Quick Scan form DRIVE

April 2017

Instructions for use:

·  This Quick Scan form is meant for interested companies that want to assess whether their project idea would possibly fit DRIVE. It is an additional service offered by the Netherlands Enterprise Agency (RVO.nl) before entering the intake phase. 11-8-201513-4-2017

·  Be concise but clear. The more concrete you fill in this form, the better RVO.nl can assess whether your project is fit for DRIVE.

·  The information you provide is not considered an official application for a DRIVE contribution, nor will it have any bearing on the actual intake and application procedures.

·  The information you provide will be treated confidentially and will not be used for any other purpose than the Quick Scan service.

·  RVO.nl only takes into consideration fully filled out forms.

·  After receipt of your form, one of our project advisors will contact you shortly about further steps in the procedure.

·  After completion you can send the form to:

Date

Applicant

Company
Contact name
Telephone
Country
Email
Website
Main activity

General Information Applicant

Number of employees
Turnover last book year
Net profit last book year
Equity last book year
Total Assets last book year

General Information about the DRIVE project

Project title
Country
Region
Sector / Food security
Water
Sexual and reproductive health and rights
Climate
Other, being:
Local authority
Main activity of local authority
Elaboration
Role of local authority in project
Elaboration

Outline of the DRIVE project

Give an outline of the DRIVE project
Outline
Feasibility study available? When available, please attach
Yes / No
Environmental and Social Impact Assessment[1] (ESIA) available? When available, please attach
Yes / No
Estimated publication date of the tender
Date:
Estimated DRIVE project costs
EUR
How will the DRIVE project be financed by the local authority?
Elaboration
What is the desired financial support by DRIVE? Explain the financial planning for the project.
Elaboration

Outline of the total project[2] (when applicable)

If the DRIVE project is part of a larger project, give an outline of the total project and its components.
Outline and components
Estimated costs of the total project
EUR
How will the total project be financed by the local authority?
Elaboration

Development Relevance

Give an outline of the background of the (total) project and the problem that the project will solve or the demands that the project will meet.
Outline
Give an outline of the total project effects on local private sector development.
Outline

2015_005_QSD_Quick Scan form DRIVE 4

[1]

http://www.ifc.org/performancestandards

[2] A distinction is being made between the (total) infrastructure project and the DRIVE project. The definition of infrastructure project is based on the OECD definition the smallest productive entity : “the smallest complete productive entity, physically and technically integrated, that fully utilizes the proposed investment and captures all financial benefits that can be attributed to the investment.” For example: "the project is defined as the development, construction, equipping and subsequent use and maintenance of a regional hospital in city X, country Y".

·  The (total) infrastructure project may have a broader scope than the DRIVE project.

·  The DRIVE project consists of the contract for works or goods, and if applicable supervision, and the related financing costs. The DRIVE project may be part of the (total) infrastructure project.