (SACCO)
Community Bank
Commercial Bank
Other Microfinance Institution
Please specify :______
Other type. Please specify:______
2.10 / For member-based organisation, number of members (total number and disaggregated by sex)
2.11 / Total number of staff and position (disaggregated by sex)
2.12 / Date of registration
2.13 / Brief description of your organisation: Mission and main services / (Max. 150 words)
2.14 / For the same project purpose have you applied for a loan? If yes, provide details. If no, why? / (Max. 150 words)
SECTION 3: BASIC ENTERPRISE INFORMATION PROFILE & BUSINESS PLAN
This section provides more information on the organisation (e.g. Bank or SACCO) that will be implementing the project. The basic business plan information described in this section gives an overview of the organisation in which the project will only partly contribute to the achievement of its overall objectives. This section puts into perspective the project submitted for funding.
3.1 / Summary / Describe brieflythe business concept, its product/services, the market opportunity, how it will serve the end beneficiaries, financial projectionsand requirements, current business position,to what extend the project is related to the business plan,etc.
(Max. 300 words)
3.2 / The Organisation and projection / Explain what your business model is. Who are or will be the members/clients? What kind of products or services are provided? Sectors targeted? What is the competitive advantage of the organisation? Describe and explain the organisation’s projection in 3 years.
3.3 / Market Research and Analysis / Classify potential members/clients into relatively homogeneous groups and identify the characteristics of each group. On what basis are decisions made in each group: price, service, etc.?
Identify the market size and the possible trend with regard to the growth.
List the competing products or services and their characteristics. Identify the organisations selling those products and provide their strengths and weaknesses
Identify which members/clients, wards are targeted? Why?
Make an assessment of the likely market share based on the market size and the competitors.
Prior Year / Yr1/1Qtr / Yr1/2Qtr / Yr1/3Qtr / …
Product/Service (e.g. Loans) / …
Amounts / …
What practices are used in order to keep track of the market?
3.4 / Terms and Conditions & Marketing Plan / Describe terms and conditions of the current financial products offered (incl. clients’ requirements) In short, describe the changes the project will make on the current financial products.
Description of various savings products and terms if any
Advertising and promotion. How does the organisation communicate with the potential members/clients to make them aware of the products or services?
3.5 / Regulatory Environment / What is the extent or nature of the regulation related to the organisation and its products? (e.g. National Microfinance Polic,y SACCO Societies Act), Central Bank Guidelines and RegulationsWhat is the impact of the regulation on your activities?
3.6 / Operation Plan / Geographic location (s)
Facilities, equipment and technology
Labour force
Efforts to predetermine credit-worthiness of borrowers (e.g. credit bureau) or other issues specific to the products
Measures in place to ensure compliance
Control of operating expenses
3.7 / Management Structure / Indicate how the organization structure is designed and how it might be structured in the near future
List key management personnel
Describe the governance structure incl. Board of directors, Supervisory Committee, etc
3.8 / Critical Risks and Assumptions / Determine the major factors that may impact on achievement of results
Define the assumptions that underlie the organisation sustainability
3.9 / Financial Plan / Financial statements for at least the previous year
Profit and loss forecasts. Identify and fully explain any assumptions
Pro forma balance sheets
Cash flow projections
Analysis of profitability of products, if appropriate
SECTION 4: PROJECT RATIONALE
This section provides preliminarily information on the additional products and/or services to be offered through the project implementation. The project rational must explain why the project is needed, describing the members/clients concerned, outlining the location, resource opportunity, constraints, strategy and potential partners.
4.1 / PROJECT AIM:
Briefly outline the main aim of the project
(Max. 200 words)
4.2 / PROBLEM(S) TO BE ADDRESSED
What problem(s) will this project address? What challenges do you face to offer credit to farmers’organizations?
