Anagold Madencilik Sanayi ve Ticaret A.S. (“Anagold ...

SKF_003_Rev01_EN August 2018

Anagold Madencilik Sanayi ve Ticaret A.S. (“Anagold”)

Sosyal Kalkınma Fonu (SKF)

2018 SKF APPLICATION FORM

Project Title:

Application Deadline: 16 October 2018 (5 PM)

Save as draft for editing later Save as final and submit for review

SKF_003_Rev01_EN August 2018 P a g e | 2 of 22

DISCLAIMER FOR THE APPLICATION

Social Development Fund ("SKF") of Anagold Madencilik San. and Tic. ("Anagold"); under any circumstances shall not be interpreted as any kind of offer, invitation to offer and/or establishment any contract between Anagold and applicant. Applicant hereby accepts that he/she has knowledge that his/her application can be rejected by any reason and Anagold shall always have the right to cancel, suspend, change the application conditions, and withdraw the request. Applicants hereby accept, declare and undertake that, under no circumstances, there is no right to claim from Anagold including but not limited expense, preliminary expenditure, damage, defect liability at contract negotiations (“culpa in contrahendo”) arising from submittal of their projects even if their projects are evaluated positively and/or contractual relation is established with them or vice versa.

Name Surname: ______________________

Signature: ______________________

Date: ______________________


PERSONAL DATA PROTECTION LAW INFORMATION

I have read over and understood the entire Enlightenment Text concerning the Law on the Protection of Personal Data No. 6698, forwarded by Anagold Madencilik San. ve Tic. A.Ş. ("Anagold"), under the Social Development Fund ("SKF") and I have been informed that Anagold shall process my personal data within the context of the purpose of conducting the required studies during the course of my application made within the scope of the Social Development Fund and after and in case of the approval of my application.

I hereby declare that I shall disclose my personal data to Anagold with my free will and that I have been enlightened and informed without hesitation that my personal data which I shall disclose with free will shall, in accordance with the Personal Data Protection Law No. 6698, be preserved as required by the laws, be utilized and processed by Anagold for determination of any information related to the signatory and the addressee of any and all applications, Works and transactions Anagold shall establish within the context of SKF; for recording and assessment of any information such as identity, address, tax registration number and etc.; for issuance of statistical data; for regulation of any information which shall constitute basis to the Works and transactions to be conducted on paper or in electronic media; for transferring of such information abroad for evaluation when necessary; for realization of such purposes through any kind of means under the light of information specified in the Enlightenment Text and for sharing such with the institutions and persons mentioned in the Enlightenment Text, in case of any necessity arising from any legal or service or business relation; thus I give my explicit consent for all the above.

APPROVAL GRANTED APPROVALNOT GRANTED

Name and Surname: ______________________

Signature: ______________________

Date: _____________________


PART A – APPLICATION DETAILS

PROJECT SUMMARY, APPLICATION HISTORY, APPLICANT DETAILS


Section A1 – Project Application(s) History

A1.1 - Project Title: [No action required – this cell is automatically updated from the cover page]

A1.2 - Is this application? (tick the relevant box below)

1.2.1 - The first application for a new Anagold SKF project

A1.3 - Project Application Number: (automatically generated, unique to this application)

A1.4 - Date / time the “Save as final and submit for review” button was pressed on the front page of this application form: (automatically generated by the system)

A1.5 – Application Submission and Review Dates: [The date this application was first submitted and the date of any application updates]

Date Submitted Comments (if required)

Original application

Updated application - 1

Updated application - 2


Section A2 – Applicant(s) Information

A2.1 – As Applicant / Owners;

A2.1.1 - Are you a business owner?

YES NO If YES go the A2.1.2 / If NO go to A2.1.3, A2.1.4, or A2.1.5

A2.1.2 – Is the SKF Application related to your existing business activities (Y) or independent of your business (N)?

YES NO If YES go the A2.3. / If NO go to A2.1.3 or A2.1.4

A2.1.3 - An individual

If this box is selected go to item A2.2

A2.1.4 – A family or unincorporated group

If this box is selected go to items A5.1 – A5.4

A2.1.5 – An incorporated entity (e.g. registered business, NGO or cooperative)

If this box is selected go to item A2.3

Applicant(s) Information for Individuals or unincorporated groups

A2.2 - Information on the individual (or unincorporated group) making this SKF application - (Applicant 1): [If there is more than 1 applicant, Applicant 1 is the primary contact for the project. Other Applicants are to include their personal details in the additional spaces provided in Section A5]

A2.2.1 - Applicant 1 - First name(s)

A2.2.2 - Applicant 1 - Surname:

A2.2.3 - Turkish Identity Number:

A2.2.4 - Date of birth (DD MM YYYY):

A2.2.5 - Gender: Female Male

A2.2.6 - Detailed residential address:

A2.2.6.1 - How long have you been a full time resident at your residential address?

