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|ORGANIZATION INFORMATION |

|Organization Name | |

|Organization Lead Individual | |

|Contact Details |Name:______________________; Position:___________________; |

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| |Phone #_______________; Email:_____________________________ |

|Organization Address | |

|Organization Telephone and Email |Telephone #: ____________ Email: _____________________ |

|Year Established in Afghanistan | |

|Registration in Afghanistan |AISA # __________________________________________ |

|Please state your current registration status (check|ACCI #__________________________________________ |

|all that apply) |Ministry of Justice #_________________________________ |

| |Ministry of Agriculture, Irrigation & Livestock #____________ |

| |Other (specify entity name and #): ______________________ |

| |Not registered |

| |Valid registration Expired registration Registration application pending |

|Current Registration Status |approval |

|Company Nationality | |

|# of Employees in Afghanistan (including owner) | |

| |1 2 3-5 6-10 11-25 26-50 Over 50 |

|Woman Owned Organization ? | |

| |Yes No |

|Geographic Area (Province, City, or District(s) as | |

|applicable) | |

|organization TYPE |

|Nature of Business (Tick all that apply) | |

| |For Profit Company |

| |Business Services Provider |

| |Training Provider |

| |Financial Institution |

| |Other (specify) ________________________ |

|CERTIFICATION |

|I hereby certify that the information provided above is accurate to the best of my knowledge |

|Name and Title |Stamp and Signature |Date |

| | | |

|FOR ACEBA USE |

|Date Received: |Date Evaluated: |Concept Note #: |

|Project Description |

|Activity Name: |

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|Name or title of your grant project. |

|Project Summary: |

|Briefly describe the purpose of the proposed grant. |

|Project Goals and Objectives: |

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|Describe goals and objectives of the proposed grant activities?. How will the activity |

|- Increase volume of exports in targeted value chains. |

|- Increase efficiency, or sales in targeted value chains, or solve a problem in the sector?. |

|- Create new jobs in targeted value chains. |

| |

|Project Activities, Activities Implementation Schedule: |

|What will be the roles and responsibilities of the grant applicant? How long will the activity take to implement? |

|Project Outcomes and Outputs: |

|Examples: |

|- How much will exports increase in targeted value chain(s) if this activity is implemented? |

|- How will the activity contribute to better functioning of the export sector? |

|- How many new jobs will be created in targeted value chains? |

|What new capacities will the grant recipient and the ultimate beneficiaries have because of the proposed grant activity? What other |

|outcome(s) will be achieved? |

|Coordination with relevant Government Authorities and/or other Donor-funded Programs: |

|Describe any coordination that will be required with relevant Government Authorities and/or other donor-funded programs during proposed |

|grant activities. |

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|Sustainability: |

|Please explain how this activity is sustainable, i.e. how will the proposed grant activities continue after ACEBA’s funding support ends?|

| |

Budget:

Please provide a detailed list of items that you and any partners will be contributing to the activity and the funds that you are requesting from ACEBA. You must state whether each item you or your partners plan to invest in will be a new item.

|Description of Investment Item |Amount to be |Amount to be |Is the item a New |Amount of ACEBA |Total |

| |Invested by the |Invested by Partners|Investment |Investment Requested|Investment Amount |

| |Applicant | | | | |

| Please specify the currency being used|AFN or USD |AFN or USD |(Yes or No) |AFN or USD |AFN or USD |

|(delete AFN or USD as applicable) | | | | | |

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|a) Capital Costs/Expenses |

|Capital costs are for fixed, one-time expenses, such as purchasing equipment or software, obtaining certifications, construction. |

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|b) Operational Costs/Expenses |

|Operational costs are on-going costs such as staff salaries, and staff training, surveying etc. |

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|Sub-Total | | | | | |

|Total Investment Cost (a+b) | | | | | |

Notes:

ACEBA will not fund/support vehicles (except for those used in an industrial non-road settings), or used equipment.

ACEBA reserves the right to request that the applicant edit the content of Concept Notes for clarity.

Instructions: Once you have completed this Concept Paper Template, please double check that all fields are completed and that you have specified the currency (USD or AFN) that your budget is presented in. Make sure that your contact information is correct, and submit your Paper by email to GRANTACEBA@ in Word format (.doc or .docx)

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