India Development Marketplace : Supporting Inclusive Business Models to Scale

1. Name of Organization: (Please do not use acronyms.)

2. Name of Contact person :

3. Title (Dr., Mr., Miss., Ms.)

4. Designation of primary contact
within organization:

5. Landline number: Please include area
code and extensions, if any.

6. Mobile number:
(Do not put spaces)

7. Fax number:
(Do not put spaces)

8. Email Address:

9. Website (if available):
(Do not put spaces)

10. Street Address:

11. City/ Town/ District / Village:

12. State:

13. PIN Code:
(Do not put spaces)

14. Type of legally registered organization : Please tick the appropriate box.

Section 25 Company

Cooperative

Trust

Society

Private Limited Company

Partnership

Other ( please specify)

15. Please describe the history of your organization, including date of establishment, current number of employees
and mission statement (Word limit: 300)

Word Count : 0

16. How long has your organization been in operation (in number of years)?

17. Is your organization a woman-owned enterprise?
Yes No

18. Please describe the current work of the organization – what functional and geographic areas are you active in?
(Word limit: 300)

Word Count : 0

19. Please describe the leadership team of your organization – their background and role in daily operations.
(Word limit: 300)

Word Count : 0

20. Title of project proposal : Avoid using general titles (such as "Supporting Inclusive Business Models") that do not
describe your specific project.

21. Current location of the Project : Please tick all that apply.
Bihar
Orissa
Rajsthan
Other (please specify)

22. How long has your Project been in operation? Please tick the appropriate box. < 2 years
2-3 years
3-5 years
>5 years

23. With the Grant, where would you want to replicate or scale the project, select all that are relevant:
Bihar
Orissa
Rajsthan

24. Total funding requested in INR: (Please note that the total amount cannot exceed the INR equivalent of USD 50,000.)

Rs.

25. Project Objective and Description: Please provide in brief;
- The project objective
- Expected outcomes
(Please reflect the overall goal of improving the livelihoods of poor communities either by 1) delivering
infrastructure or goods/services; or 2)contributing to increased income mobility) (Word limit: 300)

Word Count : 0

26. Social Impact Current: Please demonstrate the Project’s positive social impact to date and supply metrics
and indicators on how such impact is being measured.
Note:
Indicators can either be quantitative or qualitative. In either case, indicators should be clear, discrete and
measurable. (Word limit: 200)

Word Count : 0

27. Social Impact Future: Please indicate how the organization plans to scale up/replicate its impact in a two to
three years period and provide indicators that will be used to measure it. To the extent possible, provide
quantitative information/estimates of the expected results (e.g. number of beneficiaries, % of change in income, etc.)
(Word limit: 200)

Word Count : 0

28. Sustainability: Please demonstrate the project’s existing sustainability as:

-Organizational Sustainability: Describe the organization’s structure and its capacity to implement the project and
sustain the results.
-Financial Sustainability: Demonstrate that the organization is on the pathway of financial self-sufficiency.

Describe the key sources of risk in meeting your goals and strategy to mitigate the same. (Word limit: 400)

Organizations will need to upload copy of -
a) Financial statements for the past 2 financial years,
b) A project plan with operating and financial forecasts for the next 3-5 years

Word Count : 0

Please upload Financial Statements (File Size - Max 1 MB)

Please upload Project Plan (File Size - Max 2 MB)

29. Growth Potential A): Please indicate the characteristics that demonstrate project potential for being replicable/
scalable and of interest to social and mainstream venture investors. Organizations can provide their own metrics
to measure scale and financial sustainability. (Word limit: 200)
Note:
Replicability- is when a project can be adopted by other group beyond the given geographical area of the project
implementation.
Scalability- is when a project can be expanded within a geographic area to benefit more people in the project area.