A2.2.7 - Mail address for SKF correspondence (if different to residential address)

A2.2.8 - Telephone numbers (primary & alternate):

Primary (Home) Alternate (GSM)

A2.2.9 - E-mail:

A2.2.10 - Are there any outstanding claims against the Applicant from the taxation authorities?

Yes No

A2.2.11 - Applicant 1 - Education status? The last school you graduated from?


A2.2.12 - Courses, training programs, vocational skills (certificates if any):

A2.2.13 a – If A2.1.2 is “No”

b. What is the commercial status of your business? (joint stock company, or incorporated association, foundation, or cooperative,

etc.)

c. How long has the business been operating?

d. What is the nature of the business (what does it do) and how many people are employed?

e. What is the annual turnover of your business?


Applicant(s) information for registered businesses or legal entities

A2.3 Information on the entity making this application for SKF support

A2.3.1 - Name of entity:

A2.3.2 - Telephone / fax:

A2.3.3 - E-mail:

A2.3.4 - Physical address of the entity:

A2.3.5 - Mail address for all official SKF correspondence:

A2.3.6 - Legal status:

(Registered joint stock company, or incorporated association, foundation, or cooperative, etc.)

A2.3.6.1 – Are there any outstanding claims against the entity from the taxation authorities?

Yes No

A2.3.7 - Year of foundation:

A2.3.8 - Management and technical profile: (The management and technical structure of the entity and professional skills of the management and technical team)

A2.3.9 - Annual turnover of the entity for last 3 years:

A2.3.10 - Assets of the entity:

(Physical description and value)

A2.3.11 - Name of project manager for this application:


A2.3.13 - Date of Birth (DD MM 3YY):


A2.3.15 - Project manager’s telephone numbers (primary & alternate):

Primary Alternate


Section A3 - Project Overview

A3. Project Overview (Summary information about the project – more detail is required in later sections)

A3.1 - What is the objective(s) of the project?

A3.2 - Who will be the beneficiaries of the project? (Number of persons and / or households)

A3.3 - Where will the project be undertaken?

A3.4.1 - Will the project generate revenue?

YES NO If YES go the A3.4.2 – A3.4.4. / If NO go to A3.5

A3.4.2 – What is the expected annual cashflow when the business is stable? TL

A3.4.3 - How long will it take before the project will be cashflow positive (months)?

A3.4.4 - How will surplus revenue be distributed?

A3.5 – Project Organisation and Responsibility Summary (who is involved and what do they do)

A3.5.1 - List all the local partners and their functional roles in the project (if applicable)

A3.5.2 - List all third-party development partners and their functional roles in the project (if applicable)

A3.5.3 - List any public institutions and their functional roles in the project (if applicable)

A3.6 - How long are you seeking SKF funding for?

1-3 months 3-6 months 6-12 months >12 months


A3.7 - Project financial budget summary (TL)

A3.7.1 - Requested project funds from the SKF

A3.7.2 - Applicant(s) financial contribution to the project

A3.7.3 - Third-party partner(s)’ financial contribution to the project

A3.7.4 - Public Institution(s) financial contribution to the project

A3.7.5 - TOTAL PROJECT BUDGET

A3.7.6 - Ratio of applicant’s funds to the total project budget (%)

A3.8 - Project in-kind support summary (TL estimate of the in-kind support)

A3.8.1 - Applicant(s) in-kind contribution to the project (list all contributions the applicant(s) make towards the project goals. e.g. labour, equipment, land, etc)

A3.8.1.1 - Estimated cost of Applicant(s) in-kind contribution to the project

A3.8.2 - Third-party partner(s)’ in-kind contribution to the project

A3.8.2.1 - Estimated cost of third-party partners in-kind contribution

A3.8.3 - Public Institution(s) in-kind contribution to the project

A3.8.3.1 - Estimated cost of Public Institutions in-kind contribution

A3.8.4 - Total estimated financial value of in-kind project support

A3.9. Sustainability

After project support is over, how do you plan to sustain the successful results you have achieved thereafter?

A3.10 Project risks and controls

According to you, what are the three key risks which need to be addressed for this project to achieve its objectives?

1.- 2.- 3.-

What Controls have you put in place within your project plan to address those risks?


Section A4 - Application Checklist

Before checking this application form and sending it to, you are advised to make sure that you complete your application form completely and that you provide all the additional documentation appropriate for validating your application.

