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DIRECT ASSISTANCE GRANT SCHEME

REGULAR PROCEDURESAPPLICATION FORM

CARIBBEAN TRADE AND PRIVATE SECTOR DEVELOPMENT PROGRAMMEPHASE 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 OFAPPLICANT

INDUSTRY / SECTOR

Regular Procedures version February 2010


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IMPORTANT NOTICE

Please read and complete the application form, in accordance with theGuidelines to the Direct Assistance Grant Scheme (Regular Procedures).

Applications not submitted in accordance with the established guidelines willnot be accepted.

All personal data recorded on your application form will be treated in thestrictest confidence.

It is vital that the application form is completed in full, in order to facilitate aproper 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 andoriginal receipts)

Airline travel must be supported by boarding passes and only economy classtickets will be refunded.

Currency exchange movements will be the responsibility of the applicant.



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SECTIONA

COMPANY INFORMATION

PLEASE TYPE IN BOLD

1.

Contact Person: Position:

Legal Name and Status of Business:

Business Address:

Delivery Address:

City: Year Established:

Country: No. of Employees:

Tel: email:

Fax: Web Site:

Any changes in the addresses, phone numbers, and fax numbers and inparticular E-mail must be notified in writing to Caribbean Export. CaribbeanExport will not be held responsible where an applicant fails to provideappropriate contact details.

2. Nature of Business - Provide a brief description of your business type, productsand services, main clients, major markets, locations, management capacity,experience of project management, technical expertise etc.

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

Regular Procedures version February 2010 1


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4. Are you part of a group of companies? Yes No . If so attach details on theoutline 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 theaction

months

1.2 Location

2 COST OF THE PROJECT/ACTION AND THE AMOUNT REQUESTED FROMCARIBBEAN EXPORT

Total eligible cost of theproject/action

Amount requested DirectAssistance Grant

% of total eligible cost ofproject/action

EUR () EUR () %

NB: The % of total eligible cost of the project/action is calculated by dividing the Amountrequested from Caribbean Export by the Total eligible costs of the project/action andmultiplying by 100.

Please note that the cost of the project/action and the contribution requestedfrom Caribbean Export MUST be expressed in EURO.

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



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4 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 theselection 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 areaof the process or product would be considered innovative and its potentialimpact 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 mentionedbelow, 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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5 DETAILED DESCRIPTION OF THE PROJECT ACTIVITIES-Include the title and adetailed description of each activity to be undertaken to produce the results, justifyingthe choice of the activities (and specifying where applicable the role of each partner inthe activities and an action plan)

6 EXPECTED IMPACT AND PERFORMANCE INDICATORS-What is the anticipatedimpact of the activities to be supported on your business? What measurable

results will be achieved with the support of the Fund? Be specific and quantifyoutputs as much as possible. Indicate notably foreseen reports or other publications

7 SUSTAINABILITY OF THE PROJECT How will the activities be financed afterfunding 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 ofthe 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 ().

SECTIOND

EXPECTED SOURCE OF FUNDING

Fill in Annex III (A) (worksheet 2) to the Guidelines for applicants to provide information onthe expected sources of funding for the project.

Please note that there are two different sheets to be completed

In kind contributionsPlease mention here the contributions in kind provided by the applicant, partnersor 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 theGuidelines 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 THEPROJECT (where applicable)

F1 DESCRIPTION OF THE PARTNERS

This section must be completed for each partner organization within the meaning ofsection 2.1.2 of the Guidelines for Applicants. Any associates as defined in the samesection need not be mentioned. You must make as many copies of this table as necessaryto create entries for more partners.

Partner 1

Full legal name (businessname)

Legal status

VAT registrationnumber (whereapplicable):

Official address

Contact person

Telephone number

Fax number

E-mail address

Number of employees

History of cooperation withthe applicant

Role and involvement inpreparing the proposedproject/action

Role and involvement inimplementing theproposed project/action

Important: This application form must be accompanied by a signed and datedpartnership statement from every partner, in accordance with themodel 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. Toensure that the project/action runs smoothly, Caribbean Export requires all partners toacknowledge 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 rolein the project/action will be before the application is submitted to CaribbeanExport.

