Contracting authority: Enabel

Annex A.1 of the calls for proposals guidelines

GRANT APPLICATION FILE

(1ST ROUND)

Call for Proposals on Women and Young people’s Rights, Inclusion and Empowerment

Reference : BEL1707111-AP-01

Deadline for submitting the grant application file (1st round): ../../….

www.wehubit.be
wehubit@enabel.be

File n°

(for internal use only)

BEL1707111-AP-01 Annex A.1 Grant application file 1st round Page 1/8
 TABLE OF CONTENTS

1.1 PROFILE OF THE ORGANISATION ............................................................................................. 4

1.2 THE APPLICANT’S EXPERIENCE ............................................................................................... 6

1.3 THE APPLICANT’S ADMINISTRATIVE INFORMATION ........................................................... 6

1.3.1 CAPACITY TO MANAGE AND EXECUTE THE PROJECTS ........................................................................... 6
1.3.2 LIST OF MEMBERS ON YOUR ORGANISATION’S BOARD OF DIRECTORS/MANAGEMENT COMMITTEE ...... 7

1.4 THE APPLICANT’S GRANT APPLICATION DECLARATION ............................................................ 8

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Instructions for the preparation of the grant application file (1st round)

The applicant must ensure that each section hereunder is completed.

The applicant must ensure the text:

 provides the information requested in the sections below, in the order in which it is requested,
and proportionally to its relative importance (see the relevant notes entered in the evaluation
grid and guidelines);
 provides comprehensive information, given that the evaluation grid will only be used for
information appearing in the grant application file, its 5 annexes and the fields to be filled out in
the online form (secure area of the website www.wehubit.be);
 is drafted as clearly as possible for evaluation.

Title of the project MARK-MED+

Name of applicant (organisation) Mark-TEAM

Beninese, Guinean, Tchadian and Comorian

Nationality of applicant

Legal status -

Registration number (or -

equivalent)

Date of registration -

Place of registration -

We are 06: 01 doctors,02 medical student, 01Web developer,

Co-applicant1 01 network engineer and an accountant. We create MARK-
MED+ in June.

Contact details of the applicant to be used for this project

Postal address
Saboutech, Bluezone Dixinn.
Physical address

Telephone number (fixed and

mobile): country code + area code +224 627441269
+ number

Point of contact for this

Saboutech, Bluezone Dixinn.
project:

E-mail of the point of contact: awaddorado@gmail.com

Organisation’s website: -

1
Please use one line for each co-applicant.
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Any changes relating to addresses, telephone numbers, fax numbers and e-mail addresses must be notified
in writing to the contracting authority. The contracting authority will not be held liable if it is not able to
contact the applicant.

1.1 PROFILE OF THE ORG AN IS ATION

Briefly explain the origin (finding and / or response to a request / need) and the evolution of the
organisation

MARK-MED+ respond to the lack of follow up of pregnant women who is at the origin of the high rate
of pregnant women and children at birth.
Actually we are doing the market study and make partnerships with influential health workers.

Describe how the General Assembly works (# of women, # of men, average participation rate,
frequency of meetings, etc.)

In our group we have 04 women and 02 men and we work every day and meet 2 days in a week

Composition of the Board of Directors (# men / # of women):

(04women/02men)

How is the Board of Directors elected?

By consensus

How long does a Board term last?

Indefinite period

Explain how members / staff are involved in the organisation's decision-making process (organisation
chart, meetings, information transfer, etc.)

All decisions are made together and we base ourselves on Leadership

How did you become aware of this call for proposals?

By Internet

Human Resources: Number of employees? Number of volunteers? Technical profiles? Organisation

chart?

06 employees, as 03 health consultants, 02 network and web administrators and an accountant.

Impact: Does the organisation impact the social development of its members / beneficiaries (and
their communities)? Please explain:

MARKMED+ ensure during the follow up the information and sensitization of the women on the good
practice for a good health, so we contribute to the education and fulfilment of women.

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Give an overview of the technical capabilities of your organisation (profession, skills, staff, equipment,
etc.)

Collection of registration on platform by our administrators.

Sorting and orientation of users by our health consultant.
Co creation of monitoring sheet in agreement with the health specialist by our doctor and health
consultant.
SMS an Voice message advisory sharing during the subscription.