A4.1 Application Checklist - (tick if completed)

A-1 Project Application History

A-2 Applicant(s) Information

A2.2 Information on the individual (or unincorporated group) making this SKF application

A2.3 Information on the entity making this application for SKF support

A3. Overview of the Project

A3.7 Project Financial Budget Summary

A3.8 In kind contribution (Estimated in kind contribution in TL)

A3.9. Sustainability

A3.10 Project Risks and Controls

B1 Scope of the Project

B2. Project program

B3.1. Project Budget Summary

B4. Applicants Declaration and Signature Page


Section A5 - Additional Application Details (if required)

Additional Forms – Only to be used if there is more than one person making the SKF application

A5.1 - Information on the individual (or unincorporated group) making this SKF application (Applicant 2)










Primary (home) Alternate (GSM)

A5.1.9 - E-mail:

A5.1.10 - Are there any outstanding claims against the Applicant(s) from the taxation authorities? (If appropriate attach certified copy of Receipt of Discharge from Taxation Dept -"borcu yoktur kağıdı")

Yes No



A5.1.13 a – Is Applicant 2 a business owner? Yes No

b. Is the SKF application related to Applicant 2’s business activities or independent of your business?

c. What is the commercial status of your business?

d. How long has the business been operating?

e. What is the nature of the business (what does it do) and how many people are employed?













A5.2.9 - E-mail:


Yes No



A5.2.13 a -Is Applicant 3 a business owner? Yes No

















A5.3.9 - E-mail:


Yes No




















A5.4.9 - E-mail:


Yes No




b.Is the SKF application related to Applicant 5’s business activities or independent of your business?

c.What is the commercial status of your business?




PART B – PROJECT DETAILS

SCOPE, SCHEDULE AND BUDGET

This section details the main activities of the project (scope), when those activities will be carried out

(schedule), and the cost of undertaking those activities (budget).

The level of detail required for the scope, schedule and budget will depend on the technical and financial

complexity of the project. The Tables included in this Part B should be used as a guide. For large projects

a detailed feasibility study may be required.

Examples of how to complete the scope, schedule and budget sections of the Application are included in

the various case studies which can be found in the document titled “Guideline and Procedure for

Completing a SKF Application”, (Anagold 2018). Further assistance can be obtained from the staff at the

SKF Help Desk.

What is a “feasibility study”? A feasibility study is a report by an independent third-party that analyzes a business venture’s prospects for success. It impartially lays out the features of the business plan and critiques them, analyzing the strengths & weaknesses of the project, and assessing its overall feasibility.


Section B1 - Project Scope

B1. Scope of the Project:

B1.1 - Detail the objective(s) of the project

i. Objective 1

ii. Objective 2

iii. Objective 3

iv. Objective 4

B1.2 – List the main activities to achieve the objectives i. Activity 1

ii. Activity 2

iii. Activity 3

iv. Activity 4

v. Activity 5

vi. Activity 6


Section B2 - Project Schedule This section details when certain activities will be carried out.


B2. Project Schedule - the timetable for the activities listed in B1. Write the main headings of the activities listed in B1 in the table below, and put a cross in the box for the month in which the activity will be implemented (month 1 is the month when funding is awarded, i.e. the first month of your project)

ACTIVITY MONTHS

1 2 3 4 5 6 7 8 9 10 11 12

1.

2.

3.

4.

5.

6.

7.

8.


Section B3 - Project Budget and Cashflow

SKF_003_Rev01_EN August 2018 P a g e |2 1 of 22

B3.1. Budget Summary for the Project (Inclusive of all Third-Party and Institution support if applicable). This is the total budget irrespective of where the money comes from.

Write the Activity headings listed in B1 in the table below, then the total project budget for that activity, the which stakeholder is contributing to that budget, then mark out the months during which that expenditure will take place

ACTIVITY (Number and

Heading)

Total budget for

this activity

Funds from: MONTHS

Applicant 3rd

Parties Govt Inst. SKF

1 2 3 4 5 6 7 8 9 10 11 12

TOTAL

% contribution 100%


Section B4 - Applicants Declaration and Signature Page

Each person names on the Application are required to sign the declaration form below. Making false representations and statements on this application may result in future disqualification from the SKF.

Public Institutions may prefer to submit a letter of commitment rather than the declaration proposed in this section.

The sections for the witness signatures is for an approved SKF administrator.

B4. – Applicant(s) declaration and signature table – by signing this form you are declaring that the information contained in this application is true and you will do everything required to fulfil your obligations under the SKF and operate according to the principles of the SKF program.

Applicant #

Applicant Name Applicant Signature

Date & Time Witness Name Witness Signature

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