Application Questions – Results-Based Grants

Scaling Climate-Resilient WASH

This application form is aimed at impact enterprises within the WASH sector (water,
sanitation and hygiene) applying for a Results-Based Grant through the Scaling
Climate-Resilient WASH Programme.

For eligibility criteria and further information, please visit the links below:

Application Guidelines and FAQ (English)

Application Guidelines and FAQ (French)

Aqua for All’s Website

Aqua for All adheres to the relevant data protection laws, including the EU General Dat
Protection Regulation (GDPR). For more information, please refer to our Data
Protection Policy.

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1. General information questions:

1a. Enterprise name:

1b. Enterprise website:

1c. Applicant’s name:

1d. Applicant’s position:

1e. Email address:

1f. Founding year:

1g. Active in which countries:

Please list

1h. Legal form: (Multiple choice/single selection)

- Individual or sole proprietorship

- Partnership
- Private limited company
- Public listed company
- Non-profit
- Other

1i. Share of ownership by women

- <25%
- 25% - 50%
 - 51% - 75%
- 76% - 100%

1i. Please describe your enterprise in one sentence: (max. 500 characters)

1j. Number of full-time staff working for enterprise:

- 1-10
- 11-20
- 21-50
- > 50

2. Questions on business:

2a. What is your enterprise’s business model? (Multiple choice/multiple selection)

- B2C (Business to Consumer)

- B2G (Business to Government)
- B2B (Business to Business)
- B2B2C (Business to Business to Consumer)
- B2B2G (Business to Business to Government)
- B2B2B (Business to Business to Business))

2b. What is the stage of development of your enterprise? (Multiple choice)

- Formation/Concept stage (your enterprise is in the process of defining its mission and
vision with initial strategy and key milestones for the next few years.)
- Start-up/Early stage (your enterprise has a first product or service version in place and
is iterating and testing assumptions to demonstrate initial user growth and/or
revenue. You are considering or starting to attract additional resources.)
- Scaling/Growth (your enterprise is focusing on measurable growth in users and
revenues and/or market traction. You are considering or have already attracted
significant funding. Your enterprise can and wants to grow.)
- Expansion (your enterprise has grown and can attract financial and human resources
easily. You aim to grow further and consider to expand your products/services or to
enter other markets)
- Maturity (Your enterprise has achieved stable growth and profitability, with a strong
market presence and loyal customers. The focus is on maintaining/increasing market
share and optimizing operations, rather than expansion.)

2c. What are your main products and/or services?

(Please refer to each business line separately if multiple)

2d. What is your revenue model? (Multiple choice)

- Direct sales / markup (your enterprise earns money by selling goods at a price above
the costs involved in producing / providing it)
 - Subscription (your enterprise has a recurring revenue strategy, with customers paying
a pre-determined periodic cost, usually month to month)
- Rent/Lease (your enterprise receives recurring (rent) or one-time (lease) payments for
temporary use of a physical asset)
- Fee-for-service (customers pay your enterprise for the type of and / or the times the
service is provided, i.e., pay-as-you-go or pay-per-usage)
- Donations (your enterprise provides products and services free of cost (or highly
subsidised) and relies on donations, whether by the customers or external entities)
- Other

2e. Please indicate what percentage of the enterprise’s revenues comes from grants.
(i.e., time-limited philanthropic funding, excluding public contracts)

2f. If you have indicated more than 50%, please tell us whether and how (much) you are
planning to decrease the reliance on grants:

3. Questions on Scaling

3a. How do you plan to scale/grow in the next 3 to 5 years? Please include details on
your plan to achieve sustainability/profitability.
(e.g., public contracting, new partnerships, new geographical locations, economies of scale,
etc…)

3b. In this programme, enterprises will receive payments based on metrics aligned with
their scaling ambitions. Could you indicate what short-term goals your enterprise is
aiming to achieve in the upcoming 2 years, which could be the basis for results
payments? (500 words)

3b. Please indicate what (financial, human) resources you have available and/or what
you are raising in order to implement your upcoming project (500 words)

Results-based grants are paid upon completion of specified targets, requiring sufficient
working capital on behalf of the enterprise.

