GEMS4 ENTERPRISE CHALLENGE FUND CONCEPT NOTE APPLICATION FORM Off Grid Powered Storage Solutions and Preservation Techniques for Perishable Produce Instructions to Applicants Applications for funding by the GEMS4 Enterprise Fund (“the Fund”) pass through a two-stage application process: Concept Note Stage and Full Business Plan Stage The Concept Note stage involves the preparation and submission of a brief outline (i.e. a summary) of the proposed business idea for which grant funding support is required. This is the first stage of the Application process. Before completing this Concept Note, applicants must review the Term Sheet for this funding window. The Term Sheet sets out the key criteria against which applying organisations will be assessed and grants awarded. Concept Notes are reviewed by the Fund Manager. Only eligible applicants with project ideas that meet the objectives of the Fund will be invited to participate in the next stage of the application process. Notwithstanding the submission of an Application upon the approval of a Concept Note by the Fund Manager, the Fund Manager reserves the right to decline the funding of any project despite a submitted Application for such reasons as may be deemed appropriate by the Fund Manager. How to Complete this Concept Note Review the Terms Sheet for the Fund’s objective, the Project and Organization Eligibility criteria. Please ensure you understand the terms and conditions outlined in the Term Sheet before completing this form. Requests for clarification on the terms set out in the term sheet or on the information required in the Concept Note should be sent to the Fund Manager at challengefund@coffeynigeria.com Please complete ALL sections of this Concept Note. It is important that you complete each section of the Concept Note. However, the completed Concept Note must not exceed 5 pages in length, excluding this instruction page. Please be concise in addressing the questions in each section of this Concept Note. For example, you do not need to outline the importance of preserving fresh perishable produce in the wholesale and retail sector, but you do need to state how your solution will lead to reduced spoilage of perishable produce, create jobs, and deliver income benefits to poor men and women farmers and/or traders who use your solution. Please use quantitative and qualitative information where relevant to help reviewers understand the scope and scale of your project and its likely impact. Please submit the completed Concept Note Application Form in Pdf format as an attachment to the Fund Manager at challengefund@coffeynigeria.com NOTE: Applicants shall be responsible for all costs and expenses incurred by the applicant, the applicant’s staff, the applicant’s advisors, or by any third party acting under the instructions of the applicant in connection with the grant application process. This is notwithstanding that such costs may arise as a result of any direct or indirect amendments to the Term Sheet or the application process at any time. For the avoidance of doubt, GEMS4, Coffey Nigeria, Coffey International Development and DFID shall have no liability whatsoever to the applicant for any such amendments, discussions and communications arising from these amendments or from the termination of the entire application process Coffey International Development GEMS4 Enterprise Challenge Fund June 2015 1 Off Grid Powered Storage Solutions and Preservation Techniques for Perishable Produce Concept Note SECTION ONE: CONTACT DETAILS Name of Applying Organisation Main Office Address Operational Office Address (If different from above) Name of Primary Contact Position of Primary Contact Contact’s Phone Number Alternate Phone Number Contact’s Email Alternate Email SECTION TWO : COMPANY PROFILE Annual Turnover 2012 2013 2014 Employee Size Number of Full Time Employees Number of Part Time Employees Number of Women Employed Provide a brief description of your company profile. Information should include, but not be limited to, the following: Describe your main business activity. Describe the service(s) delivered and/or products produced by your company (include brand name where relevant, product use and benefits). Describe your customer profile i.e. who are your target end consumers and where are they located? SECTION THREE : PROPOSED CONCEPT Provide a summary description of your business idea or initiative. Information should include, but not be limited to, the following: Describe the storage solution and /or preservation technique to be developed and rolled out to enhance the quality and shelf life of perishable produce in the Wholesale and Retail Sector. Also indicate if this is a new solution/technique to be developed, or an existing solution/technique to be adapted or/and adopted. Describe the innovation introduced i.e. how is this solution/technique different from existing and traditional storage solutions and /or preservation techniques in use within target value chain; and why will your solution/technique result in the improved shelf life and quality of perishable produce in the value chain targeted? Describe the business case i.e. what is the commercial opportunity and expected business benefit(s) is to your organization as a result of developing and rolling out this solution/technique. Coffey International Development Wholesale and Retail Enterprise Challenge Fund June 2015 2 Off Grid Powered Storage Solutions and Preservation Techniques for Perishable Produce Concept Note Describe your financial sustainability strategy i.e. how do you intend to ensure commercial and financial sustainability of the model after grant funding support ceases? Provide a summary description of your project i.e. indicate if this is a project to test the innovative solution/technique to be developed and introduced, or to extend the adoption of an existing innovative solution/technique. Information should include on : a description of how you intend to pilot and/ or scale up the proposed solution/technique to be developed or adapted, and introduced to the target value chain. the geographical location where you intend to rollout/launch the proposed pilot. the number and profile of participants to be involved in the pilot project and/or scale up initiative. the proposed duration (in months) required to successfully implement this pilot/scale up initiative. the partnerships required to successfully deliver this project (if any), and the roles of each partner on the project. Include development stage of partnerships. SECTION FOUR: PROPOSED DEVELOPMENTAL IMPACT Describe what new functions and/or full time jobs1 will be created by your pilot project (or as a result of your pilot project) within your individual enterprise value chain (i.e. jobs in your organization and its supply chain) by the end of the funding period. State the wider economic and developmental benefits to be created as a result of this solution/technique for poor men and women in the Wholesale and Retail Sector by the end of the funding period. Information should include, but not be limited to, the following: Number of jobs to be created for low income men and women in the wholesale and retail sector or in a support service sector as a result of your proposed solution/technique. Expected income increase to low income men and women wholesale and retail sector or in a support service sector as a result of your proposed solution/technique. Is there a potential for expansion or replication of your project? If yes, please describe how and to what locations. 1 This is net additional, full time equivalent jobs (calculated as 240 days per day at 8 hours per day) Coffey International Development Wholesale and Retail Enterprise Challenge Fund June 2015 3 Off Grid Powered Storage Solutions and Preservation Techniques for Perishable Produce Concept Note SECTION FIVE : ADDITIONALITY AND USE OF GRANT FUNDS Grant amount requested (£50,000 - £150,000) What is the total investment amount required to implement this project? How much is your matching cash contribution? What is the source of the matching contribution to be committed to this project? (indicate both internal allocation and funds from external sources e.g. bank loan, other donor funds, etc.) How does your project intend to use grant funds i.e. Give a summary breakdown of major line items to which grant funds will be allocated. Why do you need grant fund support to implement this project i.e. Why does this project specifically require grant funds to move forward as against funds from other commercial sources (Including internal capital Allocation)? SECTION SIX: GENERAL INFORMATION. Delete as appropriate Is your organisation a for profit entity? Yes / No If No, What is the specific enterprise form? Is your organisation registered and operating in Nigeria? Yes / No Does your organisation have immediate past two years of unqualified audited accounts? Yes / No Do your two years audited accounts demonstrate a profit? Yes / No Does your organisation have adequate human resources to implement the project within the agreed timeframe? Yes / No If No, what human resource is needed? Have you identified a potential candidate(s) for this role? Yes / No Does your organisation have sufficient funds to cover the matching fund contribution required for this project? Yes / No If No, have adequate arrangements been made to raise the outstanding matching contribution? Yes / No If your organization is awarded a grant, are you willing and able to share project data with the Fund? Yes / No How did you hear about the Fund i.e. what was your initial information source? Please be specific. If by referral, please indicate the original information source. Coffey International Development Wholesale and Retail Enterprise Challenge Fund June 2015 4