MINISTRY OF LABOUR AND HOME AFFAIRS

GENDER AFFAIRS DEPARTMENT

APPLICATION FORM
FOR
FINANCIAL SUPPORT TO INDIVIDUAL WOMEN
SHAREHOLDERS,
WOMENS NON-GOVERNMENTAL ORGANISATIONS,
COMMUNITY BASED BUSINESSES
AND WOMENS GROUPS BUSINESS VENTURES
OCTOBER
2015

Part 1:

APPLICANTS DETAILS

Name of Organization/Business Name:

__________________________________________________________________________
Physical Address:

________________________________________________________

Postal Address:

________________________________________________________
________________________________________________________
________________________________________________________

Business Account:
Name of Bank:

________________________________________________________

Branch Code:

________________________________________________________

Account Type:

________________________________________________________

Account No:

________________________________________________________

Contact Details:
Telephone Number: ________________________________________________________
Fax:

________________________________________________________

Email:

________________________________________________________

Mobile Number:

________________________________________________________

Contact Person:

________________________________________________________

Contact Number:

________________________________________________________

Project Title:

________________________________________________________

Date of Submission: ________________________________________________________

Total Grant Requested: _______________________________________________________

-1-

Part 2 PROJECT PROPOSAL

Note: This is intended to serve as guide in preparation of project proposal. Relevant
supporting documents should be attached when presenting this proposal.
2.1

PROJECT DEFINITION
2.1.1 Project Description (type of enterprises/ products/ services
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
2.1.2 Project Goals (General statement of what the project intends to accomplish,
priority area project intends to address)
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____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2.1.3 Project Objectives (State specific things the project will be accomplishing.
They should be measurable)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2.1.4 Needs identification/Needs/ Challenges to be addressed by the project:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
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____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2.1.5 Production Process ( Describe all stages of the project processes, i.e. from
raw materials to finished goods, present step by step details of what is to be
done and how it is carried out)
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____________________________________________________________________

-3-

2.1.6 Production Forecast ( Give expected monthly output per item/ service
rendered )
ITEM

No of Production Runs

Quantity

2.1.7 Sales Forecasting (Taking into account the projects expected output,
expected share of the market and pricing strategy give the expected monthly
revenue for the next three years.
Product

Quantity

Unit
Price

-4-

Total
Amount
per
month x
25 days

Projection Projection
over 12
over 36
months
months

3.0

BUDGET
Describe exactly what will be purchased or done with the money. Make a cost
breakdown for each item needed for the project as per the table below; three
Quotations must be attached to support all the required items.
Description/ Item

Quantity

-5-

Cost
price

Total

TOTAL

-6-

3.1

Applicant Contribution (indicate how much your contribution into the

business, cash, labour, transport) and other. Specify_____________________
Description

4.0

Quantity

Cost per unit

Total

MARKET AND MARKET RESEARCH (Provide Details of the market)

Market

Action

Target Market: Who will

you sell your products or
services to

Market size: How many

products/items/services in total
could be sold and at what price

Competitors: Who are

your major competitors?

How many people or companies

are expected to buy your
products/ Services
At what price are the goods or
services being sold

Marketing Strategies:
What will you be doing
differently from your
competitors in providing your
product?
Will you adopt a cheaper or
higher pricing strategy

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Distribution Channels:
How will you get your products
or service to the buyers?
Where will you get your raw
materials?
How many suppliers are there?
How reliable are your suppliers?

Pricing:

What is the price your

competitors are selling?

What price will you sell your
product or service?
How much profit do you make
on each sale ( Selling price less
Cost price)

Promotions: How will your

target market know of your
product?
Why would they buy from you?

5.0

TECHNICAL DETAILS
5.1

Implementation Plan ( Outline the sequence of major activities required to

implement the project)
WHAT
(activity)

HOW

-8-

WHEN

WHO

5.2

Functional Responsibilities ( Provide details on what role each member

will play in the daily operation of the project).

Member

5.3

Functional
Area

Required competence
Managerial

Qualification

Technical

SWOT analysis ( Give summary of factors that can enhance or negatively

affect the business performance)

Strengths ( What is my business going to

do better than my competitors)

Opportunities (What is strong in my

business)

Weaknesses ( What is weak in my

business)

Threats (What can hurt my business)

-9-

6.0

CHECK LIST

NO

List of Attachments

Certified copies of Omang (All shareholders)

Company Registration Certificate (Shareholders

Certificate to be included if registered by Certificate of
Incorporation)
Constitution of the Group (if you are a group)
Affidavit to confirm socio economic status (for each
member)
Certificate of land use/ Intent to lease Agreement
Quotations of all the requirements
Letters of intent from potential buyers
Recommendation letter from relevant Department

3
4
5
6
7
8

- 10 -

Tick if attached

ANNEXURE A
MEMBERS PERSONAL DETAILS

NAME

AGE

SEX
M

OMANG NO
F

QUALIFICATIONS
Highest level of
Education

Training

RESIDENTIAL CONTACTS
ADDRESS
Mobile/Landline