for official The Government of Japan

use only
2011
Grant Assistance for Grass
19 Roots Human Security Projects
99 (GGP Programme)
APPLICATION FORM
for

2011
RCVD CATG REG REMARKS

VOCATIONAL TRAINING
IMPORTANT INFORMATION

Please ensure that you have read through the GGP Information Sheet
before completing the application form
CLOSING DATE :
We will only accept applications which are postmarked or hand delivered on or before:
Friday 15th January 2011

Country Name: ____________________________

Province: ____________________________
District & Town: ____________________________
Institution Name: ____________________________
Year founded in: ____________________________
Contact Person: ____________________________
Telephone Number: ____________________________
E-mail Address: ____________________________
Requested Amount: ____________________________
(Please indicate an exact amount based on the lowest of your 3 quotations)

What are you requesting the funding for?

____________________________________________________
_________________________________________________
GGP APPLICATION FORM, Updated September 2010 1
DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
√ Check List: (Please make sure that you attach ALL the necessary documentation and put
a tick in the box provided to indicate what you have included.)

Three Quotations from three different contractors / suppliers

An NPO Certificate (not necessary for schools)
Your latest auditor’s report
A list of board members including their full contact details
A letter promising to maintain the project by your own budget
A letter explaining how you will cover any excess costs should they be incurred
A letter from the Department of Education supporting your request
A map indicating the location of your project
A project implementation plan
Proof of address i.e. a copy of your most recent utility account (Only for NPO’s)
A bank statement for the last three months (Only for NPO’s)
Also, building project requests should include:

An approved floor plan (blueprint) approved (stamped) by the Board of Education
A tax clearance certificate from each contractor
An appropriate cidb certificate* from each contractor (or equivalent for SADC countries)
verifying professional accredited registration
A letter from the Department of Education promising to provide additional teachers and
furniture should it be necessary
A diagram that shows the existing buildings and the foreseen situation after construction is
complete.
A certified copy of the title deed proving that you have ownership of the land (Only for
NPO’s)

* A class 1 contractor can do building projects up to R200 000 and a class 2 contractor up to R650 000.

* To locate a contractor with a cidb certificate in your region you can conduct a search on the cidb website at:
http://registers.cidb.org.za/reports/contractorlisting.asp or contact them by phone. Tel: +27 12 482 7200

GGP APPLICATION FORM, Updated September 2010 2

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
 General Information
1. Kindly ensure that you have the correct application form, as there are specific forms for
various sectors. If you have received a copy of an application form from a third party and are
not sure whether you have the correct form, please contact the Embassy for verification.
2. Read all questions and requirements carefully before completing the application form.
3. All questions must be completed properly and in full. Incomplete applications will be
automatically declined.
4. Answers may be hand written or typed. If hand written, please write neatly and clearly.
Illegible applications will not be considered and will be automatically declined.
5. Ensure that all information provided is correct. Applications containing false information will
be automatically declined.
6. Ensure that you have made a copy of your application, including the quotations and
attachments, as applications are sometimes lost in the post. Please note that faxed or e-
mailed application forms will NOT be accepted.
7. Ensure you have attached all required information to your application and ticked it off on the
checklist on page 2.
8. Make sure you clearly indicate the exact total amount of your request.
9. The Embassy will NOT fax application forms to any organisation. Application forms will be
posted.
10. Contact the Embassy if you have any queries or require assistance completing the
application.

Additional Information
1. Please note that due to the large number of applications received during the year, it
is not always possible to respond to your application immediately or acknowledge
receipt thereof. You will be contacted by telephone or mail if we need additional
information in order to consider your proposal.

2. Make sure that the total cost remains within the budget: Our maximum budget for one
project is R500,000-00. You need to make sure when obtaining the quotations from the
suppliers and builders, that the total costs do not exceed R500,000-00, if it does, reduce
the number of classrooms / items and obtain new quotations. Please bear in mind that we
cannot assist projects exceeding our budget and such applications will be declined
automatically. Should the members of the community contribute the balance, then we
request proof of that fact, e.g. copy of the bank account statement and a sworn affidavit that
the money will be made available. Although contributions are not essential from the
community, for projects less than R500,000-00, we encourage and welcome such efforts by
the community.

