standard format for small and medium size matching grants

8/13/2019 Standard Format for Small and Medium Size Matching Grants

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ANNEX 3: STANDARD FORMAT FOR PCN SUBMISSION

Documents required in PCN

SN Documents1 A copy of registration certificate issued by the competent authorities as

specified in eligibility criteria2 A copy of registration certificate at Inland Revenue Office as applicable3 Applicant s profile and e!perience including certificates of a"ards and pri#es

if received $focus on applied value chain%& Audit reports and ta! clearance certificates as applicable' Statement on partnership and collaboration among applicants "ith the

description of roles and responsibilities of all applicants and identification ofthe lead applicant

( Documentary evidence on financial solvability of the applicant) Direct beneficiaries $*urrent and targeted%+ See belo" for the definition of

the direct beneficiaries+

Direct Beneficiaries: Direct beneficiaries are those members of a grant applicantorgani#ation $,A% "ho "ould directly participate in the proposed sub-pro.ect byproviding part of share/contribution in cash sub.ect to the approval of the proposal as

agreed by successful applicant $,rant recipient% "ith the 0A* and also contributing topro.ect ob.ective as "ell+ his implies that all direct beneficiaries are members of agrant recipient but all members may not necessarily be direct beneficiaries 1+

hen ,R is a private firm engaged in the production of a primary product li e ra" miland vegetables4 its shareholders or partners are direct beneficiaries in addition tothose 55s "ho also participate in sub-pro.ect activity and contribute to 0DO asdepicted above 2+ 6i e"ise4 "hen a ,R is a processor engaged in the value addition of aprimary product li e mil 4 coffee and cereal seeds4 55s supplying a primary product toit on regular/daily basis for the production of a processed product/value addition "ithsome traceable arrangements li e buy-bac are direct beneficiaries+ Similarly4 direct

beneficiaries of a mar et committee are those traders "ho either rent stall/spacedeveloped by the committee through 0A* s matching grant4 or provide part of thecost incurred in the stall/mar et development+

Date of Submission7 8888888888888

1 A ,R cooperative or a farmer group may have '99 general members4 but only 199 membersmay have been participating in 0A* s sub-pro.ect+ In this instance4 these 199 55s are thedirect beneficiaries and remaining &99 55s could be considered as indirect beneficiariessince they could eventually share part of the profit earned by their respective organi#ation4if earned and distributed or benefit through demonstration effect+

2 0ersons "or ing in full time or part-time employment "ill not be considered as directbeneficiaries+ Rather4 they could be considered as indirect beneficiaries+

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$b% ;inancial

$c%


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0it" 'ouror)%ni*%tion

III+ 0lan for value chain lin ages and collaboration

I@+ Inputs to be used

@+ Activities by applicants

@I+ 0lease provide brea do"n of cost by ey activities proposed+

SN -e' %cti.ities PACT2s)r%nt

A##$ic%nt2scontri!ution

Tot%$ /o0 does t"e%##$ic%nt intendsto &in%nce itscontri!ution

otal

@II+ *ost summary by type of cost and financing source

S+N ;unding source NRs1 ApplicantCs contribution $O"n source as e?uity4 o"n

investment and credit$a% *apital$b%Recurrent

2 ,rant re?uested from 0A* $a% *apital-$b% Recurrent-

otal *ost

@III+ >!pected coverage4 outputs and outcomes

I + Impact

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II+ Income pro.ection $costs4 benefits and income in the initial years4 net incomeper unit area4 per 55s4 per livestoc unit as applicable%

III+ Innovativeness7 $Describe ho" this pro.ect is different from others%I@+ Discussions on sustainability

@+ hy do you thin that your group $partners% is the most deserving andcompetent for 0A* s matching grant assistanceB

C En.ironment %nd Soci%$ S%&e)u%rd Me%sures

0rovide the declarations about the follo"ing environment and social safeguard measure+

uestions Response$Ees/No%

If yes in thesurroundings4

please specify4ho" far $appro!m% it is locatedB

1+ Does this sub-pro.ect intend to use ordepend on any resources of national par sand protected areas or any critical a?uaticand terrestrial habitat areaB

2+ ill this sub-pro.ect be implemented inareas surroundings of any national par sand protected areasB

3+ ill this sub-pro.ect be implemented inareas surroundings of any resources4forest and "ildlife resources other thannational par s and protected areas

&+ ill this sub-pro.ect be implemented inthe surroundings of "ater bodies4 la es and

ponds and intend to use or depend on themfor the implementationB'+ ill this sub-pro.ect be implemented in

the surroundings of drin ing "ater bodies4la es and ponds and intend to use ordepend on them for the implementationB

(+ Is the pro.ect area proposed in thisproposal located in high ris #one such aslandslide prone area4 steep slopes4 highlydegraded land in hills4 reverie areasusceptible to annually flooding4 or in areascausing large-scale soil erosionB

)+ ill this sub-pro.ect involve land clearance5


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uestions Response$Ees/No%

If yes in thesurroundings4

please specify4ho" far $appro!

m% it is locatedBon slopes greater than &' degreeBF+ ill this sub-pro.ect affect a heritage

siteBG+ ill this sub-pro.ect be implemented in

the surroundings of heritage site/religioustemple/religious site

19+ ill this pro.ect be implemented in thesurroundings of heritage site/religioustemple/religious site

11+ ill this sub-pro.ect be implemented inthe surroundings of grave yard

12+ ill this sub-pro.ect involve in logging orcausing any ma.or environmental harmB

13+ Is this sub-pro.ect li ely to eliminateindigenous plant species of ecologicalsignificanceB

1&+ Does this proposal involve any activity thatis li ely to ma e irreversible adverseimpact on indigenous communities4 "omenand vulnerable groupsB

1'+ Does this proposal include any activity thatpromotes or involves incidence of childlaborB

1(+ Does this proposal re?uire some familieslosing their prime farm land and assets onthe land and displacement of families dueto construction of infrastructureB

1)+ Does the sub-pro.ect intend to use any

banned pesticides and chemicalsB1F+ Are main ethnic groups residing in the

surroundings of the proposed sub-pro.ectarea are also the direct beneficiary

1G+ If yes to the above ?uestion4 pleaseprovide appro!imate proportion by ethnicgroups

Specific activities or practices proposed to prevent or mitigate any environmental orsocial problems that may arise from the implementation of the proposal4 if selected

Representing authorities from the grant applicant

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*hairpersonH *ontact personNameSignatureDate

H If chairperson and contact person is the same person4 please include herethe vice chairperson or any other members of the e!ecutive committee+

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