ANNEX I
Contracting Authority: CSIR/SANBio
BioFISA II Programme
SEED Grant Expression of Interest (EoI) Application
Form
Reference: V6LFISA/2015/SFG001
Deadline for submission of EoI
1 February 2016
Title of the Project:
<The title must not exceed 15 words and should
capture the essence of the project in a concise
manner>
Location(s) of the
Project:
<Specify country(ies), region(s), area(s) or town(s)
that will benefit from the project>
Name of the lead
applicant (institution or
organization):
Nationality of the lead
applicant:
Name of the coapplicant (institution or
organization):
Nationality of the coapplicant:
Application No
(for official use only)
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ANNEX I
Lead applicant’s contact details for the purpose of this project
Name of lead applicant:
Registration Number (please attach proof of
registration number for private
institution/companies. For statutory
institutions, provide the Act number):
Postal address:
Street address:
Telephone number: (fixed and/ mobile)
Country code + city code + number
Fax number: Country code + city code +
number
Contact person for this project:
Contact person’s email:
Website of the lead applicant:
Co-applicant’s contact details for the purpose of this project
Name of co-applicant:
Registration Number (please attach proof of
registration number for private
institution/companies. For statutory
institutions, provide the Act number):
Postal address:
Street address:
Telephone number: (fixed and/ mobile)
Country code + city code + number
Fax number: Country code + city code +
number
Contact person for this project:
Contact person’s email:
Website of the co-applicant:
Please add details of all the parties in the partnership.
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ANNEX I
Any change in the addresses, phone numbers, fax numbers or email must be notified
in writing to the Contracting Authority. The Contracting Authority will not be held
responsible in the event that it cannot contact an applicant.
Instructions:
This template must be used for the BioFISA II Programme Seed Grant applications. The
applicants must ensure that the text:
1. Does not exceed 5 pages (A4 size) of Arial 10 characters, single line spacing with 2
cm margins. Information provided on any additional pages will not be considered;
2. Provides the information requested under the headings below in the order in which it
is requested and in proportion to its relative performance;
3. Provides full information as the evaluation will be based solely on the information
provided;
4. Is drafted as clearly as possible to facilitate the evaluation process.
Information on the project details must include:
1. The objectives and expected results of the project;
2. A summary analysis of the problem the project is addressing;
3. The type of activities proposed and specified related to the outputs and results,
including descriptions of linkages between various activities;
4. An outline of the broad timeframe of the project and a description of any specific
factors that need to be taken into account;
5. A description of each of the target markets and final beneficiaries;
6. Details on how the proposed solution can be commercialised;
7. Any specific added-value elements, e.g. the promotion or consolidation of publicprivate partnerships, innovation and best practices, or other cross-cutting issues
such as environmental issues, promotion of gender equality and equal
opportunities, the needs of disabled people, the rights of minorities and the rights
of indigenous people;
8. The project team members that should include a senior scientist in the relevant
field, a business expert with commercialisation experience, and a project
administrator with a proven track record. Additional points will be given for female
candidates included in the team leadership;
9. The required grant amount being applied for and the cash and in-kind
contributions from the applicants.
Summary of the Project
Please complete the table below.
Title of the project:
<The title must not exceed 15 words and should capture the
essence of the project in a concise manner>
Total duration of the project (months):
<Maximum 18 months>
Objectives of the project
<Maximum 50 words>
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ANNEX I
Product developed
<Maximum 50 words>
Experience of the applicant
Please complete the table below which should not exceed 0.5 pages.
Introduction and background of
participants:
Experience of the partnership or
individual parties in line with the stated
objectives of this project:
<Maximum 50 words per partner. Provide a brief introduction
of the Lead and Co-applicant and explain the nature of their
operations>
<Maximum 100 words per partner. Provide a brief summary
of similar experience of the Lead and Co-applicant>
Project details
Please complete the table below which should not exceed 4 pages.
Title of the project:
<The title should be the same as on page 1>
Project introduction:
<Maximum 200 words. Briefly describe and explain the key
features and main concept/rationale of the project and
current status. Include a brief outline of prior research and
development. This section should explain how the project
links with the SANBio priorities>
Problem being addressed:
<Maximum 150 words. Clearly defined market need as well
as the value of the solution to the end-user>
Target market1:
<Define the target market for the product developed>
Planned activities and targeted
outputs:
<List the main activities needed to produce the project
outputs and main outcomes. Check that the activities are
practical, realistic, feasible and coherent. >
Illustration of how the activities will lead
to marketable products:
< Maximum 150 words. Explain how the planned activities
will lead to a product>
Team composition2:
Senior scientist with proven track
record – please write a short CV and
attach the full CV
Project manager/administrator with
proven track record – please write a
short CV and attach the full CV
Business expert with proven track
record – please write a short CV and
attach the full CV
Only a short summary CV of any additional team members must be included.
1
2
The target market is the group of consumers for which the product is aimed.
Additional points will be given for the female candidates in the team.
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ANNEX I
Any change in the team composition must be notified in writing to the Contracting Authority and the
proposed replacement should have equal qualifications and experience. The Contracting Authority will
not be held responsible in the event that it cannot contact an applicant.
Project cost
Requested BioFISA II Programme
contribution (amount)
Requested BioFISA II Programme
contribution as a percentage of total
eligible costs of the project (indicative)
(R)
%
Applicant’s cash contribution (amount)
Applicant’s costed in-kind contribution
(amount)
Declaration
I certify that the information shared in this application is true and correct
Signature of
lead applicant:
Date:
Signature of coapplicant:
Date:
Checklist for the EoI
BEFORE SENDING YOUR EOI, PLEASE CHECK THAT EACH OF THE CRITERIA
BELOW HAVE BEEN MET IN FULL AND TICK THEM OFF
Tick the
items off
below
Title of the Proposal:
Yes
No
PART 1 (ADMINISTRATIVE)
1. Has the application form been completed in full?
2.
3.
Has the declaration been signed by both the lead applicant and the coapplicant?
Have the companies’/institutions’ registration documents or numbers been
attached/provided?
4.
Has the Letter of Intent been signed by both parties and is it attached?
5.
Has the letter of co-funding commitment been signed by the relevant person(s)
and is it attached?
6.
Are the CVs of the key personnel attached?
PART 2 (ELIGIBILITY)
7. The project will be implemented in eligible countries and involves two countries
in the SADC region where SANBio operates.
8.
The duration of the project is between 12 and 18 months.
9.
The requested contribution is in line with the maximum allowed.
LATE AND INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
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