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: 1 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 2 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. 3 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 4 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 5 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 6 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 7 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 8 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. 9 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 10 Additional Information if necessary 11 Additional Information if necessary 12 Additional Information if necessary 13 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 ______________________ 14 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/ 15 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. 16 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. 17