Word Count : 0

30. Growth Potential B): Please state the amount and type of funds the enterprise needs to raise beyond the
resources generated by the grant for successful scale implementation. (Word limit: 200)

Word Count : 0

31. Innovation Potential: Proposals should indicate the extent to which the organization and project have an innovative and inclusive approach to lowering costs and enhancing affordability. (Word limit: 300)

Word Count : 0

32. Please download and fill the Budget Template (Download Template) to demonstrate how you plan to deploy the
Grant funds over a 2 year period. The budget template is only for reference and organisations can add other budget
heads, if required, for their project. (File Size - Max 1 MB)

ORGANIZATION INFORMATION
1. Name of Organization: (Please do not use acronyms.)
2. Name of Contact person :	3. Title (Dr., Mr., Miss., Ms.)	4. Designation of primary contact within organization:
5. Landline number: Please include area code and extensions, if any.	6. Mobile number: (Do not put spaces)	7. Fax number: (Do not put spaces)
8. Email Address:	9. Website (if available): (Do not put spaces)	10. Street Address:
11. City/ Town/ District / Village:	12. State:	13. PIN Code: (Do not put spaces)
14. Type of legally registered organization : Please tick the appropriate box.
Section 25 Company	Cooperative	Trust
Society	Private Limited Company	Partnership
Other ( please specify)
15. Please describe the history of your organization, including date of establishment, current number of employees and mission statement (Word limit: 300) Word Count : 0
16. How long has your organization been in operation (in number of years)?
17. Is your organization a woman-owned enterprise? Yes No
18. Please describe the current work of the organization – what functional and geographic areas are you active in? (Word limit: 300) Word Count : 0
19. Please describe the leadership team of your organization – their background and role in daily operations. (Word limit: 300) Word Count : 0
BASIC PROPOSAL INFORMATION
20. Title of project proposal : Avoid using general titles (such as "Supporting Inclusive Business Models") that do not describe your specific project.
21. Current location of the Project : Please tick all that apply. Bihar Orissa Rajsthan Other (please specify)
22. How long has your Project been in operation? Please tick the appropriate box. < 2 years 2-3 years 3-5 years >5 years
23. With the Grant, where would you want to replicate or scale the project, select all that are relevant: Bihar Orissa Rajsthan
24. Total funding requested in INR: (Please note that the total amount cannot exceed the INR equivalent of USD 50,000.) Rs.
PROPOSAL DETAILS
25. Project Objective and Description: Please provide in brief; - The project objective - Expected outcomes (Please reflect the overall goal of improving the livelihoods of poor communities either by 1) delivering infrastructure or goods/services; or 2)contributing to increased income mobility) (Word limit: 300) Word Count : 0
26. Social Impact Current: Please demonstrate the Project’s positive social impact to date and supply metrics and indicators on how such impact is being measured. Note: Indicators can either be quantitative or qualitative. In either case, indicators should be clear, discrete and measurable. (Word limit: 200) Word Count : 0
27. Social Impact Future: Please indicate how the organization plans to scale up/replicate its impact in a two to three years period and provide indicators that will be used to measure it. To the extent possible, provide quantitative information/estimates of the expected results (e.g. number of beneficiaries, % of change in income, etc.) (Word limit: 200) Word Count : 0
28. Sustainability: Please demonstrate the project’s existing sustainability as: -Organizational Sustainability: Describe the organization’s structure and its capacity to implement the project and sustain the results. -Financial Sustainability: Demonstrate that the organization is on the pathway of financial self-sufficiency. Describe the key sources of risk in meeting your goals and strategy to mitigate the same. (Word limit: 400) Organizations will need to upload copy of - a) Financial statements for the past 2 financial years, b) A project plan with operating and financial forecasts for the next 3-5 years Word Count : 0 Please upload Financial Statements (File Size - Max 1 MB) Please upload Project Plan (File Size - Max 2 MB)
29. Growth Potential A): Please indicate the characteristics that demonstrate project potential for being replicable/ scalable and of interest to social and mainstream venture investors. Organizations can provide their own metrics to measure scale and financial sustainability. (Word limit: 200) Note: Replicability- is when a project can be adopted by other group beyond the given geographical area of the project implementation. Scalability- is when a project can be expanded within a geographic area to benefit more people in the project area. Word Count : 0
30. Growth Potential B): Please state the amount and type of funds the enterprise needs to raise beyond the resources generated by the grant for successful scale implementation. (Word limit: 200) Word Count : 0
31. Innovation Potential: Proposals should indicate the extent to which the organization and project have an innovative and inclusive approach to lowering costs and enhancing affordability. (Word limit: 300) Word Count : 0
BUDGET
32. Please download and fill the Budget Template (Download Template) to demonstrate how you plan to deploy the Grant funds over a 2 year period. The budget template is only for reference and organisations can add other budget heads, if required, for their project. (File Size - Max 1 MB)