3. The Embassy does not fund facilities that are incomplete or that are currently under
construction

GGP APPLICATION FORM, Updated September 2010 3

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
1. APPLICANT’S DETAILS

(1.1) Official / Registered Name of Organisation:

_________________________________________________________________________________________
NPO Registration Number: ____________________________________________________________

(1.2) Street Address (Head/ Main Office):

_______________________________________________________________________________________
_______________________________________________________ Postal code: __________________
Province: ____________________________________________________________________________
(1.2.1) Physical Address of Project Location (if different from 1.2.)
_______________________________________________________________________________________
___________________________________________________ Postal code: ________________________
Province: ____________________________________________________________________________

(1.3) Mailing address: (Please supply correct information to avoid further delays)
________________________________________________________________________________________
_______________________________________________________ Postal Code: ___________________
Province: _____________________________________________________________________________

(1.4) Organisation’s telephone number: (_________)__________________________________________________

Fax number: (_________)____________________________________________________________________
E-mail address: _____________________________________________
Should you relocate or have a change of telephone number please inform us immediately by letter

(1.5) Project Manager / Individual who has signing power:

Name: ______________________________________ Title: (Mr, Mrs, Miss,________)
Position: _________________________________________________________________________________

(1.6) Contact person (if different to Section 1.5):

Name: ________________________________________ Title: _____________________________
Position: _________________________________________________________________________________
Telephone number: (________) ______________________ Cellular Number: __________________________

(1.7) Name of Contact at the Department of Social Development (Project Observer).

Name: Title:
Position: _____________________________________________________________________________
Telephone number: (W) (H)
Fax number: ( )
Cell number:

GGP APPLICATION FORM, Updated September 2010 4

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
(1.8) Name of Auditor that is responsible for auditing the project:
Name: Title:
Name of auditing firm/body: _______________________________________________________________
Telephone number: (_________) ____________________________________________________________
Fax number: (____________)______________________________________________________________

(1.9) Has your organisation received any donor funding, financial, technical support and running/ operational costs
from foreign governments, international organisations or NGOs (if previously funded by the Embassy of Japan
do include)? If so, describe the content of the assistance (kindly attach separate list if space is insufficient):

Name of Donor Telephone Number Year Funded Amount Funded Form of Assistance

* Please attach separate list if space is insufficient

(1.10) Please list your organisations revenue resources (Please tick the appropriate one):
 Grant
 Subsidy
 Self-financing
 Income generation/ non- training project
 Training and income generation

(1.11) What will the running and operational costs of your project/ organisation be after the project is complete?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
______________________________________________________________________

(1.12) How would you secure the necessary funds for the running and operational costs which should you be funded?

GGP APPLICATION FORM, Updated September 2010 5

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
(1.13) Please answer the following questions about your organisation:
1.13.1 Is it an NGO, CBO or other? _____________________________________________
(Please provide copy of the NPO registration certificate)

1.13.2 Year of establishment: _________________________________________________

1.13.3 Place of original establishment (circle one)

South Africa, UK, USA
Other (specify):
_________________________________________________________________

1.13.4 Country of activities other than South Africa (if any):

_______________________________________________________________________________

1.13.5 Number of personnel: (total) _____________________________________________

(full-time)
__________________________________________________
(part-time)_________________________________________

1.13.6 Summary purpose of establishment of your organisation: (Please attach mission statement)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

1.13.7 Main activities (please attach organisational background/profile and organisational structure):
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

(1.14) Are there any similar projects, already being implemented in your community?
________________________________________________________________________________

(1.14.1) How long is the training course? (1 week, 1 month, etc.) __________________________________
(1.14.2) How many courses are held per year? (Attach/provide details) ______________________________

(1.14.3) How many trainees are allowed per training course? ______________________________________

(1.14.4) How do you recruit trainees? ________________________________________________________

________________________________________________________________________________

GGP APPLICATION FORM, Updated September 2010 6

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
 1.14 Does your organisation have a constitution? YES / NO
(If yes, attach a copy)

1.14.1 Does your organisation have a committee or board? YES / NO

(If yes, attach a list with members' contact details)

