Ministry Of Business, Innovation & EmploymentPage 1 of 13Community Organisation Application Form

Community Organisation Refugee Sponsorship Category

MBIERFAApplication Form Template

Check list for Applicants

Ministry Of Business, Innovation & EmploymentPage 1 of 13Community Organisation Application Form

Community Organisation Refugee Sponsorship Category

Task / 
1.Complete all sections of the Application Form.
2.Delete all ‘Tips for Applicants’ boxes from the Application Form and remove all yellow highlight throughout.
3.Make sure that you have complied with the following instructions:
  • Ensure that your email attachments are no greater than 30MB. If your application exceeds this size it may be automatically rejected by our servers.
  • You can submit your application in two or more parts if needed, but please appropriately label these.
  • Ensure that all file attachments used are compatible with Microsoft Office or Adobe Acrobat software.
  • Ensure that all materials submitted are complete, legible and readable.

4.Arrange for the declaration to be signed.
5.Prepare your Application for electronic submission by creating final soft copies of all documents and required paperwork.
6.Arrange for the Application to be submitted via email to before the Deadline for Applications.

Community Organisation Refugee Sponsorship Category

RFA Application Form

Submitted by [Respondent Name]

Date of this Application: [insert date of this document]

Ministry of Business, Innovation and Employment

15 Stout Street

PO Box 1473

Wellington 6140


Tips for Applicants / Words and phrases that have a special meaning are shown by the use of capitals. Refer to Appendix A of the Request for Applications (RFA) for definitions.

Community Organization Refugee Sponsorship Category Pilot

Application Form Template for Community Organisations

1.About the Applicant


Tips for Applicants /
  • The section gives MBIE basic information about your organisation and identifies your Point of Contact for the duration of the RFA process.
  • If an item is not applicable e.g. you do not have a registered office complete the box by stating ‘not applicable’.
  • If you are submitting a joint or consortiumApplication complete an ‘Our profile’ table for each Applicant Organisation. Cut and paste the table as appropriate. Provide only one Point of Contact for your joint/consortiumApplication.

Our profile

Choose one of these statements to complete, and delete the others

This is an Application by [insert the name of your organisation] (the Applicant) alone to deliver the Requirements.

OR This is a [joint/consortium] Application, by [insert the name of your organisation] and [insert the name of the other organisation/s] (together the Applicants) to deliver the Requirements.

Item / Detail
Trading name: / [insert the name that you do business under]
Full legal name (if different): / [if applicable]
Physical address: / [if more than one office – put the address of your head office]
Postal address: / [e.g. P.O Box address]
Registered office: / [if you have a registered office insert the address here]
Business website: / [URL address]
Type of entity (legal status): / [sole trader / partnership / limited liability company / other please specify]
Registration Number/Unique Identifier (e.g. NZBN) / [if your organisation has a New Zealand issued registration number or overseas equivalent, insert it here and identify what it is]
Country of residence: / [insert country where you (if you are a sole trader) or your organisation is resident for tax purposes]
GST registration number: / [NZ GST number if applicable / if overseas please state]

Our Point of Contact

Item / Detail
Contact person: / [name of the person responsible for communicating with MBIE]
Position: / [job title or position]
Phone number: / [landline]
Mobile number: / [mobile]
Email address: / [work email]

2.Response to the Requirements


Tips for Applicants /
  • In this section you are asked to provide your response to our Requirements (RFA Section 2) by demonstrating your organisation’s ability to meet our criteria (RFA Section 3: Our Evaluation Approach). Carefully read RFA Sections 2 and 3 before completing this part.
  • If there is anything that you do not understand ask our Point of Contact to clarify.
  • If any information you provide is commercially sensitive to your business you must let MBIE know. Please mark the information ‘commercially sensitive’ or ‘Confidential Information’. It is not acceptable to render this whole document confidential unless this is truly the case. MBIE has a duty to protect Confidential Information, subject to the exceptions in the RFA Terms (Section 5).
  • If some of an answer is in another document e.g. a marketing brochure, copy and paste the relevant extract into thisApplication. Do not submit the whole brochure.Please do not include any advertising brochures or similar material in your Application.
  • You may include information not specifically requested by us in yourApplication. But only if it adds value and is relevant to the Requirements.