Define the problem(s) in concrete and specific terms. / (Max. 200 words)
Do any of the problem(s) identified relate to specific inequality or gender issues? / (Max. 200 words)
How will your project address the problem(s) identified in order to increase access to credit for farmers’ organizations? e.g. interest rates reduced for loans, reduced collateral requirements, etc. / (Max. 200 words)
4.3 / TARGET MEMBERS/CLIENTS:
Who will be the direct (individuals, SMEs, cooperatives, etc.) and indirect beneficiaries (households, etc.) of the project?I.e., who will be better off as a result of the loan you provide? What is your business projection? Please provide figures (disaggregated by sex and age).
(Max. 150 words)
4.4 / STRATEGY
Describe the product and/services to be offered through the project i.e. maximum amount of loans, characteristics, requirements, etc.
What is your strategy to increase your membership/clientele (outreach)
What is your strategy and model for loan tracking and recovery?
4.5 / NON FINANCIAL SERVICES NEEDED BY YOUR MEMBERS/CLIENTS:
The project will aim at providing loans to farmers’ organizations.In addition to the loan, an enterprise needs non financial services to develop. In this section please provide the types of services your members/clients might need for their business to succeed in addition to the loan secured from your organisation: e.g. management services, governance, accounting, market access, market information, etc.
Please identify up to 5 key services required by your members/clients
Please identify the potential service providers
SECTION 5: PROJECT STRUCTURE
This section aims at describing how the project will be implemented in a more technical and detailed manner by giving an overview of the project’s outcomes, results and key activities.
5.1 / OUTCOMES, RESULTS and ACTIVITIES PROJECT STRUCTURE
OUTCOMES OF THE PROJECT:
Please give a short description of the immediate outcomes of the project. The outcomes of the project are the effects or changes that your project intends to bring about among farmers that the loan will be offered to.
RESULTS
Please give a short description of the specific results which are the concrete products to be achieved in order to obtain the outcomes
ACTIVITIES:
Please give a short description of the key activities that you intend to carry out for each result and describe the process which will lead to the delivery of the lending facility.
RESULT 1:
ACTIVITIES / NAME OF IMPLEMENTING ORGANISATION
(Applicant or Implementing Partner)
1.1
1.2
1.3
1.4
1.5
1.6
RESULT 2:
ACTIVITIES / NAME OF IMPLEMENTING ORGANISATION
(Applicant or Implementing Partner)
2.1
2.2
2.3
2.4
2.5
RESULT 3:
ACTIVITIES / NAME OF IMPLEMENTING ORGANISATION
(Applicant or Implementing Partner)
3.1
3.2
3.3
3.4
3.5
3.6
Please add or delete lines if more or less results and activities are needed
SECTION 6: GENDERMAINSTREAMING
6.1 / Please describe whether your project will address gender equality issues, and how. In particular, you should explain whether the objectives and results of the project have a gender dimension, and which of your activities will respond to gender issues and how?
(Max. 200 words)
SECTION 7: MANAGEMENT ARRANGEMENTS
7.1 / PROJECT MANAGEMENT STRUCTURE
More details will be required in the Work plan template that you will have to fill out only if your application form is selected.
Describe the project management structure specifying the roles and responsibilities of the staff involved. This section should be completed in accordance with the management structure explained in 3.7.
Who will oversee the implementation of the project on a daily basis?
SECTION 8: PROJECT FEASIBILITY AND SUSTAINABILITY
8.1 / FEASIBILITY
Does your organisation have similar project management experience?
Please specify
What are your organisation’s strengths in project management?
What aspects does your organisation need to improve upon in terms of project management?
Please list in the matrix below the similar projects your organisation have implemented over the past 5 years, the total budget and source of funds (if any)
Project title / Project Aim / Date / Total Budget (USD) / Source of Fund
8.2 / SUSTAINABILITY
How does your organisation intend to extend the benefits of the project after termination of funding from UNDAP COOP Challenge Fund?
Specify the strategies to promote financial, technical and management sustainability. / (Max. 300 words)
SECTION 9: MONITORING, EVALUATION AND LESSONS LEARNT DISSEMINATION
9.1 / MONITORING: How will the performance of the project be monitored?