1.15 Is your organisation running any other projects? If so, list these ________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

1.16 Whom and how has your organisation had a direct and immediate impact on the well-being of
disadvantaged communities at a grass-roots level? _________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

2. PROJECT OBJECTIVES

(2.1) Please state your project objectives (What do you want to achieve?).
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

(2.2) What do you need to realise the objectives stated in (2.1)? For what do you require financial assistance from
the Embassy of Japan?
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

GGP APPLICATION FORM, Updated September 2010 7

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
(2.3) What will be the result once the objectives stated in (2.1) are achieved?
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

(2.4) How many people will benefit: _______________________________________________________________

How many direct beneficiaries: _______________________________________________________________
How many indirect beneficiaries: ______________________________________________________________

(2.4.1) Who are the beneficiaries of the project and how will the completion of the project have a direct impact and
immediate affect on the community? (Please give us as much detail as possible)
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

(2.5) Please state your organisation’s goals for the future in regards to this project?
Five years from now:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

(2.5.1) Has a needs analysis / market research been conducted to determine the need for your project in your
community? (If yes please attach details): _____________________________________________________

3. PROJECT BASICS

(3.1) Project name: ____________________________________________________________________________

(3.2) Location of the project site: (Please attach a map)
(3.3) G.P.S Co- ordinates (if possible): ____________________________________________________________
Village:_______________________________________________________________________________________
City/Town:____________________________________________________________________________________

GGP APPLICATION FORM, Updated September 2010 8

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
Province: _____________________________________________________________________________________

(3.4) Nearest major city (if possible, attach a provincial map and indicate the location of your project site):
Direction: ________________________ of name: _____________________________________________
(e.g. North, South-East, etc) (City name)

(3.5) Additional Information on the area/communities within which the project will be implemented
(climate, population, unemployment ratio, terrain, environment, infrastructure, social activities):

(3.6) Ownership of the project site:

* Is your organisation the owner, tenant, other? (specify)
_____________________________________________________________________________________

* If you are not the owner, please explain the legal relationship with the landowner (provide relevant
documents)

_____________________________________________________________________________________
_____________________________________________________________________________________
* Postal address of owner: _________________________________________________________________
* Telephone number of owner: ______________________________________________________________

(3.7) If the Embassy of Japan is unable to fund your project, which other organisation have you approached to
finance your project? (Please notify us in writing if you receive funding from another source on this project)
_____________________________________________________________________________________
_____________________________________________________________________________________

(3.8) Duration of the project. How long will it take to complete the project in full?
___________months. (Maximum 12 months)

4. PROJECT DETAILS (COMPULSORY)

(4.1) Type of vocational / Job skills training: _______________________________________________________

(e.g. sewing, dress-making, welding, carpentry etc.)

PLEASE ATTACH A DETAILED OUTLINE OF THE TRAINING COURSE.

(4.2) How many people have already been trained?

GGP APPLICATION FORM, Updated September 2010 9
DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
 Per Year: __________________________________________
Total: _____________________________________________
(4.3) How many people have found employment as a result of the training?
Per Year:
Total:
Please specify in which sector (formal, informal, self employment) and in which area (province) they
obtained employment: ____________________________________________________________

(4.4) What kind of follow-up system do you have in place in order to support ex-trainees or to follow-up the impact
of your training on job creation? If any, kindly attach any data/figures about the follow-up system:
______________________________________________________________________________________________
______________________________________________________________________________________________

(4.5) How will or do you advertise your training programme to the community?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

(4.6) Is the Department of Labour involved in your project (e.g. subsidies, certificate, etc.)? If yes, please state their
involvement as well as attach a letter from the Department accordingly:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

Is your course accredited by SAQA (South African Qualifications Authority)? _________________________

Is your organisation linked to SETA (Sectoral Education and Training Authority)? ______________________

(4.7) Are any other organisations involved in your projects (e.g. technical support, market research, etc.)? If yes,
please state their involvement: ______________________________________________________________________
_______________________________________________________________________________________________

PLEASE ATTACH A PROJECT IMPLEMENTATION PLAN

*Please attach a complete project implementation plan.

