ROYAL NORWEGIAN EMBASSY MACEDONIA QUESTIONNAIRE - SMALL POT FUNDING

1. INFORMATION ABOUT THE MUNICIPALITY Name of the Municipality: Postal address: Telephone: Fax: E-mail: Contact person, position: Authorised person, position: Ban account: !" Num#er $maticen #ro%&: Ban name: Period of existence and pre'ious achie'ements of the Municipality: Num#er of employees: Permanent: Financial capacity +as the applicant pre'iously recei'ed a *rant from the Em#assy, !f yes, -hen, 2. PARTNER / IMPLEMENTING ORGANIZATION (if a !" Name: Postal address: Telephone: Fax: E-mail: Contact person: Authorised person, position: #. ./ 0/ 1/ 3/ 5/ 6/ INFORMATION ABOUT THE PRO$ECT Pro%ect title: Pro%ect *oal: Tar*et 2roup: Pro%ect 4ustification: Pro%ect )trate*y +as this pro%ect #een su#mitted to other potential donors, $Please -rite the names of the donors& 7/ !nformation a#out Tender "ocumentation 8/ 9ther useful information that are not included -ith this :uestionnaire ;/ Total amount re:uested from the <oyal Nor-e*ian Em#assy $M="&: Pro'ided #y the )tate Bud*et:

(olunteers : Pro'ided #y "onations:

Total costs of the pro%ect $M="&:

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