Please describe how you will monitor the achievement of the foreseen results
Please list two indicators(sex-disaggregated)of achievement for each of the results listed in 5.1.

(Max 300 words)
9.2 / EVALUATION
Please specify what disposition your organisation will take to make sure a final independent evaluation of the project will be conducted.
Please keep in mind that the independent evaluation is compulsory and the applicant has to include a provision in its budget of a minimum of USD 2,000(5% of total)(see guidelines)
(Max 200 words)
9.3 / LESSONS LEARNT & DISSEMINATION:
Please explain how lessons learnt from this project will be disseminated.
(Max 250 words)
SECTION 10: BUDGET, PROJECT INPUTS AND COFUNDING BREAKDOWN
Please fill also the annexed detailed budget
10.1 / INPUTS
What are the human resources and inputs needed to conduct the activities listed and achieve the results (staff, seed money for loans, guarantee scheme, training, consultants, material, equipment type, etc.)? The grant should primarily serve as seed money to provide credit facilities for the target groups. Other inputs (staff, training, equipment, etc.) should be recorded but largely funded through in-cash and/or in-kind contribution from the applicant (see guidelines, section on terms of conditions).
Please keep in mind that all inputs listed here should also appear in the Budget Form (to be filled in separately and annexed to the application) and vice versa
10.2 / IN-KIND CONTRIBUTION OF THE APPLICANT?
Please list the in-kind contribution and how your organisation will report on its use (example: time sheet for staff paid by applicant and accounted for the project, etc.)
10.3 / CO-FUNDING BREAKDOWN
Total Project Budget / 2012
(in USD)
Contribution of the applicant (in kind)
Contribution of the applicant (in cash)
Funding requested from UNDAP COOP Challenge Fund
Partner contribution, if any (in kind)
Partner contribution, if any (in cash)
Please specify what % of the budget relates to the monitoring and evaluation.
SECTION 12: DOCUMENTATION PROVIDED – CHECKLIST
12.1 / Please check boxes for each of the documents you have submitted with your proposal / Mandatory for all projects
□Cover letter
□Application Form
□Budget form
□UNDAP COOPObjectives Matrix
□Work plan and Monitoring Matrix
□Commitment letters (when partners are involved)
□Copy of official registration certificate
□Detailed CV of key persons
□Certification of labour compliance
Additional documents mandatory for first time applicants only
□Constitution
□Latest annual Accounts
Optional Document
□Fully-fledged Business plan (applicants may be asked to submit it at a later stage but can submit it straight with the application form)

UNDAP COOP Objectives Matrix

Please answer the questions below based on your project’s targets (expected results). It is not expected that all projects will have project targets relating to every question. If the indicator is not relevant to the project please write NA in the Answer column. This matrix will help us to assess the contribution of your project to UNDAP objectives. Please note these questions are of key concern to us and need to be referred to in the M&E section of the Application Form as well as in the Workplan.

UNDAPobjective: Agriculture support organizations and small-holder farmers increase agricultural productivity, access to markets and food security
No. / Question / Answer
1 / * How many loans will be disbursed to farmers’ organizations through the project? / Baseline (Number of loans disbursed to farmers’ organizations, by sex and value of gross portfolioper product in local currency and USD)
Target (Number of loans disbursed to youth groups through the project, by sex and value of gross portfolio per product in local currency and USD)
2 / *How many young women and men will benefit from the loans disbursed through the project? / Baseline (Number of young women and men benefiting from loans prior to the project implementation, by sex)
Target (Number of young women and men benefiting from loans provided through the project, by sex if possible)
3 / * How many jobs for women and men will be created through the project? / Target (Number of new jobs linked to project management, by sex):
Target (Number of new jobs not linked to project management, by sex):
4 / * How many new start-up businesses will be created thanks to the project? / Target (Number of new start-up businesses established by the beneficiaries of the loans)
Provide an explanation:
5 / *How many self-help groups established/strengthened through the project will have access to credit thanks to the project? / Target (Number of self-help groups that have access to credit)
6 / *How many cooperatives established/strengthened through the project will have access to credit thanks to the project? / Target (Number of cooperatives that have access to credit)
7 / *How many small and medium enterprises established/strengthened through the project will have access to credit thanks to the project? / Target (Number of small and medium enterprises that have access to credit)
8 / *Increase in income levels of the members of farmers organizations / Baseline : Average Member Income before the project (female and male)
Target:
9 / *No. of existing jobs improved / Baseline: N/A
Target: No. of existing jobs improved by the end of the project: (female and male)

[1] Project should start not before May 1st 2012, and end no later than November 30th 2012.