DIRECT ASSISTANCE GRANT SCHEME

REGULAR PROCEDURES APPLICATION FORM

CARIBBEAN TRADE AND PRIVATE SECTOR DEVELOPMENT PROGRAMME PHASE 2

Caribbean Export Development Agency with the Financial Support of the European Union Call for proposals Number 01-10 Publication Date: March 8, 2010 Deadline: April 9, 2010 @ 4:30 p.m.

FULL LEGAL NAME OF APPLICANT INDUSTRY / SECTOR

Regular Procedures version February 2010

IMPORTANT NOTICE

Please read and complete the application form, in accordance with the Guidelines to the Direct Assistance Grant Scheme (Regular Procedures). Applications not submitted in accordance with the established guidelines will not be accepted. All personal data recorded on your application form will be treated in the strictest confidence. It is vital that the application form is completed in full, in order to facilitate a proper assessment of your submission, and to prevent unnecessary delays in processing Applications must be submitted in English with one (1) original and one (1) copy, including supporting documents. Handwritten applications will not be accepted. Original documents needed for reimbursement (i.e. original invoices and original receipts) Airline travel must be supported by boarding passes and only economy class tickets will be refunded. Currency exchange movements will be the responsibility of the applicant.

Regular Procedures version February 2010

SECTION A
1. Contact Person:

COMPANY INFORMATION
PLEASE TYPE IN BOLD Position:

Legal Name and Status of Business:

Business Address: Delivery Address:

City: Country: Tel: Fax: Year Established: No. of Employees: email: Web Site:

Any changes in the addresses, phone numbers, and fax numbers and in particular E-mail must be notified in writing to Caribbean Export. Caribbean Export will not be held responsible where an applicant fails to provide appropriate contact details. 2. Nature of Business - Provide a brief description of your business type, products and services, main clients, major markets, locations, management capacity, experience of project management, technical expertise etc.

3 RECENT EXPORT ACTIVITIES- Please summarize recent export activities (region and/or international)

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4. Are you part of a group of companies? Yes No . If so attach details on the outline of the partnership. (See Section 2.1.2 of the Guidelines)

5.

Is this your first application for a Direct Assistance Grant at Caribbean Export? Yes No If No, please mention details including title of project, year and the amount requested.

6.

Have you previously received support from Caribbean Export Direct Assistance Grant? Yes No If Yes, state amount and year approved: ____________________________

7.

Are you currently receiving support from other donors (IDB, CDB, USAID, DFID etc)? Yes No If Yes, please state amount and purpose.

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SECTION B PROJECT/ACTION
1. TITLE

1.1 Duration of the action 1.2 Location

months

COST OF THE PROJECT/ACTION CARIBBEAN EXPORT Total eligible cost of the project/action

AND

THE

AMOUNT

REQUESTED

FROM

Amount requested Direct Assistance Grant EUR () %

% of total eligible cost of project/action

EUR ()

NB: The % of total eligible cost of the project/action is calculated by dividing the Amount requested from Caribbean Export by the Total eligible costs of the project/action and multiplying by 100. Please note that the cost of the project/action and the contribution requested from Caribbean Export MUST be expressed in EURO.

OBJECTIVES OF THE PROJECT. Describe the overall objective(s) to which the project aims to contribute and the specific objective that the project aims to achieve.

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JUSTIFICATION FOR YOUR REQUEST FOR DIRECT ASSISTANCE GRANT-

a. Relevance of the project to the objectives and priorities of the Call for Proposal.
Description of the target group(s) and final beneficiaries. Reasons for the selection of the target group(s) and identification of their needs and constraints. How does the Project contribute to the needs of the target group(s)?

b. Innovation: if your project is considering innovation, please indicate which area of the process or product would be considered innovative and its potential impact in your company and your community? By innovation we refer to the following, which is not exhaustive: New products Intellectual Property Rights (IPR) protected products Strategic alliances which derive a new approach to production or marketing Strategic alliances which derive a new approach to traditional sectors etc

c. New Sectors: if your project falls under one or more of the sectors mentioned
below, please indicate the sector and its potential impact? New Sectors are defined below as: Creative Industries Health and Wellness Information and Communications Technology (ICT) Professional Services

