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APPLICATION FORM - CONCEPT NOTE

  1. ELIGIBILITY

Before you start an application, please take the time to understand what we are looking for in our investments by reading carefully our Application Guidelines. The fund’s review process is highly selective and rigorous, and only those that are rated highly according to the selection criteria are invited to submit full proposals. Keep in mind that in the process of filling in the application form, you can save the information and continue at a later time.

Am I eligible for IAP? / Yes / No
My business idea will be inclusive of the Low Income People (LIP) either as suppliers, employees, distributors and/or consumers for mutual benefits?
My business idea is relevant to at least one of the four focus sectors of IAP and at least to one of the four target countries?
Does my business idea bring a clear product or business model innovation?
My company or partner(s) related to the proposed business idea are not involved in the arms, tobacco, alcohol and gambling industries; registered in so called tax-havens; involved in environmental or human rights abuses or corruption; or have not been an EU beneficiary of €200 000 or more in the last 3 years
My application is submitted and led by a private company, which secures a co-investment ≥ 51%, of which part of it should directly benefit the LIP

* Low income people (LIP): those living in urban or rural areas on USD 8 or less per day per capita; equivalent to USD2,920 per capita per year.
** Sectors: Agriculture and food, energy, WASH or ICT. Countries: Cambodia, Ethiopia, Uganda, Zambia.
*** According to EU regulations, a company in the EU may receive a maximum of €200,000 in public funding from European authorities during a three year period. Sida as the donor of IAP also applies the same rule also to companies which are not based in the EU.

  1. ABOUT YOUR COMPANY

General data

Company name:
Address / Contact person
Telephone number / Year of establishment and business registration No
E-mail / Country of registration
Website / Type of legal entity

Staff information

2014 / 2015 / 2016 (if available)
# offull time employees
# offemale full time employees

Financial information

2014 / 2015 / 2016 (if available)
Revenues (EUR)
Net Profit (EUR)
Liabilities (EUR)
Equity (EUR)

Company description

Describe the following: history of the company, relation to any mother or sister organizations, organizational and, mission, vision and future strategy, sector active in, products and/or services (max 1200 characters)

Responsible Business: Self-Assessment*

1
(lowest) / 2 / 3 / 4 (highest)
Labour: Compliance with decent labour conditions, entailing fair remuneration in the scale of minimum national wage or higher, policy on no child labour, non-discriminatory practices and safe working conditions.
Environment: Compliance with local minimum environmental standards; taking actions to reduce the consumption of energy and raw materials, limit greenhouse gas emissions, minimize waste and pollution, and protect and restore ecosystems.
Tax: Compliance with local regulations and procedures.
Ethics and Anti-corruption: compliance with relevant regulations on anti-corruption and fraud.

* The information provided will be verified by the IAP team at a later stage of the selection process. This information will be used to assess the potential for improvement.

  1. BUSINESS IDEA AND THE REQUIRED FINANCING

General information

Short name of the proposed inclusive business project
One sentence pitch summarizing your idea (max 180 characters)
Please give a pitch summarizing your innovative Inclusive Business idea in one sentence only
Country/countries where project will operate
Sector of this project
Please pick only the most relevant sector / Agriculture and food
Energy / Water, sanitation, and hygiene
Information and communication technologies (ICT)
Current stage of the project (multiple answers allowed) / Concept
Pilot / Implementation
Scaling up
Other…
Describe project partners and their roles (max 1200 characters)

Inclusive Business Idea

Descriptions
What is the market opportunity? (Max 1200 characters)
What is the proposed inclusive business ideathat can create social impact and business growth and how is this profitable for the company? (Max 3000 characters)
Describe how the proposed project is innovative and the rationale behind the innovation (Max 1800 characters)
What is the proposed timeframe and what are the expected results of the project?(Max 1200 characters)
Describe how the business model will be sustainable and scalable after the IAP funding and support (Max 1200 characters)
Describe your key team members and their relevant skills for the success of your project (max 1800characters)
  1. SOCIAL AND ENVIRONMENTAL IMPACT

The expected benefits and results from IAP are related to good financial performance of the companies and social return regarding jobs created, income increase and access to basic goods & services by the low income beneficiaries, including women. Moreover, any environmental impact by the company’s activities is mitigated. The following questions are related to the social and environmental impact of the proposed project.

Social impact indicators

Description (Only for low income beneficiaries(<8 USD per day)The above-mentioned impact rationale should be reflected in quantitative terms in the following table (For low income people (<8 USD per day)) / Total
(by project end)
# of new jobs
# of new beneficiaries with increased income
# of new beneficiaries with access to basic goods and services
Ratio of female beneficiaries / %
Describe how women and young individuals will be included and empowered (max 1800 characters)

Environmental Impact

What would be the potential impact on the environment and how does the company plan to mitigate environmental risks? (Max 1800 characters)
  1. PROJECT BUDGET AND FINANCING REQUIRED

Why does your company need financial support from IAP?(Max 1800 characters)If the project will be implemented by multiple partners, please specify how much each implementing partner will contribute.
Budget Item / Total financing (EUR) / Total financing (cash and in-kind) / Company contribution
in-kind (EUR)
Company / IAP / Other
Project total cost / € / % / € / % / € / %

N.B. The company co-investment should be at least 51% of the total project investment size, other sources funding will be added to the company contribution. The IAP funding cannot exceed €200 000.

I confirm that the information given in this form is true, complete and accurate and accept the IAP application terms and conditions

View the Terms and Conditions: