Download - Application for Funding
The Standard Bank of South Africa Limited Reg No
APPLICATION FOR FUNDING
Name of the organisation applying for financial assistance
Name of the project for which assistance is being sought
Official use: (not to be completed by the applicant)Areas
Health (
Education (Community Capacity Building (Income Generation and Job Creation (Infrastructure Development (Community Sport Development (Cultural Event (Environmental Issues (
Date received:
Received by:
Unit:
Reference no.
A.Tell us about your organisation:1.Name of organisation:
2.Name and surname of projectco-ordinator or project manager:
Title: Mr/Mrs/Ms/Dr/Prof/Rev/Other (specify):
3.Postal address:
Postal code:
4.Physical address:
Postal code:
5.Telephone number:Fax number:
Cellular number:Email address:
Website (if applicable)
6.Bank account details:
Bank:Type of account:
Account holder:Account number:
Branch:Branch code:
7.Name of auditor
Postal address:
Postal code:
Telephone number.Fax number.
8.Registration details
How is your organisation registered: (e.g.: Trust, NPO, CBO, FBO)
If NPO, what is the NPO number:
PBO Number:
9.Is your organisation registered for:
Section 21 (not for profit)YesNo
Tax exemption in terms of Section 10(1)(f) of the Income Tax ActYesNo
Tax exemption in terms of Section 18A of the Income Tax ActYesNo
If yes, please attach a certified copy of the necessary authority from the Tax Exemption Units of SARS
And your NPO Certificate
10.If you are an income generating project, has your organisation registered for:
Please indicate registration number
Section 21 (not for profit)YesNo
CooperativeYesNo
Sole ProprietorshipYesNo
Closed CorporationYesNo
PartnershipYesNo
Voluntary association
NPO
11.Governance
Name of Trustees / Members of the Board or Advisory Management CommitteeDesignationID NumberHDI / PDI
Status
Name of manager responsible for daily operations and any other key managers in the organisation
12Brief history of organisation: (Complete on a separate sheet of paper if more space is required)
Date established:
Mission statement:
Service to community:
Major achievements:
Please attach copy of your:
Constitution
Organisational Profile Verified: (office use only)
13Previous funding
Give fetails and totals of all donations/grants received during last two complete financial years
YearAmountDonor
Do you receive financial or other support from government (provincial or your municipality?
Please add any comment you may feel necessary
14.Give details of any previous funding or material support from ARM
YearType of supportAmount of financial support
UNDERTAKING
I certify to the correctness of all the information, figures, data and documentation contained in and attached to this funding application. I also undertake to supply additional information if required by ARM. I also indicate my willingness to abide by the rules, regulations and instructions issued by ARM in respect of any funding awarded and agree to subject my organisation to any audit or monitoring and evaluation initiative required by ARM.I also understand that completion and submission of this document does not commit ARM to approving this application and subsequent funding
________________________ _____________________ ______________________
Signature Position in the organisation Date application submitted
B. Tell us about your projectThis part of the application form focuses on the project for which you are seeking funding or supportB1.Name of project:
B2.Focus area (select from categories below)
NB: A project may fit into several categories
Will the project create job opportunities
if yes, please explain
Health
Education
Community Capacity Building
Income Generation and Job
Creation
Infrastructure Development
Community Sport
Development
Cultural Event
Environmental Issues
Other (Specify in line below)
B3.Where will the project be rolled out?
Nationalif yes, indicate if in all 9 provinces or indicate the selected provinces
Province (Specify)Location
Indicate
name of town / village / informal settlement
B4.Need and rationale of project to be funded:
What community support do you have for this project?
How will the community be involved in the project?
B5.Who are the primary beneficiaries of the project?
How many women?
How many youth?
How many senior citizens?
How many disabled person?
How many men?
Will the project ultimately benefit a wider number
than the primary beneficiaries?If yes indicate how many?
Will any new jobs be created by this project?Immediately
3 12 months from now
B6.Summary description of project to be funded:
Purpose Statement:
Objectives of the Project
What will be the deliverables
What will be the indicators of success
How do you intend to monitor and evaluate your project
B7.Project personnel
What staff resources will be allocated to this project?
Will the project make use of volunteers? YesIf yes how manyNo
Please attach the CVs of the key personnel
Do you require any training support for your staff?
If yes what kind of training would be useful for you?
B8.Funding Needs
What is the total cost of the entire project for the year?R
Indicate how much money you would like ARM to consider donating to you?R
How will you use this money?
Please indicate on which items or activities you will spend the donation that
you would like Cost of item or activity
Please attach a detailed project budget to this application
B9.Donations in kind
If you do not need money but would prefer donations in kind, please indicatePlease explain how these items or support activities will assist your organisation to achieve its project objectives
Infrastructure / buildings
Office equipment
Computers
Office or project furniture
Training
Mentorship
Prizes for functions
Transport
B105.Additional funders
Have you approached any funders to support this project?
Have you received any feedback or promises of support from government, national agencies or other funders?
If yes please indicate what type of support
B117.Sustainability of project to be funded
In the event of ARM approving your application, how will the project continue after ARM terminates its funding of the project?
B12If training is involved, are you an accredited training
Provider?yesno
If yes please give your accreditation number
Is this particular programme you intend to deliver as part of
this project, accredited?yesno
B13.Authorised signatories of organisation and designations:
Name of authorised signatureDesignation
.
15. Please submit your completed application form to: Contact Person: Ms. Noluthando Vavi
Leader: Corporate Social Investment
Phone:
011-779 1000
Fax:
011-779 1248
Physical Address
African Rainbow Minerals Limited24 Impala Road
Chislehurston, Sandton
Johannesburg
Postal Address
African Rainbow Minerals Limited
Corporate Social Investment Department
PO Box 786136
Sandton, 2146
PAGE 11