APPLICATION BY ANIMAL WELFARE ORGANISATION



APPLICATION FOR EX GRATIA FUNDING TO ANIMAL WELFARE ORGANISATIONS 2019This application form should not be construed as an indication that funding will be provided. Please note first time applicants must demonstrate that they have operated an animal welfare body in the two years prior to application. Please answer ALL questions, write Not Applicable where not appropriate. Please note all successful applicants will have their names and addresses and amounts awarded published on the Department’s website and also in press releases. Name of Organisation: (Please ensure that the name provided is the same as stated on all accompanying documentation).Address: Contact person in Organisation: Tel No: Fax No: Mobile No: Email:Please provide information on the purposes of your grant application, i.e. how you propose to spend funding if successful.If you are successful, your organisation’s name and address will be published on the DAFM website and provided to national press etc. Can you confirm that you consent to the publication of your organisation’s details. (Please circle the answer that applies to your organisation) Yes NoPlease provide the name and address you wish to appear on the DAFM website if successful.9 (a) Did your organisation receive any funding in the calendar year 2018 from any other Government Department, Local Authority (as some operate ‘pounds’ for Local Authority) or Public Body? If so please state source of funding and amount received. It is ESSENTIAL that this information is also provided clearly in your supporting accounts, ie source of funding and amount received. (b) Did your organisation receive 2018 Ex-gratia funding from the Department of Agriculture, Food and the Marine? If the answer is yes please state the amount of funding. € _____________Please note this funding must be identified separately as income received from Dept of Agriculture, Food and The Marine (DAFM) in all Accounts/ financial statements submitted in support of your application. If the answer to question 9(b) is yes, please provide details of how this funding was spent with particular emphasis on how it was of direct benefit to animals cared for by your organisation. Please confirm that all of the funding awarded was taken to income in this year. If any discrepancies please provide details by way of a table. In the case of applicants successful in previous years, the Terms and Conditions of Ex-Gratia funding which you have signed up to stated that your organisation should provide details of funding received from DAFM on your websites and literature. Please supply in support of your application evidence that you have complied with this requirement. Welfare organisations in receipt of Ex-gratia funding must acknowledge receipt of funding by letter to the department. Please provide a letter acknowledging receipt of funding received in December 2018 if you have not already done so.10. Are you a first time applicant? (Please circle the answer that applies to your organisation) Yes No11. In order to be eligible for funding you must be in operation for a period of two years, please state the number of years your organisation has been in existence. For first time applicants you may be asked to provide evidence of same. 12. In order to be considered for ex-gratia funding your organisation must be registered with the Charities Regulator. Please provide your registration number CRA No:(Please note this is different to the Revenue Commissioners Charity Number). Also please note as from 2020 all organisations registered with the Charity Regulator must comply with the Charity Regulator Governance Code. Please see link below . If your organisation is in the process of registering with the Charities Regulator, please provide evidence of same. 14. What is the annual income of your organisation? (Please note organisations with income in excess of €100,000 per annum must provide audited accounts).15.(a) What is the annual expenditure of your organisation? (It is essential that this figure corresponds with accounts submitted). (b) Supporting accounts must be submitted with the application. Please note that: Organisations with income below €13,000 can provide a statement of accounts signed and dated by an executive in the organisation showing Income and Expenditure for the most recent 12 month period. Organisations with income between €13,000 and €100,000 must provide certified accounts signed and dated by the anisations with income in excess of €100,000 must provide audited accounts signed and dated by the auditor.Please state what form of accounts you are submitting with application, i.e. statement of accounts, certified or audited16.Please provide a breakdown of total salary bill incurred by your organisation and the number of staff employed full-time and part-time. Please list the duties undertaken by the various staff members. For staff in receipt of a salary of €60K or more (not including pension), please list the individual salary amounts. There is no need to submit staff names. 