4. Questions on impact:

4a. What does your business focus on? (Multiple choice/multiple selection)

- Toilets/ containment
- Human waste collection and transport
- Waste/ wastewater treatment
- Circular economy (i.e., reuse human waste into high value end-products)
- Piped water supply
- Water technology solutions
- Operation and Maintenance (O&M) models
 - (Household) water treatment and storage
- Decentralised safe water services (e.g., safe water enterprises, kiosks)
- Water efficiency solutions
- Integrated water resource management (e.g., rainwater harvesting)
- Digital or smart technology solutions
- Hygiene and/or menstrual health
- Other

4b. Please describe your enterprise’s main impact on the WASH challenge you are
addressing. Please also highlight if your enterprise specifically targets low-income or
marginalised groups (max. 500 words)

4c. Please list out your main impact key performance indicators (KPIs) that you measure
(at least) on a yearly basis:

4d. Do you have a formal impact ambition or strategy? (Multiple choice)

(This can range from an impact statement or Theory of Change, to an impact strategy with
implementation plan, i.e. objectives and tools to measure and manage impact).
- Yes
- No
- Not clear yet

4e. Impact enterprises also have a unique opportunity to create positive impact gender
equality. With this in mind, we'd like to know if you see any opportunities for your
enterprise. (For example: women's ownership, leadership, employment, women-focused
products and/or services, etc.)
If so, please describe the impact you would like to generate:

5. Questions on climate:

Climate Risk and Emission assessment

5a. What changes to the climate and related hazards are you already experiencing
and/or do you expect over the coming years? How do these impact your operations
and/or your customers?

5b. Do you have an adaptation strategy to reduce the climate risks faced by your
operations and/or your customers?

5c. Which activity/area of your business is potentially creating negative impacts on the
climate through the emission of greenhouse gases?

5d. Do you have a mitigation strategy in place to reduce your greenhouse gas
emissions?

Assessment of climate impact targets

5e. Would you be interested in exploring your climate impact further?
If so, please describe the impact you would like to generate (For example: emission reduction,
higher resilience of operations and/or communities to climate change etc.):

6. Questions on previous support and current needs

6a. Has your organisation previously participated in an Acceleration/Incubation

programme or received Technical Assistance before? If so, please elaborate.

6b. If applicable, what specific challenges or obstacles are you currently facing in your
enterprise’s operations or processes?
(This can include but also be broader than funding/finance)

7. Questions on financials:

7a. What were your enterprise’s revenues, gross profit, EBITDA (earnings before
interest, tax, depreciation and amortization) and net profit in 2023 (in EUR)? Please list:
(You can use a currency converter like the one found here:)

1. Revenues
2. Gross Profit
3. EBITA
4. Net Profit

7b. What are your latest forecasts for 2024 (in EUR)? Please list revenues, gross profit,
EBITDA (earnings before interest, tax, depreciation and amortization) and net profit.
(You can use a currency converter like the one found here:)

1. Revenues
2. Gross Profit
3. EBITDA
4. Net profit

7c. What are your forecasts for 2025 (in EUR)? Please list revenues, gross profit,
EBITDA (earnings before interest, tax, depreciation and amortization) and net profit.
(You can use a currency converter like the one found here:)

1. Revenues
2. Gross Profit
3. EBITDA
4. Net profit

7d. Check for agreement: do you have AUDITED FINANCIALS for the years 2021, 2022,
2023 , which can be submitted during the due diligence
7e. If your enterprise has not yet reached breakeven, when is it expected to do so and
how?

7e. Are you planning to raise repayable finance (e.g., loans, equity, etc.) within a year and
what kind? (Multiple choice)

- No, we have never raised investment, and we are not planning to do so in the future.
- No, we have already raised investment, but we are not planning to undertake any
follow-on rounds for now.
- Yes, and this is our first-time raising repayable investment
- Yes, and we already have experience in raising repayable investment.

7f. Please your fundraising targets per source of funding for the next 3 years (in
numbers):

1. Debt:
2. Equity:
3. Mezzanine:
4. Grants:
5. Other:
6. N/A (Please explain):

8. Please enter the following additional information:

8a. Please upload your enterprise’s presentation or pitch deck.

(A version you have used for previous investors will suffice. We advise using a PDF).

8b. Is there anything else you would like to share with us?

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Can we contact you in the future? Please let us know if you allow us to keep your contact
and enterprise information to receive updates on existing and upcoming Scaling
Climate-Resilient WASH instruments, Aqua for All initiatives, call for applications, and
programmes for your consideration. If you change your mind, you can let us know at
any time by sending an email to [email protected]

- Yes, I give permission to have my contact and enterprise information stored and get
contacted in the future.
- No, I prefer not to be contacted. Please do not store my contact and enterprise
information.

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submitting your application.
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