Application Form for Ex-Gratia Funding 2015

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APPLICATION
FOR EX-GRATIA FUNDING TO ANIMAL WELFARE ORGANISATIONS
This Department does not operate specific schemes of financial assistance for animal welfare bodies but has in the
past provided ex-gratia funding to organisations involved in the delivery of animal care and welfare services.
Provision of funding is subject to the availability of funds at the year end, accordingly, submission of this application
form should not be construed as an indication that funding will be provided.
Please answer all questions, write in None, Nil or Not Applicable where appropriate.
(Please ensure that the name given here is the same as the name stated on all accompanying documentation e.g. Accounts and Tax Clearance Certificates)
1. Name of Organisation:
Address:
Tel No
Fax No
Mobile No
Email:
2. Please provide a summary of the nature of the work and stated objectives of your organisation:
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3.
Please provide details of the following:-
a) Premises used – address if different to organisation address at 1 above.
b) Capacity to hold animals – species and numbers
c) Animals cared for by species and numbers
Species
2014
2015 year to date
Dogs
Cats
Equines
Other please specify
Other please specify
Other Please specify
Other Please specify
d) outlet for animals disposed of
e) Are you a first time applicant?
f) number of years in existence
4. All recipients of funding must be participating in a neutering programme to assist in controlling numbers
of animals. Please provide details of same to include a description of arrangements in place for neutering,
the numbers of cats and dogs neutered and re-homed, together with an explanation for any difference in
numbers between those re-homed and neutered.
2014
2015 year to date
No of dogs neutered
No of dogs rehomed
No of cats neutered
No of cats rehomed
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5.
Microchipping of Dog Regulations 2015 SI No 63 of 2015 is the legislative basis for dog microchipping.
This legislation requires that all dogs born after 1 June 2015 upon reaching the age of 12 weeks be
microchipped and will apply to all dogs from 31 March 2016. You should ensure therefore that all dogs
in your care are microchipped in accordance with the legislation. Once applicable, all dogs must be
microchipped when leaving your premises. Ideally, in anticipation of the application of the legislation,
all dogs should be microchipped when leaving your premises. Please outline the arrangements you
have made to comply with this requirement. Please note the costs associated with this procedure could
be reclaimed from new owners.
6. Have you been involved in the rehoming of dogs to another EU Member States in the 2014 year
and 2015 year to date? Please provide details, including details of transport arrangements.
7. If you answered yes to question 6, please confirm compliance with microchip ID and rabies
vaccination requirements for these animals.
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8. If you answered yes to question 6, please provide details of the number of animals re-homed to
other EU states in the 2014 year and 2015 year to date, including details of the transporters you
use, capacity of vehicles and Transporter type 2 Authorisation number.
Date of rehoming animals to
Number of animals
another EU member state
rehomed to other
Member State rehomed to
EU Member state
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Transporter Used
Transporter Type 2
Authoristation no, vehicle
approval certificate no
9. It is essential that Organisations in receipt of funding from DAFM should wherever possible
endeavour to have a day time or helpline service to be contacted by members of the public, the
Gardai and to DAFM. Please outline how many hours per day /week etc your organisation is
contactable.
10. Are you involved in the rescue of feral cats? If so please provide details of your programme of
Trap/Neuter and Release and the numbers involved in the 2014 year and also in the 2015 year to
date.
Trap/Neuter/Release
2014
2015 year to date
Number of cats involved
11. Are you involved in the rescue and re-homing of equines? If so please provide details of your
equine premises registration number.
12. Please state the number of horses rescued by your organisation in the 2014 year and also in 2015
year to date
Horses rescued 2014
Horses rescued 2015
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13. If you have provided care and shelter for horses in the 2014 year and also in the 2015 year to date
at any premises other than your main premises (i.e. if horses have been fostered etc, or passed on
to another welfare organisation), please provide details on the table of the equine premises
registration numbers of premises at which you have accommodated these horses, you may list
these on an additional page if necessary.
Name and number of Equine Premises
Date of handling the equine
Date of handling the equine
to which horse has been fostered or
2014
2015 year to date
passed to another organisation for
accommodation
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14. In the case of horses rehomed, in the 2014 year and 2015 year to date please list (on a separate
page if necessary) the equine premises registration numbers of the equine premises in which they
have been re-homed. (Note: all holdings in which horses are kept must be registered with the
Department as an equine premises).
Equine Premises Registration number to
Date of rehoming 2014
which horse has been rehomed
Date of rehoming 2015 year to
date
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15. Are all equines in your care passported and microchipped in compliance with equine identification
legislation (i.e. S.I 207 of 2014)?
16. Please provide details of your organisation’s fundraising programme
17. Did your organisation receive 2014 Ex-gratia funding from the Department of Agriculture, Food
and the Marine?
18. If the answer to question 17 was Yes, state amount and provide details of how the funding (if
received) was spent with particular emphasis on how it was of direct benefit to animals cared for
by your organisation. € ___________
19. Has your organisation received any funding in the calendar year 2014 from any other Government
Department, Local Authority (as some operate ‘pounds’ for Local Authority) or Public Body?
20. If you answered yes to question 19, please state the source and the amounts received
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21. For 2015, all applicants must provide a tax clearance certificate or a registered charity number. If your
organisation has a Registered Charity Number, a Tax Clearance Certificate is not required.
However the Department reserves the right to seek a tax clearance certificate from any recipient of
exgratia aid at any juncture.
Please tick which one you are providing
Charity Number
Tax Clearance Certificate
22. If you ticked registered Charity No. In Box 21, 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.
www.revenue.ie/en/business/charities.html)
23. If you ticked tax clearance certificate in Box 21, this should be provided in the organisation’s name. In
the case of those organisations with a very small turnover run by an individual, who is not eligible to
apply for charity status etc, a tax clearance certificate in the name of the individual running the
organisation will suffice. (Please attach your tax clearance certificate) It is essential that the expiry
date is after 31/12/2015). The tax clearance Certificate should in the case of organisations bear the
same name and address as given on the application form at question 1. page 1)
Tax Clearance Certificate No
Tax Clearance Name
Expiry Date
24.
Should you receive funding this year please outline briefly your plans for expenditure of these monies.
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25. If you received a grant in December 2014, can you attach a brief statement which highlights that your
Organisation has complied with the Terms and Conditions of funding issued to all recipients of ex-gratia
funding in December 2014. Please provide information on same.
26. (a)What is the annual income of your organisation? (Please note organisations with income in excess of
€100,000 per annum must provide audited accounts. It is essential that this figure corresponds with that
on your accounts submitted
(b)What is the annual expenditure of your organisation?. It is essential that this figure corresponds with that
on the accounts submitted.
(c) Please provide information on the salaries paid by your organisation
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Additional Information if necessary
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Additional Information if necessary
12
Additional Information if necessary
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Additional Information if necessary
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 ______________________
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The closing date for receipt of completed application forms, reports of expenditure and
supporting documentation is:
Friday 26th June 2015
Please return all forms and documentation to: Ms Clare Hosford, AHW Division, 4C
Department of Agriculture, Food and the Marine
Kildare Street, Dublin 2
If you have any queries please contact the above at (01) 6072469
FREEDOM OF INFORMATION (FOI) ACTS
It should be noted that information provided by you may be subject to disclosure under the FOI Acts 1997 and
2003. 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 records.
CHECK LIST FOR APPLICANT
1. Are all questions answered? Write in None, Nil or Not Applicable where appropriate, do not leave any
question blank.
2. Enclose Accounts for a recent 12 Month Period or a signed and dated Statement of Income and
Expenditure.
3. Audited and Certified Accounts MUST BE ACCOMPANIED with a letter signed and dated from the
accountant.
4. Do not enclose invoices, receipts with application form. Retain these with your own records
5. All applicants should enclose a breakdown of salaries paid to staff/executives of the organisation
6. Enclose Tax Clearance Certificate valid up to 31 December 2015
7. In the case of new applicants please ensure bank or credit union form is completed and attached.
8. Information on the transport of animals can be found on the Department website at
http://www.agriculture.gov.ie/animaltransport/
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SUPPORTING DOCUMENTATION – PLEASE READ CAREFULLY
ACCOUNTS:

Detailed financial accounts, i.e certified or audited should be submitted with the application.
They MUST be accompanied by a letter signed and dated by the accountant.

With effect from 2012, in situations where an organisation Annual Income exceeds €100,000
Accounts must be audited.

If an organisation operates on low expenditure/income levels, a statement of accounts signed and
dated by an executive in the organisation showing Income and Expenditure for a 12 month
period e.g. for the calendar year 2014, or part of 2014 and part of 2015 e.g. from 01/07/2014 to
30/06/2015. Please see sample statement provided with the application for guidance.

DO NOT send in copies of invoices, receipts with the application form. Retain invoices, receipts
etc with your own records.
TAX CLEARANCE
 A copy of your current Tax Clearance Certificate is required, and/or Registered Charity
Number. Please ensure that the Tax Clearance Certificate expiry date is after 31/12/2015.
 Please note that the Tax Clearance Certificate should bear the same name and address as given
on the application form at question 1.
 In the case of small organisations who are not eligible to apply for tax clearance in the
organisations name a certificate is acceptable in the name of the individual running the
organisation
BANK DETAILS

All payments to successful applicants in 2015 will be made by Electronic Funds Transfer only,
to either a bank account or a credit union account.

All NEW applicants must complete the attached bank/credit union form. Please complete form
and return with your application.

Please note in the case of previous recipients, there is no need to complete this form unless you
have changed bank recently.
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DETAILS FOR EX-GRATIA FUNDING TO ANIMAL WELFARE ORGANISATIONS
1. The Department of Agriculture, Food and the Marine 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.
2. 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.
3. LATE APPLICATIONS will not be considered
4. Following receipt of an application for ex-gratia funding the Department of Agriculture, Food and the
Marine 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 the payment.
5. 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) rules and procedures regarding disbursement
of public funds.
6. Prior to any decision being made, the premises of each applicant may be inspected by a Department
Veterinary Inspector. The premises of all first time applicants will be visited by a Department Veterinary
Inspector.
7. All applications will be assessed taking account of the following:
8. 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).
9. The organisation must be of good standing (based on such enquiries as can reasonably be made e.g.
veterinary inspection reports).
10. The level and type of assistance provided by the organisation.
11. The organisation must satisfy the Department that it has an active programme of fundraising from other
sources.
12. For those organisations who received funding in 2014, applications will not be considered if the “Terms
and Conditions to be adhered to by animal welfare organisations in receipt of DAFM ex gratia funding
in 2014”, have not been signed and returned to DAFM.
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