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A1 - CN Application Form

Southern Africa Trust is seeking proposals for rebranding of Vicco group products. Organisation must provide full legal name, physical address, Telephone number, Fax number, e-mail address and Website address. Project must be implemented in countries in which it is based.

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Priyanka Sj
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79 views

A1 - CN Application Form

Southern Africa Trust is seeking proposals for rebranding of Vicco group products. Organisation must provide full legal name, physical address, Telephone number, Fax number, e-mail address and Website address. Project must be implemented in countries in which it is based.

Uploaded by

Priyanka Sj
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 4

Concept Note

Concept Note reference


number 001
Given by the Trust in the call for
proposals

Project Title Rebranding of Vicco group products

Section 1: General Organisational Information

Full legal name of lead organisation Vicco group

Acronym -

Legal status (type of organisation) Private

Physical address 25, Jerbai Wadia Road,


Include country Bhoiwada, Parel,
Mumbai - 400 012
Tel. : +91 22 24147780
+91 22 24143552
+91 22 24149096
+91 22 24147992

FAX : +91 22 24143316

E-mail : gkp@vicc olabs.c om

Head office physical address


If different from above
Postal address

Name of contact person

Telephone number
Include country code
Fax number
Include country code
E-mail address of contact person

Website address

Country in which head office is based

In which countries in will the project be


implemented

Section 2: Budget Estimate and Implementation period


Total budget estimate for implementation of proposal USD
Total estimate grant amount to be requested from the Southern Africa USD
Trust

Period of implementation [insert number] months from [insert month] [insert year] to [insert month] [insert year]

Have you submitted any other proposals under this call? YES If yes, list the proposal reference numbers assigned to the
Delete incorrect answer NO other proposals by the Trust:

© Southern Africa Trust: Grant Application Form – Full Proposal A1 Page


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Section 3: Organisational Profile and Capacity

When was the lead organisation


founded?
When did the lead organisation start its
activities?
When was the network/alliance/coalition
founded? (if applicable)
When did the network/alliance/coalition
start its activities? (if applicable)
Which organisation/s initiated the
establishment of the
network/alliance/coalition?
(if applicable)
1
List the three MAIN activities of the lead
organisation at present
2
3
List the three MAIN activities of the 1
network/alliance/coalition at present (if 2
applicable) 3
Name Sex (M or F) Country of Origin

List the names, sex, and countries of


origin of the board of directors or
governors of the lead organisation

Name Sex (M or F) Country of Origin

List the names, sex, and countries of


origin of the board of directors or
governors of the
network/alliance/coalition
(if applicable)

Has the organisation ever before


managed a grant of a similar amount to
the one you are requesting from the
Southern Africa Trust? If yes, give a very
brief description of the project (no more
than fifty words).
What was the lead organisation’s total
annual expenditure in the last financial
year? In US Dollars
How many staff does the lead
organisation currently employ?
Is the lead organisation a member of any
other networks/alliances/coalitions or
umbrella bodies? If yes, list them.

Other organisations in
partnership/alliance/coalition to
implement this proposal
© Southern Africa Trust: Grant Application Form – Full Proposal A1 Page
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Section 4: Background/Situational Analysis

Problem Analysis In the space below, give a summary outline of the background, context, and rationale to explain why
your organisation thinks it is important to undertake this proposed initiative. The summary should be no longer than half a page.

Section 5: Results: Proposed Project Goal, Outcomes and Outputs

State the main AIM or GOAL of the project


This is the higher level objective to which the proposed project is intended to contribute. List only one MAIN goal of the project
that seeks to address the problem(s) identified above

Main outcomes of the project


These are the intended short-term and medium-term effects of the proposed project. Outcomes give an indication of the
impact of the project. List no more than three main outcomes.
1

Section 6: Processes
In the space below, very briefly describe the preparatory and follow up processes or the broader programmatic context that is
related to the project or programme proposed. This is especially relevant for proposals that include conferences or once-off
© Southern Africa Trust: Grant Application Form – Full Proposal A1 Page
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events. We will use some of this information to assess the sustainability, due process, and legitimacy of some of the activities
being proposed.

Section 7: Target Groups, Countries of Implementation


Main target groups
Country/ies of implementation

Section 8: Budget Summary Estimates


Budget Line Amount
Programme/project Costs
Travel Costs
Meetings, Workshops and Conferences
Research
Publications
Special Events
Operational Costs
Human Resources
Office Running Costs
Audit Fees
Capital Costs
Office Furniture and Equipment
Other (specify)
Grants
Grants to other organisation (specify)
Total

Section 9: Declaration
I, the undersigned, being the person responsible in the applicant organisation or lead organisation for the
project/programme, certify that:
• The information given in this declaration is correct; and
• Any organisation mentioned as a partner organisation in the implementation of this proposal as part of a
network, alliance, coalition or other collaborative arrangement, is aware of this application to the Southern
Africa Trust and consent’s to its submission.

Name: [add name]

Designation: [add position]

Signature: _____________________________

Date: DD/MM/YYYY

Place: [add town and country]

NOTE: When completed, this entire form should not be more than four pages long. Concept notes that are longer than four pages
may not be considered by the appraisals committee. All proposals must be submitted in a sealed envelope addressed to the
Grants Manager, Southern Africa Trust. The outside of the envelope must reflect the name and return address of the applicant and
the proposal reference number. Applications must be sent by registered mail, courier, or hand-delivered to the addresses. Faxes
and e-mails will be accepted with prior arrangement with the grants facility. No late applications will be accepted. Please read and
complete this form with all due care. Omissions cannot be rectified and if any required information or documentation is missing,
your application may be rejected.

© Southern Africa Trust: Grant Application Form – Full Proposal A1 Page


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