17.All recipients of ex-gratia are required to have an active fundraising programme. Please provide a breakdown of fundraising by category and amounts raised. If your organisation has electronic or other methods of fundraising please provide details of same, including system used, and breakdown of donations received. All organisations in receipt of PAYPAL or similar electronic methods should declare this in their accounts.18.Please provide a summary of the nature of the work and stated objectives of your organisation.19.All organisations must have an active re-homing policy. Please outline the re-homing policy for your organisation, including the maximum period of time for which an animal will be retained for re-homing. If your policy is to provide care to the end of life, you must also state in this policy under what circumstances you deem an animal unsuitable for re-homing. Please state what arrangements are in place for an animal that is unsuitable for re-homing.20.Please specify written policy on euthanasia.Please describe how your organisation deals with the following:Animals suffering pain or suffering (including mental and emotional), an unacceptable risk to people or to other animals, quality of life for the animal is compromised to an unacceptable degree, with no realistic prospect of improvement.21.It is essential that organisations in receipt of funding from DAFM should have a day time telephone number or online service for contact by members of the public/Gardai/DAFM. Please outline how your organisation is contactable and how many hours per day /week this service is provided.Animal sheltersUnder EU Animal Health Law coming into operation in April 2021, all establishments keeping dogs and cats will be required to register with DAFM (i.e. Animal shelters, kennels, grooming/training facilities). Animal shelters dealing with dogs and cats will be required to seek approval of DAFM, if they are moving dogs and cats to another EU Member State.? There are isolation, biosecurity and record keeping requirements which must be fulfilled in order to be approved by DAFM.'Animal shelter' is defined as an establishment where former stray, feral, lost, abandoned or confiscated terrestrial animals are kept and whose health status might not be known for all of them at the time of entry into the establishment.22.Please provide details of the location(s) of all premises used by your organisation.23. What is the name of Animal Collector/Knackery used by your organisation when disposing of animal carcasses 24. What is your organisation’s Maximum Capacity to hold animals – species and numbers. 25. Animals on hand (i.e. in the possession of the organisation) by species and numbers at end 2018 and end May 2019Species2018to end May 2019DogsCats* (include TNR statistics)EquinesOther please specifyOther please specify26. Total throughput of animals by species and numbers in 2018 and 2019 (to end May).Species2018to end May 2019DogsCats* (include TNR statistics)EquinesOther please specifyOther please specify27. Does you organisations micro-chip all dogs and register the new owner’s name and contact details before they are re-homed? Which database are the details registered with? Please provide details of the number of dogs that you have registered in 2018 and to end of May 2019. (b) Does your organisation assist a Local Authority Pound in re homing dogs? If yes please provide name(s) of Pound.I authorise the dog microchip database which hold the details of animals chipped and registered to this organisation to provide DAFM with details of the animals held by this organisation, transferred to new owners, or held by this organisation during the period January 2018 to present and since declared to have passed away; animals held by this organisation during the period January 2018 to present which have transferred to new owners; and animals currently in the process of being registered to the organisation.Please tick appropriate boxYesNo28. Does your organisation provide subsidised neutering, if so please provide details of same?29. What arrangements have you in place if you export dogs to comply with microchip identification and rabies vaccination requirements? 30. Have you been involved in the re-homing of dogs and/or equines to another EU Member State or to a non EU Country in the 2018 year and to end of May 2019. Please circle the answer that best applies to your organisation. Yes No If you answered yes to question 30, please complete the table below with details of the number of animals re-homed to other EU states or to a non EU Country in the 2018 year and to end May 2019, including details of the Transporters you use, Transporter type 2 Authorisation number and Vehicle Approval Certificate No Date of Re-homingSpeciesNumber of AnimalsMember State/3rd Country Re-homed toTransport Used/Transporter Type 2 Authorisation No/Vehicle Approval Certificate Number31. Are you involved in the rescue and re-homing of equines? (Please circle the answer that applies to your organisation) Yes No32. If