FSD GRANT APPLICATION
Name of Applicant
Project Title
Date of Application
Contents
SECTION A: EXECUTIVE SUMMARY ............................................................................................................... 3
SECTION B: COMPANY INFORMATION .......................................................................................................... 3
SECTION C: PROJECT INFORMATION ............................................................................................................ 3
SECTION D: DETAILS OF THE APPLICANT...................................................................................................... 3
SECTION E: MANAGEMENT AND PERSONNEL .............................................................................................. 4
SECTION F: FINANCIAL PERFORMANCE FOR THE PAST 3 YEARS ................................................................. 4
SECTION G: PROPOSED PROJECT IDEA ......................................................................................................... 5
SECTION H: INNOVATION .............................................................................................................................. 5
SECTION I: MARKET AND COMPETITION ....................................................................................................... 6
SECTION J: ADDITIONALITY ........................................................................................................................... 6
SECTION K: DESCRIPTION OF THE GRANT FUNDING .................................................................................... 6
SECTION L: DIRECT AND INDIRECT DEVELOPMENT IMPACT ........................................................................ 6
SECTION M: SOCIAL AND ENVIRONMENTAL PERFORMANCE AND IMPACT ................................................ 6
SECTION N: RESULTS CHAIN .......................................................................................................................... 7
SECTION O: OTHER INFORMATION ............................................................................................................... 7
SECTION P: ANNEXES ..................................................................................................................................... 9
SECTION A: EXECUTIVE SUMMARY
EXECUTIVE SUMMARY (Summarise your project in no more than 1,000 words)
SECTION B: COMPANY INFORMATION
Company details
B1
Company Name
B2
Company Name
B3
P.O. Box
B4
Street
B5
City/Town
B6
Telephone numbers
B7
Fax number
B8
Website
Details of the contact person/s
B9
Name
B10
Job title
B11
Email address
B12
Mobile numbers
SECTION C: PROJECT INFORMATION
Project details
C1
Project title
C2
Region /Districts of focus
C3
Start date
C4
End date
Funding details (in Uganda Shillings)
C5
Grant funds requested from aBi Trust
C6
Matching funds by your company
C7
Total project cost (C5+C6)
Break-down of Matching funds ( C6 in Uganda Shillings)
C8
Matching funds 1:Applicant’s cash investment
C9
Matching funds 2: Applicant’s “in-kind” investment
C10
Total value of matching funds (C8+C9)
C11
Matching funds ratio (C10 / C7)
SECTION D: DETAILS OF THE APPLICANT
Details of the company
D1
Year of establishment
D2
Company mission & vision
D3
Company objectives
D4
Products & services
D5
Describe main customer
segments
Company Registration
D6
Operating license issuer
D7
Operating license number
D8
Regulator name (if regulated)
Major Shareholders
D9
Shareholder
D10
Shareholder 1
Number of shares
%
Shareholder 2
Shareholder 3
Shareholder 4
Other shareholders
Company Strategy
Briefly describe your current company’s strategy and whether this is expected to change in the short or medium term.
Describe your current and planned rural finance initiatives. Do you have a deliberate focus on rural areas?
D11
SECTION E: MANAGEMENT AND PERSONNEL
Management and Personnel
Set out the structure and key skills of senior management team
E1
SECTION F: FINANCIAL PERFORMANCE FOR THE PAST 3 YEARS
Financial Year (From most recent)
Net Income
Growth rate (%)
Total Assets
Growth rate (%)
Gross loan portfolio
Growth rate (%)
Portfolio at Risk (>30days)
Total Liabilities
Growth rate (%)
Customer deposits
Growth rate (%)
Total Equity
Selected Ratios
Cost ratio (operating expenses/(net financial margin + other
operating income
FY ________
FY ______
FY ________
Financial Year (From most recent)
FY ________
FY ______
FY ________
Operating expense ratio (operating expenses/average gross
portfolio
Loan loss reserve ratio (loan loss reserves/Gross loan
portfolio)
Write off ratio (loans written off/average gross portfolio)
Gross loan portfolio/total assets
Gross loan portfolio/client deposits
Capital adequacy (Total equity/total liabilities)
Leverage (Total liabilities/total equity)
Portfolio yield (interest and fee income from portfolio/
average gross portfolio
Return On Assets (Net income/average assets)
Return On Equity (Net income/average equity)
Other operational Information
Number of branches
%age of rural branches
Number of staff
Number of active deposit accounts
Number of active loan accounts
Other alternative delivery channels (please give number and description)
Please make any appropriate brief explanations on the financial performance in the space below
F1
SECTION G: PROPOSED PROJECT IDEA
Project Background (development challenge to be addressed, focus, target population, gender and other
demographic considerations)
G1
Project purpose and objectives (the objectives must be “SMART”)
G2
Sustainability of the project (This is the degree to which the project is likely to lead to longer term impact beyond
the duration of the aBi Trust’s support. This longer term impact could take the form of the sustainable scaling up or
continuation of project activities, replication of the project by other institutions, the adoption of innovation by
other players, or the continuation of the project through securing funding from other sources.)
