Application form Shared Heritage Fund The Netherlands Shared

Application form Shared Heritage Fund
The Netherlands Shared Heritage Fund is applicable to the shared cultural heritage sector in Indonesia with the
objective to work together on the conservation, use, management and visibility of the shared Dutch-Indonesian cultural
heritage. The programme supports initial and temporary projects with a duration of a maximum of four years. Projects
will be judged on their capacity to strengthen the cultural identity in Indonesia, and on their impact on the symbolical
meaning of the heritage concerned, on other policy sectors such as employment, tourism, culture, science and
education, as well as on the extent to which it guarantees the destination and conservation of the heritage items in the
Requests for subsidy need to comply with the following conditions:
- The Embassy will fund up to a maximum of 60% of the project costs, whereas the budget should not exceed €
- A significant contribution from the executing organisation itself is required, either financially or in kind;
- The project should strengthen cultural identity, contribute to the conservation, use, management and visibility of
Dutch-Indonesian shared heritage, include a strong component of training, education, capacity building, or
exchange of knowledge (both in the technical and in the policy field) and should be of importance for various policy
- Applications should be made by an Indonesian organization;
- For your application to be considered for financing under the Netherlands Shared Heritage Fund the questions in
the application form and budget model should be answered as clear and complete as possible. Apart from the
application form, a full description of the project may be submitted as well.
- Applications should be submitted at least three months before the start of the project. Incomplete forms and/or
budgets will not be considered.
The application form and budget model can also be found on the Embassy’s website:
At your request this form can also be sent by mail or e-mail (MS Word-document) to the applicant. This can be
requested through e-mail:
An original, signed application can be sent to the Embassy of the Kingdom of the Netherlands, Press & Cultural Affairs
together with the following annexes:
Detailed Budget
Time frame
Statutes, organization scheme and registration documents
The application form can be adjusted in size but should not exceed a maximum of 10 pages excluding annexes
No rights can be derived from filling out this application and its annexes by the applicant.
Applications for funding through the Shared Heritage Fund can be sent to:
Embassy of the Kingdom of the Netherlands
Public Diplomacy & Cultural Affairs
Attn. Mrs. Ineke de Hoog
Jl. H.R. Rasuna Said Kav. S-3
Kuningan, Jakarta
Tel (021) 524 1052
Fax (021) 527 5981
Page 1 of 6
General data applicant
Name organization
Legal form
Objectives organization
Duration of the legal form: date of creation and date of
termination (indefinite or not)
Official registration
Correspondence address and city
Visiting address and city
Telephone number
E-mail address
Bank account details:
Please fill in - and sign - the bank account form
(the last page of this application form)
Important note: project funds cannot be transferred
to private accounts; therefore the bank account that
is provided has to be in the name of the
Name contact person
Position contact person
What have been the most important results your organization
has achieved over the past three years?
With which activities have these results been achieved and
how have they been financed?
Annexes: Please attach the following information from your organization:
1. The statutes
2. The registration documents
If another organization than the organization applying for the funds will be executing the project, please also
answer the following questions:
Important: The organization requesting the funds from the Shared Heritage Fund will remain responsible for the
execution of the project and its activities and for the narrative and financial report in case the contribution is granted.
Name executive organization
Legal form
Page 2 of 6
Statutory objective of the organization
Duration of the legal form: date of creation and date of
termination (indefinite or not)
Official registration
Correspondence address and city
Visiting address and city
Telephone number
E-mail address
Name contact person
Position contact person
What is the role of the applicant organization in relation to the
executive organization?
Annexes: Please attach the following information of the executive organization:
1. The statutes
2. The official registration
If applicable:
Are there other organizations involved in the execution of the
If so, please mention those organizations.
Information on the contents of the project proposal
Title of the project
Short description of the project (max. 5 sentences)
Planned start- and end date of the project
Page 3 of 6
Region/cities of execution
(what objectives is the project intended to achieve, enumerate
if more than one)
Expected result(s) of the project
(what are the concrete results needed to achieve the project
purpose(s), formulate as concretely as possible, enumerate,
and make sure the results will be measurable e.g. number of
people trained or with gained skills etc,)
(What are the activities to be carried out to achieve the
expected results, group the activities by result)
(please specify costs for each activity in the budget and put
the activities in the timeline model)
Specific target group of the project proposal (direct and/or
If you have already executed this project elsewhere, what has
been your experience with it. What interest did it attract? What
was the amount of visitors/participants?
How is the project contributing to capacity building and/or
knowledge exchange related to conservation, study,
accessibility, use, management and/or visibility of DutchIndonesian Shared Heritage?
Who are the (if necessary) collaborators you have in mind for
this project? Please mention their names if known. If the
project involves a meeting (congress, conference etc.) please
mention the names and background of the speakers
What actions or provisions will be taken to ensure the project
is sustainable?
Page 4 of 6
Financial data project proposal
► Amounts should be mentioned in the currencies in which expenses are actually made
Total estimated project costs
Has your organization proven to be able to realize activities of
such magnitude within the budget originally submitted? Please
explain your answer.
Do you have a financing scheme for the total estimated project
costs? Have you submitted requests for contributions
elsewhere for this project proposal and for what amount?
Which contributions have already been pledged and when do
you expect decisions to be made on other requests?
Financial or in kind contributions by the applicant organization
Requested amount from the Shared Heritage Fund
Has your organization received a contribution from the
Netherlands Embassy in Jakarta or from the Netherlands’
Ministry of Foreign Affairs in the past? If so, when and what
for, reference numbers?
Budget model Shared Heritage Fund
Please fill in the budget model according to the provided guidelines
Page 5 of 6
Dear Sir/Madam,
In order to transfer payments to your company/institution, our system requires the following information:
Supplier detail information
Phone number
Email address
Bank account details
Beneficiary name (the name
which the account is registered
Beneficiary address
Bank name
Bank address
Account number
IBAN (only applied for banks in
the Netherlands and SEPA
countries with Euro account)
Swift code
Bank Branch Code
By signing this form, you confirm that the above information is correct.
__________, ____________20…
Note: please ensure that the beneficiary’s name is spelled correctly and that there is no mistake in the account number,
as this often leads to payments being rejected by the bank.
Page 6 of 6