you are involved in re-homing & rescuing equines please provide your equine premises registration number (EPRN). Also please complete the attached document (Appendix 1).33. Please confirm you comply with the requirements of transfer of ownership of Equidae. S.I. No 601 of 2014 Equidae (Transfer of Ownership) (No.2) Regulations 2014.34. Please confirm all equines in your possession or under your control are passported and microchipped in compliance with Commission Implementing Regulation (2015/262) as regards the methods for the identification of equines and as transposed into national legislation via – S.I. No 62 of 2016 European Union (Identification of Equidae) Regulations 2016.I authorise the equine passport issuing organisation which hold the details of animals chipped and registered to this organisation to provide DAFM with details of the animals held by this organisation, transferred to new owners, or held by this organisation during the period January 2018 to present and since declared to have passed away; animals held by this organisation during the period January 2018 to present which have transferred to new owners; and animals currently in the process of being registered to the organisation.Please tick appropriate boxYesNo35. Have you verified the identification status of rescued equines? i.e. have you scanned for microchip all equines rescued by your organisation. If any of these equines were previously microchipped, please list the chip numbers below Microchip Number 2018To end of May 201936. Please state the number of equines rescued by your organisation in 2018 and also to end May 2019. 37. Please confirm that all equines re-homed by your organisations in 2018 and to end May 2019 were re-homed to premises compliant with equine premises registration. S.I. 113 of 2014 Control on Places where Horses are Kept Regulations 2014. (Please circle the answer that applied to your organisation) Yes No38. Please provide details on number of equines re-homed in Ireland and outside of Ireland in 2018 and from Jan 2019 to end May 2019. You must ensure that microchip number, passport number and equine premises registration of the individual (if re-homed within the state ) to whom each equine was re-homed is available for DAFM if requested. You must ensure that you have fully completed question 30.39. Please confirm that, prior to leaving your premises, all equine passports (including passports for foals born on your premises) are stamped ”EXCLUDED FROM THE FOOD CHAIN” (Please circle the answer that applies to your organisation) Yes NoNumber re-homed in 2018Number re-homed to end May 201940. For 2019, all applicants must provide an ETax clearance certificate number or a Revenue Commissioners Charity number. Please tick which one you are providing Revenue Commissioners Charity NoETaxClearance Certificate 41. If you ticked Revenue Commissioners Charity No in question 40, please provide charity registration number. (Please note if you are quoting a registered charity number please ensure that the name of the organisation as stated on this form matches the name on the Revenue list of Charities i.e. revenue.ie/en/business/charities.html. 42. If you ticked E-Tax clearance certificate in Question 40, the certificate should bear the same name and address as given on the application form at Question 1 (Page 1). Companies Registration Office (CRO) No: (if applicable) VAT Number of company: (if applicable) ETax Clearance Certificate No: ETax Clearance Name: Expiry Date: (if applicable)43. Please sign and return the “Terms and Conditions to be adhered to by animal welfare organisations in receipt of DAFM ex-gratia funding 2019-2020”. You should also keep a copy for your organisation. Failure to sign the terms and conditions will result in your organisation not being considered for funding. I hereby declare that the particulars stated on this form are true and correct to the best of my knowledge.Signed _________________________________Date _______________ Position in Organisation ______________________The closing date for receipt of completed application forms, reports of expenditure and supporting documentation is: Friday 26th July 2019Please return all documentation original and one copy to: Ms Clare Hosford, AHW Div Department of Agriculture, Food and the Marine, Kildare Street, Dublin 2If you have any queries please contact the above at (01) 6072469APPENDIX 2Freedom of Information (FOI) ActsIt should be noted that information provided by you may be subject to disclosure under the FOI Act 2014. If you wish to have any of the records concerned protected under the Confidentiality, Commercially Sensitive, Personal Information or other exemption provisions of the FOI legislation you should mark those records accordingly and state your reasons. The relevant exemptions will then be considered in the event of an FOI request relating to those recordsAPPENDIX 3CHECK LIST FOR APPLICANTAre all questions answered? Write None, Nil or Not Applicable where appropriate, do not leave any question blank.If