Pre-conditions


Tips for Applicants /
  • You must be able to answer ‘yes’ to each of these pre-conditions. Make sure you are able to verify that this is the case, if asked.
  • ‘Yes’ means that you can currently meet the pre-condition. It does not mean that you are planning to, or intend to at some time in the future.
  • If you cannot answer ‘yes’ to all, your Application will not meet the basic Requirements and will be declined.

# / Pre-condition / Meets
1. / Applicant community organisation must be a legal entity. / [Yes/No]
2. / Applicant community organisation must have the financial resources to meet the Approved Sponsor settlement responsibilities. / [Yes/No]
3. / Applicant community organisation must have previous experience working with refugees and/or vulnerable people. / [Yes/No]
4. / Applicant community organisation must have the capability and capacity to arrange suitable accommodation and employment support for the sponsored refugees. / [Yes/No]
5. / Applicant community organisation must be willing and able to enter into a Deed of Agreement for Services with MBIE for the provision of settlement services to the agreed standard. The Authorised Representative who will sign the Deed of Agreement for Services (Agreement) on behalf of the community organisation must be:
  • 18 years of age or older; and
  • a New Zealand citizen or permanent resident.
/ [Yes/No]

Overview of our Organisation and Application

Please provide an overview of your organisation and application.

Overview of your Organisation
Please provide an overview of your organisation, for example, your organisation’s background, history, mission/purpose and goals.
Overview of your Application
Please provide an overview of your Application, for example the length of the sponsorship arrangement proposed, how many refugee candidates you wish to sponsor, duration/sponsorship periods, etc.
Identification of refugee candidates:
Choose one of these statements to complete, and delete the other:
We intend to nominate the refugees we wish to sponsor if we are selected as an Approved Sponsor for the pilot of the CORS. [The CORS Refugee Nomination Formwill shortly be available on the INZ website].
OR
We wish to sponsor refugees who have been referred to Immigration New Zealand by the United Nations High Commissioner for Refugees (UNHCR). [The CORS Referred Refugee Form will shortly be available on the INZ website.]

Questions relating to the evaluation criteria


Tips for Applicants /
  • Here you are asked to answer questions relating to the evaluation criteria. Your Application will be scored against your answers to these criteria. Aim to give answers that are relevant, concise and comprehensive.
  • Consider the percentage (%) weighting for each criterion. The higher the weighting, the more important it is. Take the weightings into account in deciding how much detail to include.
  • If you have made any assumption about the Requirements or any aspect of the criteria, clearly state the assumption.
  • There may be several questions that relate to one criterion. These questions are not individually weighted, so you should assume that they are of equal importance.

Criterion
1. Financial Viability / 20%
a.)Please outline the financial resources available to your organisation. Please also explain how these resources are sufficient to meet the sponsorship responsibilities following Sponsored Refugees’ arrival in New Zealand for a minimum of two (2) years.
[Please insert answer here]
b.)Please provide an overview of your organisation’s income and expenditure (including commitments), and outline how these demonstrate financial solvency for the period of sponsorship.
[Please insert answer here]
c.)Please provide a proposed, indicative budget that captures the Approved Sponsor’s Settlement Service responsibilities. Also outline what contingencies or reserves (if any) are available.
[Please insert answer here]
d.)Please summarise the evidence of funds, assets and other resources held by your organisation to meet the resourcing requirements. Please provide this evidence in your final application when you submit.
[Please insert answer here]
2. Capability of the Applicant to deliver Settlement Services to Sponsored Refugees / 40%
a.)Please provide a summary of your organisation’s capability to meet the Approved Sponsor’s Settlement Service responsibilities for two years.
[Please insert answer here]
b.)Please outline and detail the experience your organisation and staff/personnel have had working with refugees and/or vulnerable people, including in delivering budgeting, education, housing and health advice or support.
[Please insert answer here]
c.)Please outline the relationships and/or networks your organisation has with third parties that are able to support aspects of refugee settlement in the community. Demonstrate or explain how these relationships and/or networks relate to each of the following:
  • Housing
  • Education
  • Health and Mental Health
  • Community Orientation

