FUNDING APPLICATION FORM The National Heritage Council (NHC) is a statutory body established in terms of Section 3 of the National Heritage Council Act 11 of 1999. It has, as one of its key mandates, a responsibility of disbursing funds for approved heritage projects. In allocating these funds, the National Heritage Council aspires to expand the base of participation of heritage organizations in the country. Applications are invited from individuals, organizations and institutions.
Domus Building, No. 57 Kasteel Road, Lynnwood Glen, South Africa, Tel: (012) 348 - 1663, Fax: 086 556 0289, E-mail:
[email protected], www.nhc.org.za
FEEDBACK (Please answer the question below to the best of your ability) How did you learn or hear about the NHC Funding? Choose and provide the name of your source Newspaper: (Name) Radio (Name) Website (Name) Other (Name) CHECKLIST Please make sure that you have supplied the following with your application form:
TYPE OF BUSINESS
NGO Section 21 PBO NPM Individual Other (specify)
A. Items (Compulsory)
No
Yes
No
2. Tax Clearance Certificate of not less than 6 months from date of application 3. Audited Financial Statements for entities registered for more than one (1) year 4. Latest financial statements for newly registered entities 5. Certified ID copies of members 6. Business Plan with a project plan and itemised budget 7. Form signed by 3 people 8. Completed SBD 4 and SBD 8 forms
Registration number: Registration date: Income Tax number: VAT registration number:
SIZE OF ORGANISATION (in terms of employment) SINGLE ENTITY/AFFILIATE BODY(IES)
Yes
Small (1-50) Medium (51-100) Large (101+)
B. Items (Optional) 1. Memorandum of understanding (for partnership) 2. Testimonials 4. Reports 5. Letters of support 7. Letters of endorsements for research conducted on third parties 8. Other
SECTION 1: ORGANISATION/INSTITUTION/COMPANY DETAILS Name of Organisation/Institution/Company Contact person Position in Company I.D. No. Physical address Postal address Rural/Urban Province Municipal area name Contact Details:
Tel Fax
( (
) )
Cell E-mail
1
SECTION 2: PROJECT SPECIFICATION Name of project
Description of project
Purpose of project
Project deliverables
1. 2. 3. 4.
EVALUATION
SECTION 4 :
Total cost of project (including VAT)
Declaration of other funds towards the Relevance project being applied for and the value 1. 2. of such support: 3. Financial management and reporting systems (Give names of persons responsible for1. Innovation the finances and the method they use to prepare/ produce financial reports e.g. 2. Excel, Pastel, etc) 3. 4. Knowledge Application Duration of project
Project to adequately address the scope of work. The work plans and deliverables to the stated objectives. Content of the project must meet or exceed the terms of reference, focus on matters of high priority in terms of rationale and objectives practice and technology or creation of new ones. Project unique and not duplication of work already undertaken.
1. 2. 3.
Capacity Building & Sustainability
1. 2.
Value for Money Reporting Structure (Give names and positions of all committee members with contact numbers. Indicate gender, age and if Representativity disabled)
1. 2. 3. 1. 2.
property. Start date: Adequate consideration to be given to the end product if commercialization is to be considered. Project demonstrates clear, careful and detailed planning. End date:
Project recognizes political, geographical and cultural diversity of the country.
Subcontractors 1. (If applicable, attach endorsement / 2. commitment letters, also indicate 3. gender, age & if disabled) Signatures of Authorising Person(s):
1........................................................................................
(POSITION)..........................................................................
2........................................................................................
(POSITION)..........................................................................
3........................................................................................
(POSITION)..........................................................................
4
2
SECTION 3: BENEFICIARIES DETAILS List (indicate gender, age & if disabled )
Name & Surname including ID
Type of work
1. 2. 3. 4. Name & Surname including ID
Type of work
1. 2. 3. 4. Impact of project
Internal ( how many people would be retained as permanent employees through this funding):
Job creation as a result of funding received
Senior Management: Middle Management: Entry level employees:
Males = Males = Males =
Females = Females = Females =
External (how many people would be employed/recruited on a temporary basis through this funding: Senior Management: Middle Management: Entry level employees:
Capacity building/ training
Males = Males = Males =
Females = Females = Females =
Indicate the capacity/training to be provided as well as the levels of necessary through this funding: Skills programmes necessary : Number of people to be trained/capacitated: Males =
Females =
Service providers for such training: 1. 2. 3. 4.
3
SECTION 4 : EVALUATION
Relevance
Innovation
1.
Project to adequately address the scope of work.
2.
The work plans and deliverables to the stated objectives.
3.
Content of the project must meet or exceed the terms of reference, focus on matters of high priority in terms of rationale and objectives.
1.
practice and technology or creation of new ones.
2. 3.
Project unique and not duplication of work already undertaken.
4. Knowledge Application
1. property.
Innovation
Capacity Building & Knowledge Application
Value for Money
2.
Adequate consideration to be given to the end product if commercialization is to be considered.
3.
Project demonstrates clear, careful and detailed planning.
1. 2.
Project to reflect skills development component.
1. 2. 3.
Representativity
Project to benefit heritage sector.
1. 2.
Project recognizes political, geographical and cultural diversity of the country.
Signatures of Authorising Person(s): 1........................................................................................
(POSITION)..........................................................................
2........................................................................................
(POSITION)..........................................................................
3........................................................................................
(POSITION)..........................................................................
4
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