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DETAILED DESCRIPTION OF THE PROJECT ACTIVITIES-Include the title and a detailed description of each activity to be undertaken to produce the results, justifying the choice of the activities (and specifying where applicable the role of each partner in the activities and an action plan)

EXPECTED IMPACT AND PERFORMANCE INDICATORS-What is the anticipated impact of the activities to be supported on your business? What measurable results will be achieved with the support of the Fund? Be specific and quantify outputs as much as possible. Indicate notably foreseen reports or other publications

SUSTAINABILITY OF THE PROJECT How will the activities be financed after funding ends? Are Will structures allowing the activities to continue to be in place at the end of the project? Will there be local ownership of the results of the project? What will be the structural impact of the project?

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SECTION C BUDGET
Fill in Annex III (A) (worksheet 1) to the Guidelines for applicants for the total duration of the project. For further information see the Guidelines for grant applicants (Section 2.1.4). The budget must be in EURO ().

SECTION D

EXPECTED SOURCE OF FUNDING

Fill in Annex III (A) (worksheet 2) to the Guidelines for applicants to provide information on the expected sources of funding for the project. Please note that there are two different sheets to be completed In kind contributions Please mention here the contributions in kind provided by the applicant, partners or other source (please specify), if any (maximum 1 page).

SECTION E BANK DETAILS

Applicants must supply a financial identification form using the model in Annex VI to the Guidelines for applicants, certified by the bank where the payments are to be made.

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SECTION F PARTNERS OF THE APPLICANT PARTICIPATING IN THE PROJECT (where applicable)

F1 DESCRIPTION OF THE PARTNERS

This section must be completed for each partner organization within the meaning of section 2.1.2 of the Guidelines for Applicants. Any associates as defined in the same section need not be mentioned. You must make as many copies of this table as necessary to create entries for more partners. Partner 1 Full legal name (business name) Legal status VAT registration number (where applicable): Official address Contact person Telephone number Fax number E-mail address Number of employees History of cooperation with the applicant Role and involvement in preparing the proposed project/action Role and involvement in implementing the proposed project/action Important: This application form must be accompanied by a signed and dated partnership statement from every partner, in accordance with the model provided on the next page.

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F2

PARTNERSHIP STATEMENT

Important: This declaration must be provided by each partner. A partnership is a relationship of substance between two or more organizations involving shared responsibilities in undertaking the project/action funded by Caribbean Export. To ensure that the project/action runs smoothly, Caribbean Export requires all partners to acknowledge this by agreeing to the principles of good partnership practice set out below.

1.

All partners must have read the application form and understood what their role in the project/action will be before the application is submitted to Caribbean Export. All partners must have read the standard grant contract and understood what their respective obligations under the contract will be if the grant is awarded. They authorize the lead applicant to sign the contract with Caribbean Export and represent them in all dealings with Caribbean Export in the context of the project/action's implementation. The applicant must consult with his partners regularly and keep them fully informed of the progress of the project/action. All partners must receive copies of the reports - narrative and financial - made to Caribbean Export. Proposals for substantial changes to the project/action (e.g. activities, partners, etc.) should be agreed by the partners before being submitted to Caribbean Export. Where no such agreement can be reached, the applicant must indicate this when submitting changes for approval to Caribbean Export. Where the Beneficiary does not have his headquarters in the country where the project/action is implemented, the partners must agree before the end of the project/action, on an equitable distribution of equipment, vehicles and supplies for the project/action purchased with the EU grant among local partners or the final beneficiaries of the project/action.

2.

3.
4.

5.

6.