[Please insert answer here]
d.)Please detail the links your organisation has to the wider community, and explain how these will support the community orientation to be provided to Sponsored Refugees.
[Please insert answer here]
e.)Please provide detail about the support that your organisation is able to provide to Sponsored Refugees in the area of employment, employment advice and skills or employment training (including any linkages to employers or training and education institutes).
[Please insert answer here]
f.)Please provide detail about the areas your organisation would include in a Settlement Plan for a Sponsored Refugee. You could include a detailed Plan as an attachment if available.
[Please insert answer here]
g.)Please describe how you have considered contingency planning to address possible problems that may arise with the provision of the Approved Sponsor’s Settlement Service responsibilities, and outline what the contingency plans are.
[Please insert answer here]
3. Capacity of the Applicantto deliver Settlement Services to Sponsored Refugees / 40%
a.)Please outline your organisation’s size, structure and key relationships. Explain how these support the aims and objectives of your organisation as well as the aims and objectives of the Community Organisation Refugee Sponsorship Category.
[Please insert answer here]
b.)Please outline and detail the human resources, networks or linkages your organisation has with other organisations or community groups, and detail their respective roles in implementing the Settlement Plan, or elements of the Settlement Services provided to Sponsored Refugees.
[Please insert answer here]
c.)Please detail the non-financial resources, skills and expertise in your organisation that would support the settlement of the sponsored refugees and their families, for example people/key personnel, systems and processes or networks.
[Please insert answer here]
d.)Please detail the ability of your organisation, or linkages with other organisations, to deliver appropriate and adequate furnished housing for Sponsored Refugees on their arrival in New Zealand.
[Please insert answer here]
e.)Please detail the systems, processes and methods that your organisation will use to manage and implement the Sponsored Refugees’ Settlement Plan, and delivery of the Settlement Services. If applicable to your application, please also include in your answer how links to other organisations will be used.
[Please insert answer here]

Assumptions

Please state any assumptions you have made in relation to the Requirements, Criteria or Questions above. Where you have made assumptions in relation to budgeting or financials, please state these in the next section.
[Please insert answer here]

3.Financial Viability


Tips for Applicants /
  • In Criteria 1 we have outlined the financial viability information that we are seeking. This should inform you on how to present your financial information. In this section of the RFA Application Form we have provided further space which you can use for your financial information.
  • In preparing your financial information you must consider all risks, contingencies and other circumstances relating to the delivery of our Requirements and include adequate provision for them. You must also document any assumptions that you have made in costing the full delivery of the Requirements.
  • Please ensure that you include copies of evidential documents as appropriate. If these must be treated as commercially sensitive, please label these as such. All documents and Applications will be treated as confidential.

Supporting Documents

Please submit your financial information, including a proposed, indicative budgetas separate documents/attachments to this application form. Please also provide any evidence or supporting documents related to your financial and non-financial resources, and include these as separate attachments.

Please list all attached financial documents. Include the name/title and a brief description of each document.
[Please insert answer here]

Assumptions

Please state any assumptions you have made in relation to the pricing information.

Please state any assumptions you have made in relation to the Financial Viability criteria, supporting documents or indicative budget. Where you have made assumptions in relation to the non-financial criteria, please outline in the Assumptions area at the end of Section 2.
[Please insert answer here]

4.Deed of Agreement for Services


Tips for Applicants /
  • In the RFA Section 4 we have detailed the terms and conditions of our Deed of Agreement for Services (“Agreement”). We need to know whether or not you are prepared to accept this Agreement.
  • If you have any points that you wish to make about the Agreement this is where you tell us.
  • In deciding which Applicants to shortlist MBIE will take into account each Applicant’s willingness to meet the Agreement terms and conditions.

Choose one and delete the other:

Having read and understood the Deed of Agreement for Services, in the RFA Section 4, I confirm that these terms and conditions are acceptable. If successful, I agree to sign a Deed of Agreement for Services.

OR

Having read and understood the Deed of Agreement for Services, in the RFA Section 4, I have the following suggestions to make. If successful, I agree to sign a Deed of Agreement for Services based on the Agreement, subject to discussing the following:

Clause / Concern / Proposed Solution
[insert number] / [briefly describe your concern about this clause] / [describe your suggested alternative wording for the clause or your solution]
[insert number] / [briefly describe your concern about this clause] / [describe your suggested alternative wording for the clause or your solution]

5.Referees


Tips for Applicants /
  • Here you are asked to provide the names and contact details of your referees. These must be work or professional related referees, i.e. not a friend or family member.
  • The best referees are those for or with whom you have recently delivered similar services.
  • Before including their details check with them to make sure that they consent to acting as referee on behalf of your organisation.

Please supply the details ofat least two referees for your organisation. Include a brief description of the services that your organisation provided and when.