2. All partners must have read the standard grant contract and understood whattheir respective obligations under the contract will be if the grant is awarded.

They authorize the lead applicant to sign the contract with Caribbean Export andrepresent them in all dealings with Caribbean Export in the context of the

project/action's implementation.

3. The applicant must consult with his partners regularly and keep them fullyinformed of the progress of the project/action.

4. All partners must receive copies of the reports - narrative and financial - made toCaribbean Export.

5. Proposals for substantial changes to the project/action (e.g. activities, partners,etc.) should be agreed by the partners before being submitted to CaribbeanExport. Where no such agreement can be reached, the applicant must indicatethis when submitting changes for approval to Caribbean Export.

6. Where the Beneficiary does not have his headquarters in the country where theproject/action is implemented, the partners must agree before the end of theproject/action, on an equitable distribution of equipment, vehicles and suppliesfor the project/action purchased with the EU grant among local partners or thefinal beneficiaries of the project/action.

I have read and approved the contents of the proposal submitted to Caribbean Export. Iundertake to comply with the principles of good partnership practice.

Name:

Organization:

Position:

Signature:

Date and place:



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SECTIONG

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 ofundertaking activities to improve our competitiveness.

We hereby declare that:

we are a private enterprise, registered in a CARIFORUM country and majority owned byprivate interests;

the project for which we are applying for a direct assistance grant can be reasonablyexpected to produce measurable benefits to our company, well in excess of totalconsulting fees and expenses;

we are able and agree to pay for the full cost of the project activities prior to receivingthe 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 auditorto have access to and sight of all areas and records of our operations relating to theproposed project for a period of up to two years after project completion;

we accept that the Project Management Unit of Caribbean Export, the European Unionand the ACP Group will bear no liability for any event resulting from the project forwhich a Direct Assistance Grant has been awarded or paid;

the information and statements contained in the accompanying Application for a DirectAssistance Grant are fair and accurate to the best of our knowledge and that theCaribbean Export may withhold payment of the assistance in the event of seriousmisrepresentation of any facts stated in this Application or in any subsequent requestby ourselves for the payment of a Direct Assistance Grant;

we agree to abide by the decisions of the Caribbean Export regarding the award orpayment 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 disclosureregarding our enterprise, our activities or the project under application without our priorwritten consent.

This Application is made with the full knowledge and acceptance of ourDirectors/Proprietors.

Name:

Position held:



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Date:

Signature:

JULY 2008 10


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SECTIONH

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 applicantfirm/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 twofinancial 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 deemedto 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 tofinance the project.

The supporting documents requested must be supplied in the form of originals or certifiedcopies (certification must be done by the relevant government agency / registry).



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FOR OFFICIAL USE ONLY

We have reviewed the foregoing application and recommend that the


SECTION I. REGULAR PROCEDURES CHECKLIST

CALL FOR PROPOSALS NUMBER 01-10

BEFORE SENDING YOUR PROPOSAL, PLEASE CHECK THATEACH OF THE FOLLOWING COMPONENTS IS COMPLETEAND RESPECTS THE FOLLOWING CRITERIA :

To befilled inby the

applicant

To befilled in

byCaribbean Export

Yes No Yes No

1. The correct Direct Assistance Grant applicationform, published for this call for proposals, has beenused (Annex 1 (A))

2. The proposal is typed and is in English

3. One (1) original application and one (1) copy are

included4. Financial Identification Form completed, signed and

stamped by bank (Annex VI)

5. Financial statements for 2 years and additionalfinancial 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 andsigned 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 lessthan 4 months (the maximum allowed)

12. The requested contribution is equal to or greaterthan 5,000 EUR (the minimum allowed)

13.The requested contribution is equal to or less than30,000 EUR (the maximum allowed)

14.The requested contribution is equal to or less than70 % 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

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ASSESSORS

company

_________________________________________________________-___

be accepted as a beneficiary of the Direct Assistance Grant

Signed:

Date:

NOTES:

EVALUATIONCOMMITTEE

EVALUATOR

EVALUATOR

EVALUATOR

EVALUATOR

APPROVED:

YES:

NO:

DATE:

NOTES:

JULY 2008 13

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