I have read and approved the contents of the proposal submitted to Caribbean Export. I undertake to comply with the principles of good partnership practice. Name: Organization: Position: Signature: Date and place:

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SECTION G

DECLARATION FORM

From: (Name and address of Enterprise): To the Project Management Unit Caribbean Export: Dear Sir or Madam, We hereby apply for a direct assistance grant for our Enterprise to meet part of the cost of undertaking activities to improve our competitiveness. We hereby declare that: we are a private enterprise, registered in a CARIFORUM country and majority owned by private interests; the project for which we are applying for a direct assistance grant can be reasonably expected to produce measurable benefits to our company, well in excess of total consulting fees and expenses; we are able and agree to pay for the full cost of the project activities prior to receiving the Direct Assistance Grant; we do not use child labour in the normal production of our goods and services; we conform with national health, safety and environmental requirements; we will allow Caribbean Export Project Management staff and any EU-appointed auditor to have access to and sight of all areas and records of our operations relating to the proposed project for a period of up to two years after project completion; we accept that the Project Management Unit of Caribbean Export, the European Union and the ACP Group will bear no liability for any event resulting from the project for which a Direct Assistance Grant has been awarded or paid; the information and statements contained in the accompanying Application for a Direct Assistance Grant are fair and accurate to the best of our knowledge and that the Caribbean Export may withhold payment of the assistance in the event of serious misrepresentation of any facts stated in this Application or in any subsequent request by ourselves for the payment of a Direct Assistance Grant; we agree to abide by the decisions of the Caribbean Export regarding the award or payment of any Direct Assistance Grant requested by ourselves.

We understand that the Caribbean Export PMU shall hold in confidence all information contained in this Application and shall not at any time make any public disclosure regarding our enterprise, our activities or the project under application without our prior written consent. This Application is Directors/Proprietors. Name: Position held:
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made

with

the

full

knowledge

and

acceptance

of

our

Date: Signature:

JULY 2008

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SECTION H

SUPPORTING DOCUMENTS

The following documents must be submitted as part of the application process:

1. The legal registration, Statutes or Articles of Association of the applicant

firm/organization and of each partner. 2. Financial Identification Form 3. Legal Entities Form 4. Company Profile

5. Copy of the applicants (or lead organization) latest accounts for the previous two
financial years (the income statements and balance sheets for the two previous years for which the accounts have been closed). In accordance with section 2.1.1 (i) of the Guidelines to the Direct Assistance Grant Scheme the applicant is deemed to be the lead organization in the case of groups. 6. Additional financial support documentation (i.e. loans, certificates of deposits, etc.) may be submitted with applicants financial statements to support their ability to finance the project. The supporting documents requested must be supplied in the form of originals or certified copies (certification must be done by the relevant government agency / registry).

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SECTION I.

REGULAR PROCEDURES CHECKLIST To be filled in by the applicant Yes No To be filled in by Caribbea n Export Yes No

CALL FOR PROPOSALS NUMBER 01-10 BEFORE SENDING YOUR PROPOSAL, PLEASE CHECK THAT EACH OF THE FOLLOWING COMPONENTS IS COMPLETE AND RESPECTS THE FOLLOWING CRITERIA :

1. The correct Direct Assistance Grant application

form, published for this call for proposals, has been used (Annex 1 (A)) 2. The proposal is typed and is in English 3. One (1) original application and one (1) copy are included 4. Financial Identification Form completed, signed and stamped by bank (Annex VI) 5. Financial statements for 2 years and additional financial support documentation 6. Legal Entities Form completed (Annex VI) 7. Proof of Registration or Incorporation of entity 8. Company profile completed and signed 9. Where applicable: each partner has completed and signed a partnership statement and the statements are included (if applicable).

10. The budget is presented in the format requested, is

expressed in EURO () is enclosed. (Annex III (A)) 11.The duration of the project/action is equal to or less than 4 months (the maximum allowed) 12. The requested contribution is equal to or greater than 5,000 EUR (the minimum allowed) 13.The requested contribution is equal to or less than 30,000 EUR (the maximum allowed) 14.The requested contribution is equal to or less than 70 % of the total eligible costs(maximum percentage allowed)

15. The Declaration Form (Section G of the application)

has been filled in and signed by the applicant FOR OFFICIAL USE ONLY

We have reviewed the foregoing application and recommend that the

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company ASSESSORS _________________________________________________________-___ be accepted as a beneficiary of the Direct Assistance Grant Signed: Date: NOTES:

EVALUATOR EVALUATOR EVALUATION COMMITTEE EVALUATOR EVALUATOR

APPROVED: YES: NO: DATE: NOTES:

JULY 2008

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