Who are the people who drafted the application? What functions do they have in the organisation?
Our health consultants co-create and manage health content and follow up plan with health
specialists.
Our web and administrator manage and coordinate activities on the platform .

What are your current and past partners?

Name: Saboutech
Contact person: 626400748
Period: JULY
Type of collaboration / support / activities: Entrepreneurship Training “Vacances
Entreprenariale”

Have you received funding (grants or loans in the last 5 years)? If yes, which ones ?

Name of the funding institution:

Amount:
Period:
Interest rate:
Purpose of the funding:

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 1.2 THE APPLICANT’S EXPE RIENCE
This information will enable applicants to evaluate whether they have sufficient and solid enough
experience in managing projects in the same sector and on a scale comparable to that for which a grant is
being requested2.

Please give a detailed description of projects carried out in the same sector and on a scale comparable to
that for which a grant is being requested and which were managed by your organisation in the last three
years.

1 page maximum per project.

Name of applicant:
Project title: Sector:
Project Cost of Role in project: Donor Amount of Dates (from
location project coordinator, co- (name) the dd/mm/yyyy to
(EUR) applicant, contribution dd/mm/yyyy)
(from the
donor)
… … … … … …
Project objectives and achieved results

1.3 THE APPLICANT’S ADMINISTRATIVE INFOR MATION

1.3.1 Capacity to manage and execute the projects

 Please provide the following information, where applicable, based on the management accounts
and balance sheet of your organisation (amounts in euros)

Year Turnover Net profit or Balance Equity Medium and Short-term

or equivalent sheet total capital or long-term debt debt (< 1 year)
equivalent equivalent

N3 2000 -2000 6000 600 5600 -

N-1 3000 1000 2000 600 - -

N-2 6000 4000 2000 600 - -

 Please indicate your organisation’s source(s) of revenue (public donors, private sector,
contributions from members and others) and any additional information requested and their
respective proportions.

2
Provide proof of having managed a grant of at least 40% of the amount requested.
3
N = previous financial year
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  Please provide the references of the external audit report drawn up by an approved auditor,
certifying the applicant’s accounts from the last available financial year. This obligation does not
apply to public organisations.

Year Name of the approved auditor Period of validity

N From dd/mm/yyyy to dd/mm/yyyy

N–1 From dd/mm/yyyy to dd/mm/yyyy

N–2 From dd/mm/yyyy to dd/mm/yyyy

1.3.2 List of members on your organisation’s board of directors/management

committee

On the board
Name Department Function Nationality
since

Mr ABDELHAK Marketing and Communication Tchadian the beginning

BARKA Khadîdja Communication Management

Dr RAMNA Mahamoud Health consultant Health content Comorian the beginning

Management

Mrs DIALLO Brigitte Web administrator Platform Management Guinean after the
beginning

Mr ADEBO Awad Health Consultant Operational and Beninese the beginning

and General relational Mangement
coordinator

Mrs Maïlon BIGNÈ Accoutant Financial Mangement Guinean the beginning

Mr DIALLO Boubacar Network Platform Management Guinean the beginning

Admonistrator

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 THE APPLICANT’S GRANT APPLICATION DECLAR ATION

The applicant, represented by the undersigned, the applicant’s authorised signatory and in this application,
representing any co-applicant(s) and/or affiliated entity/entities in the proposed project, hereby declares
that:

o the applicant has the sources of financing, skills and professional qualifications mentioned in the
guidelines for applicants;
o the applicant undertakes to comply with the obligations provided for in the grant application form
affiliated entities’ declaration and the principles of good practice concerning partnerships;
o the applicant shall be directly responsible for the preparation, management and implementation of
the project, where applicable with the co-applicant(s) and is not acting as an intermediary;
o the applicant and, where applicable, each co-applicant shall be able to immediately provide, on
request, the supporting documents mentioned in the guidelines for applicants;
o the applicant and, where applicable, each co-applicant are eligible in accordance with the criteria
set out in points 2.1.1 and 2.1.2 of the guidelines for applicants;
o if recommended for a grant, applicants shall accept the contractual conditions as laid down in the
standard Grant Agreement annexed to the guidelines for applicants (Annex F);

Signed in the name and on behalf of the applicant

Name ADEBO Awad .A. Oswald

Signature

Function General Coordinator

Date 30-07-2018

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