Please note: in providing these referees you authorise us to collect any information about your organisation, except commercially sensitive pricing information, from the referees, and use such information in the evaluation of your Application. You also agree that all information provided by the referee to us will be confidential to us.

First Referee
Name of referee: / [insert name of the referee]
Name of organisation: / [insert name of their organisation]
Goods/services provided: / [brief description of the goods/services you provided to this referee]
Date of provision: / [insert the date when you provided the goods/services]
Address: / [insert street address]
Telephone: / [insert mobile or landline]
Email: / [insert email address]
Please contact me before you approach this referee for a reference / Yes/Not required
Second Referee
Name of referee: / [insert name of the referee]
Name of organisation: / [insert name of their organisation]
Goods/services provided: / [brief description of the goods/services you provided to this referee]
Date of provision: / [insert the date when you provided the goods/services]
Address: / [insert street address]
Telephone: / [insert mobile or landline]
Email: / [insert email address]
Please contact me before you approach this referee for a reference / Yes/Not required

6.Our declaration


Tips for Applicants /
  • Here you are asked to answer questions and make a formal declaration.
  • Remember to select ‘agree’ or ‘disagree’ at the end of each row. If you don’t you will be deemed to have agreed.
  • Remember to get the declaration signed by someone who is authorised to sign and able to verify each of the elements of the declaration e.g. chief executive or a senior manager.
  • If you are submitting a joint or consortium Application each Applicant(Community Organisation involved in the joint or consortium Application) must complete a separate declaration.

Applicant’s declaration
Topic / Declaration / Applicant’s declaration
RFAProcess, Terms and Conditions: / I/we have read and fully understand this RFA, including the RFA Terms and Conditions (shortened to RFA-Terms detailed in Section 5, as amended by Section 1, paragraph 1.6. if applicable). I/we confirm that the Applicant/s agree to be bound by them. / [agree / disagree]
Collection of further information: / The Applicant/s authorisesMBIE to:
a.collect any information about the Applicant, except commercially sensitive pricing information, from any relevant third party, including a referee, or previous or existing client
b.Use such information in the evaluation of this Application.
The Applicant/s agrees that all such information will be confidential to MBIE. / [agree / disagree]
Requirements: / I/we have read and fully understand the nature and extent of MBIE’s Requirements as described in Section 2. I/we confirm thatthe Applicant/s has the necessary capacity and capability to fully meet or exceed the Requirements and will be available to deliver throughout the Sponsorship period. / [agree / disagree]
Ethics: / In submitting this Application the Applicant/s warrants that it:
a.has not entered into any improper, illegal, collusive or anti-competitive arrangements with any Competitor
b.has not directly or indirectly approached any representative of MBIE(other than the Point of Contact) to lobby or solicit information in relation to the RFA
c.has not attempted to influence, or provide any form of personal inducement, reward or benefit to any representative of MBIE. / [agree / disagree]
Offer Validity Period: / I/we confirm that this Application, including the financial information, remains open for acceptance for the Offer Validity Period stated in Section 1, paragraph 1.6. / [agree / disagree]
Conflict of Interest declaration: / The Applicant warrants that it has no actual, potential or perceived Conflict of Interest in submitting this Application, or entering into a Deed of Agreement for Services to deliver the Requirements. Where a Conflict of Interest arises during the RFA process the Applicant/s will report it immediately to MBIE’s Point of Contact. / [agree / disagree]
Details of conflict of interest:[if you think you may have a conflict of interest briefly describe the conflict and how you propose to manage it or write ‘not applicable’].
DECLARATION
I/we declare that in submitting theApplication and this declaration:
a.the information provided is true, accurate and complete and not misleading in any material respect
b.the Application does not contain intellectual property that will breach a third party’s rights
c.I/we have secured all appropriate authorisations to submit this Application,to make the statements and to provide the information in the Applicationand I/we am/are not aware of any impediments to enter into a Deed of Agreement for Services to deliver the Requirements.
I/we understand that the falsification of information, supplying misleading information or the suppression of material information in this declaration and the Application may result in the Application being eliminated from further participation in the RFA process and may be grounds for termination of anyDeed of Agreement for Services offered or awarded as a result of the RFA.
By signing this declaration the signatory below represents, warrants and agrees that he/she has been authorised by the Applicant Organisation/s to make this declaration on its/their behalf.
Signature:
Full name:
Title / position:
Name of organisation:
Date:

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