an organisation operates on low expenditure/income levels, ie, total income under €13,000, a statement of accounts signed and dated by an executive in the organisation showing Income and Expenditure for a 12 month period will be sufficient e.g. for the calendar year 2018, or part of 2018 and part of 2019 e.g. from 01/07/2018 to 30/06/2019. Please see sample statement provided with the application for guidance. Organisations with income between €13,000 and €100,000 must provide certified accounts signed and dated by the anisations with income in excess of €100,000 must provide audited accounts signed and dated by the auditor. Audited and Certified Accounts MUST BE ACCOMPANIED with a letter signed and dated from your anisations with income in excess of €100,000 must provide AUDITED ACCOUNTSIf your organisation uses PayPal or any other electronic method of fundraising, have you included details of same.Do not enclose any invoices or receipts with application form. All applicants should enclose a breakdown of salaries paid to staff/executives of the organisationIn the case of new applicants please ensure Bank or Credit Union form is completed and rmation on the Transport of Animals can be found on the Department website at on equine ID can be found on the Department website at you included an original and a copy of the application form? Have you included written acknowledgement of last year’s funding?Have you included the signed Terms and Conditions Document?Supporting Documentation – Please read carefullyACCOUNTS: Detailed financial accounts, should be submitted with the application. They MUST be accompanied by a letter signed and dated by the accountant. DO NOT send in copies of invoices and receipts with the application form. ETAX CLEARANCE Your current ETax Clearance Certificate number is required, and/or Registered Charity Number. Please note that the ETax Clearance Certificate should bear the same name and address as given on the application form at question 1.BANK DETAILSAll payments to successful applicants in 2019 will be made by Electronic Funds Transfer only, to either a bank account or a credit union account in the organisations name. All NEW applicants must complete and return the attached Bank/Credit union form.Please note in the case of previous recipients, there is no need to complete this form unless your bank details have changed.DETAILS FOR EX-GRATIA FUNDING TO ANIMAL WELFARE ORGANISATIONSThe Department of Agriculture, Food and the Marine (DAFM) does not operate specific schemes of financial assistance for animal welfare bodies. However since 1995 funding has been provided to organisations involved in the delivery of animal care and welfare services particularly to companion animals. Funding is limited and is intended only as a contribution to the overall costs of the organisation.Applications for ex-gratia funding will only be considered on foot of receipt of a fully completed application form accompanied with the supporting documentation outlined. Failure to submit supporting documentation may result in your application no longer being considered for funding.LATE APPLICATIONS will not be consideredFollowing receipt of an application for ex-gratia funding and/or award of funding, DAFM reserves the right to visit the premises of the organisation and inspect any documentation and any services provided or assets purchased from same. Should such an inspection reveal that funding has not been used for the purpose for which it was intended, or cannot be properly accounted for, the Department reserves the right to recoup any funding provided. An invitation for ex-gratia funding should not be construed as a commitment to payment. It merely implies that the application will be considered along with all other applications. All payments are subject to Department of Public Expenditure and Reform (DPER) No 13/2014 rules and procedures regarding disbursement of public funds. Prior to any decision being made, the premises of each applicant may be inspected by a Department Veterinary Inspector or other authorised officer of the Department. All applications will be assessed taking account of the following:Animals must benefit from the payment - the organisation must be involved in the actual delivery of care and welfare services to animals (as distinct from lobby or pressure groups).The organisation must be of good standing (based on such enquiries as can reasonably be made e.g. veterinary inspection reports).The level and type of assistance provided by the organisation.The organisation must satisfy the Department that it has an active programme of fundraising from other sources. Data Protection Notice:Ex-gratia paymentsData Protection Notice:Part A:Information applicable to all Department of Agriculture, Food and the Marine customers: The Department of Agriculture, Food and the Marine is fully committed to keeping all personal data submitted by its customers, fully safe and secure during administrative processes. All necessary technical measures have been put in place to ensure the