G3
Previous experience: Describe your FI’s prior experience and success in implementing a similar project
G4
SECTION H: INNOVATION
Describe what is innovative about the project. Does the idea further satisfy the needs and expectations of the rural
population? In the frame of the aBi Trust, innovation is not perceived to be always something new; it could also
mean enhancements of existing products/services to better meet the needs of the rural clients.
H1
SECTION I: MARKET AND COMPETITION
Analyse the market and state competitive advantage and disadvantages
I1
SECTION J: ADDITIONALITY
Explain what is 'additional' about your project.
Additionality of the projects’ net, rather than its gross impact after making allowances for what would have
happened in the absence of the intervention of the aBi Trust. It is the extent to which an activity takes place, or is
undertaken on a larger scale, or earlier, or to a higher standard, or within a new region, as a result of the
intervention of the aBi Trust.
J1
SECTION K: DESCRIPTION OF THE GRANT FUNDING
Description of what the grant funding will be used for (Attach detailed budget)
K1
List the project activities already undertaken and expenditure already made, if any
K2
Description of source of matching funds. Will the project take-off without the grant funds from aBi Trust?
K3
SECTION L: DIRECT AND INDIRECT DEVELOPMENT IMPACT
Job Creation resulting from the project
L1
Number of new jobs created in your company
L2
Annual wage bill at start of project (UGX)
L3
Annual wage bill at end of project (UGX)
Justification and description of new jobs created in your company
L4
Direct Impact. Measurable indicators of success must be seen within the duration of the project.
L5
Number of new clients gaining access to financial services.
L6
Number of existing clients getting better access to financial services.
Indirect Benefits of the project
L7
Replication (What is the potential to replicate the innovation in order to reach more clients?)
L8
SECTION M: SOCIAL AND ENVIRONMENTAL PERFORMANCE AND IMPACT
Please provide information on how your company is performing on each of the following dimension of social
performance.
No.
1
Dimension
Social Mission
Management
Does the mission have a social intent?
Are social objectives imbedded your
strategy?
Comments
No.
Dimension
Comments
Does the FI have report on social indicators?
Level of market penetration
2
3
4
Outreach &
Access to
finance
Does the FI target the clients defined in the
mission?
Quality of
Customer
service & client
protection
principles
Does the FI asses its client satisfaction?
Human
Resources
How close are the service points to the target
group?
Are the products & services varied and
flexible?
Does the FI follow client protection
principles?*
Formal HR structure, code of ethics, fair
hiring and firing, incentives etc.
Internal promotion, training, competitive
salary
Staff retention, staff satisfaction survey
5
Environment &
social practices
Exclusion list for environmental & social
reasons, internal environment policy
Provision of non-financial services
Impact surveys, financial exclusion
The six core principles of client protection are: (i) Avoidance of over-indebtedness (ii) Transparent and responsible pricing
(iii) Appropriate collection practices (iv)Ethical staff behaviour (v) Mechanisms for redress of grievances and (vi) Privacy of
client data.
SECTION N: RESULTS CHAIN
Activities that will be undertaken to achieve project goals
N1
Expected outputs from the activities to be undertaken (e.g. no. of new clients, no of staff trained etc.)
N2
Expected project outcomes (e.g. increased savings, better staff productivity).
N3
Expected project Impact (Specific changes the project is expected to bring about in the beneficiaries e.g. increase
client incomes)
N4
Key assumptions associated with the project
N5
Potential risks the project is likely to face and mitigation strategies
No.
Potential risk
Impact
(L, M, H)
Probability of
risk occurring
(L, M, H)
1
2
3
Mitigation Strategies
4
5
SECTION O: OTHER INFORMATION
Other relevant information not included in other sections.
P1
SECTION P: ANNEXES
Annexes
Annex A Project work plan (Gantt chart)
Annex B Project budget showing expenditure already undertaken
Annex C Proposed disbursement plan linked to the work plan
Prior to final submission, please fill in the checklist below to ensure that all
documentation is complete.
ITEM
SUBMITTED
COMMENTS / EXPLANATION
Grant Application form
Completed Grant application form (this document)
Annexes
Completed Project work plan (Gantt chart)
Completed budget showing expenditure already
undertaken
Completed proposed disbursement plan linked to the work
plan
Additional Documentation Required
Company registration documents & copy of valid operating
license
Certified / Audited Accounts for the last 2 years
Management report for the current year
Completed fact sheet
Details of Board members (name, profession, contact
information)
Organisational chart highlighting the structure of the
proposed project within the entire organisation
Summary biographies of key management
Resume of the individual directly responsible for the
project
You may include additional documents as further annexes to support your application as you see fit and / or if
these have been requested by aBi Trust
Additional information provided as Annexes
Financial Services Development (FSD) – Application Submission
Please send a soft copy of the completed application to the email: application@abi.co.ug
Deadline for the concept/proposal papers 22th June 2015
Documents should not be more than 4MB.
Annex #