I, the undersigned, hereby declare that the statements given in this Application Form are true and correct, and, when
necessary, I will provide more information requested by the Embassy of Japan. I further understand this is only an
application, and I will have no objections even if it is turned down as a result of an evaluation.

DATE: (day) _________ (month) _______________________ (year) __________

GGP APPLICATION FORM, Updated September 2010 10

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
NAME: _________________________________________ TITLE __________

POSITION: ___________________________________________________

SIGNATURE: __________________________________________________

Quotations must be based on blueprints

COSTING BREAKDOWN

FORMAT

BREAKDOWN OF THE TOTAL PROJECT COST BASED ON THE QUOTATIONS OBTAINED FROM 3
GGP APPLICATION FORM, Updated September 2010 11
DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
 SEPARATE SUPPLIERS

(1) Please note that the below is merely a format for the required information and
should be prepared by your organisation independently.
(2) Please select the most reasonable quotation from the supplier for each item
requested.
(3) It is most desirable to obtain the 3 separate quotations from suppliers who can
provide both building materials AND labour in terms of smooth project
implementation.

Example:

Breakdown of the proposed project cost

Item Supplier Amount(R)

Building ----- 200,000.00
Materials
Labour ----- 150,000.00
Transport ----- 45,000.00
Equipment ----- 92,000.00
(Total) 487,000.00 Total cost of equipment referred
to in Part B (only if you are
requesting equipment)

I hereby confirm that the above breakdown is

based on the most reasonable(s) of the three (3)
separate quotations for each item

Signature: (Job Title) for (organisations

name)

PLEASE ATTACH QUOTATIONS FROM 3 SEPARATE SUPPLIERS FOR THE FACILITIES YOU ARE
REQUESTING. KINDLY NOTE THAT THE QUOTATIONS FROM EACH SUPPLIERS FOR EACH
ITEM MUST BE PREPARED ON THE BASIS OF THE FOLLOWING FORMAT:

(Please note: the highlighted section of the below example must be hand written by the
organisation)

For each item:

Example:
Staple
GGP APPLICATION FORM, Updated September 2010 12
DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
Quotation (Supplier #3)
Quotation (Supplier #2)

Quotation
(Supplier #1)
Quotation
Name of Supplier: ---------- (Supplier #1)
Date: ---------- Name of Supplier
Expiry Date: ---------- Date:
Expiry Date:
Item quantity amount
------------ --- Item quantity amount
------------ --- ------- ---
------------ --- ------- ---
------------ --- ------- ---
(Total) ----- ------- ---

(Total) ------

Please Note:

(1) The quotation for the same item from the 3 separate suppliers should be numbered on the
top left hand corner and stapled together.

(2) The following information must be attached to the quotation:

 Tax Clearance Certificate (most recent)

 Name of supplier/ contractor
 Date of issue
 Expiry Date (3 month validity)
 Signature of suppliers/ contractors
 CIDB Certificate (or similar certification of competence)
 Content:
o Services and Items to be supplied;
o Labour/ Building materials for ____ classroom construction at __________
School;
o Materials for fencing: perimeter of ______________ School;
o Labour for erection of a Borehole at _______________ School.
(3) Total amount on each quotation must be highlighted.

HAND DRAWN MAP OF LOCATION OF SITE

Map(s) indicating the Project site(s) together with written directions from nearest town/city.
(Note: Important landmarks e.g. post office, police station, cafe, road names,
important main roads e.g. N1, R34, D532 etc.)

GGP APPLICATION FORM, Updated September 2010 13

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za
 NORTH

WEST EAST

SOUTH

WRITTEN DIRECTIONS ON HOW TO GET TO YOUR PROJECT SITE

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

* G.P.S Co- Ordinates (if possible): _______________________________________

GGP APPLICATION FORM, Updated September 2010 14

DEVELOPMENT SECTION, EMBASSY OF JAPAN, PRIVATE BAG X999, PRETORIA, 0001
259 Baines Street, Groenkloof, Pretoria, 0181
Tel: +27 12 452 1500 Fax: +27 12 460 3800/1 Email: Economic@embjapan.org.za Website: www.japan.org.za