safety and security of the systems which hold this data. Department staff are also considered as customers of the Department from a Data Protection perspective and may exercise their data protection rights in the same way.Transparency and openness in the use of personal data held is important to the Department and therefore we aim to fully inform all our customers about the purpose(s) for which their data will be used and why, where it may be shared elsewhere and why and how long their data may be held by the Department. Information on the rights of the customers will also be provided. The current legislation for Data Protection in Ireland is the Data Protection Act 1998 as amended by the 2003 Data Protection Act. The General Data Protection Regulations (GDPR) (EU 2016/679) came into effect on 25 May 2018. The Data Controller for the collection and processing of all personal data in the Department of Agriculture, Food and the Marine is the Minister for DAFM as a legal entity. The Data Protection Officer can be contacted as follows:Data Protection OfficerData Protection Unit, Corporate Affairs, Department of Agriculture, Food and the MarineGrattan Business Park, Dublin Road,Portlaoise, Co Laois.Email: dataprotectionofficer@.iePersonal data processed by the Department will only be used for the specific purpose (s) as outlined when the data is collected, or in later communications, and will only be used in accordance with the Data Protection legislation in force. Rights of the individual in relation to personal data held by the Department:When you, as a customer, provide personal data to the Department you have certain rights available to you in relation to that data. However, it should be noted that not all rights listed shall be applicable in every circumstance. These rights are outlined below and can be exercised by contacting the Data Protection Officer, as detailed above, indicating which right(s) you wish to exercise: Currently customers of the Department have the following rights (up to 24 May 2018):access to their datarectification of their dataerasure of their dataright to lodge a complaint with the Supervisory Authority (Data Protection Commissioner – dataprotection.ie)With effect from 25 May 2018 onwards with the introduction of GDPR all Department customers can also avail, where applicable, of the following additional rights:restriction of processingdata portability objection to processingwithdraw consent if they previously gave it in relation to processing of their personal datarelating to automated decision making, including profiling.Part B – Information specific to the personal data being collectedThe following data is specific information in relation to the personal data processed for the purpose of determining eligibility for ex-gratia funding. Specified purpose: The data being sought from you, the applicant, is required for the purpose of determining eligibility for ex gratia funding for animal welfare organisations. Eligible animal welfare organisations are encouraged to apply for funding. The information requested is in connection with the size and capacity for animals of the organisation, the fundraising programme, expenditure details, salaries paid etc. Legal basis: There is no legal basis for collecting the information other than determining eligibility for funding. Recipients: Your data will be stored on the Department’s Corporate Customer System (CCS) for payment purposes, and on paper and electronic files located in the office. The data on bank details is forwarded to accounts section for the purpose of payment. Your organisations name and address and amount awarded will also be issued in a press release, and will be available on the DAFM website.11.Retention Period The data collected for this purpose will be held by the Department only as long as there is a business need to do so in line with the purpose(s) for which it was collected. After this time it will be marked for destruction and will be destroyed in line with internal guidelines or guidelines for destruction received from the National Archives Office or associated permissions received from them.12.Data provision being statutory or contractual obligation:The data provided for this purpose is being requested under the requirements of the provision of ex-gratia funding. If this information is not provided funding cannot proceed.13.Automated Decision MakingCertain personal data provided in this application/licence/etc. will be processed automatically for the purpose of processing payments. Technical information on data collected:Technical information on the cookies used on our Department’s website is available at the following link: of equine (i.e. where the animal was rescued fromDate equine was rescuedDid you pay a fee for rescuing the equineMicrochip no UNIQUE EQUINE LIFE NUMBEREquine Premises Registration number to which horse has been re-homed or fosteredDate of re-homing if relevantDate of euthanasiaif relevantKnackery used ................
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