Download 1 - SANBio

ANNEX I
Contracting Authority: CSIR/SANBio
BioFISA II Programme
Seed Grant Expression of Interest Application Form
Reference: V6LFISA/2016/SGF002
Deadline for submission of Expression of Interest
31 August 2016
Title of the Project:
<The title must not exceed 15 words and should
capture the essence of the project in a concise
manner>
Location(s) of the
Project:
<Specify country(ies), region(s), area(s) or town(s)
that will benefit from the project>
Name of the lead
applicant (institution or
organization):
Country of the lead
applicant:
Name of the coapplicant (institution or
organization):
Country of the coapplicant:
Application No
(for official use only)
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ANNEX I
Lead applicant’s contact details for the purpose of this project
Name of lead applicant:
Registration Number (For private
institution/companies. For statutory
institutions, provide the Act number):
Postal address:
Street address:
Telephone number: (fixed and/ mobile)
Country code + city code + number
Contact person for this project:
Contact person’s email:
Website of the lead applicant:
Co-applicant’s contact details for the purpose of this project
Name of co-applicant:
Registration Number (For private
institution/companies. For statutory
institutions, provide the Act number):
Postal address:
Street address:
Telephone number: (fixed and/ mobile)
Country code + city code + number
Contact person for this project:
Contact person’s email:
Website of the co-applicant:
Please add details of all the parties in the partnership.
Any change in the addresses, phone numbers or email must be notified in writing to
the Contracting Authority. The Contracting Authority will not be held responsible in
the event that it cannot contact an applicant.
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ANNEX I
Instructions:
This template must be used for the BioFISA II Programme Seed Grant applications. The
applicants must ensure that the text:
1. Does not exceed 5 pages (A4 size) of Arial 10 characters, single line spacing with 2
cm margins. Information provided on any additional pages will not be considered;
This page limit is applicable to the main content of the Expression of Interest form
from Project cost to project summary;
2. Provides the information requested under the headings below in the order in which it
is requested and in proportion to its relative performance;
3. Provides full information as the evaluation will be based solely on the information
provided;
4. Is drafted as clearly as possible to facilitate the evaluation process.
Information on the project details must include:
1. The objectives and expected results of the project;
2. A summary analysis of the problem the project is addressing;
3. A summary of the work that has been done thus far, including the description of
the technology/service proposed;
4. A description of each of the target markets and final beneficiaries;
5. Details on how the proposed solution can be commercialised including the type of
activities proposed and specified related to the outputs and results, including
descriptions of linkages between various activities;
6. The project team members that should include the lead innovator, a business
expert with commercialisation experience, and other relevant expertise with a
proven track record. Additional points will be given for female candidates included
in the team;
7. The required grant amount being applied for and the cash and in-kind
contributions from the applicants.
Summary of the Project
Please complete the table below.
Title of the project:
<The title must not exceed 15 words and should capture the
essence of the project in a concise manner>
Total duration of the project (months):
<Maximum 18 months>
Objectives of the project
<Maximum 50 words>
Product developed
<Recommended 50 words>
Experience of the applicant
Please complete the table below which should not exceed 0.5 pages.
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ANNEX I
Introduction and background of
participants:
< Provide a brief introduction of the Lead and Co-applicant
and explain the nature of their operations>
Experience of the partnership or
individual parties in line with the stated
objectives of this project:
< Provide a brief summary of similar experience of the Lead
and Co-applicant>
Project details
Please complete the table below which should not exceed 4 pages.
Title of the project:
<The title should be the same as on page 1>
Project introduction:
< Recommended 200 words. Briefly describe and explain the
key features and main concept/rationale of the project and
current status. Include a brief outline of prior research and
development. This section should explain how the project
links with the SANBio priorities>
Problem being addressed:
< Recommended 150 words. Clearly defined market need as
well as the value of the solution to the end-user >
Target market1:
<Define the target market for the product developed>
Solution proposed
< Recommended 150 words. Clearly define the solution
proposed to address the problem and the potential impact
that the solution will have to the end-user or on the market ,
and competitive advantage of solution >
Planned activities and targeted
outputs:
<List the main activities needed to produce the project
outputs and main outcomes. Check that the activities are
practical, realistic, feasible and coherent. >
Illustration of how the activities will lead
to marketable products:
< Recommended 150 words. Explain how the planned
activities will lead to a product>
Team composition2:
Lead innovator with proven track
record – please write a short CV
Other relevant experts with proven
track record – please write a short CV
Business expert with proven track
record – please write a short CV
Industrial partnership or other partner
< Recommended 100 words. State the industrial partner or
other partner critical in the project and their role(s) in
implementing the project>
Only a short summary CV of any additional team members must be included.
Any change in the team composition must be notified in writing to the Contracting Authority and the
proposed replacement should have equal qualifications and experience. The Contracting Authority will
not be held responsible in the event that it cannot contact an applicant.
1
2
The target market is the group of consumers for which the product is aimed
Additional points will be given for the female candidates in the team
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ANNEX I
Project cost
Requested BioFISA II Programme
contribution (amount)
Requested BioFISA II Programme
contribution as a percentage of total
eligible costs of the project (indicative)
Applicant’s cash contribution (amount)
Applicant’s costed in-kind contribution
(amount)
Total project cost (amount)
(R)
%
(R)
(R)
(R)
Declaration
I certify that the information shared in this application is true and correct
Signature of
lead applicant:
Signature of coapplicant:
Date:
Date:
Checklist for the Expression of Interest
BEFORE SENDING YOUR EXPRESSION OF INTEREST, PLEASE CHECK THAT
EACH OF THE CRITERIA BELOW HAVE BEEN MET IN FULL AND TICK THEM
OFF
Title of the Proposal:
Tick the
items off
below
Yes
No
PART 1 (ADMINISTRATIVE)
1. Has the application form been completed in full?
2.
Has the form been signed by both the lead applicant and the co-applicant?
3.
Is there an industrial partner involved in the project?
4.
Does the project have proof of concept or a prototype?
PART 2 (ELIGIBILITY)
5. Are at least 2 countries in the SANBio Member States 3 involved in implementing
the project?
6.
3
Is the project duration at most 18 months?
Any of the 12 SADC Member States that the SANBio Network is currently working in, namely, Angola,
Mozambique, South Africa, Lesotho, Swaziland, Malawi, Namibia, Mauritius, Botswana, Zimbabwe, Seychelles
and Zambia
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ANNEX I
7.
Is the requested contribution in line with the maximum allowed (both in-kind and
cash contributions)?
Additional Information (This does not affect the above checklist)
May the SANBio/BioFISA II publish the title of your project and the names of the
institutions involved on the SANBio website should you be shortlisted?
LATE AND INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
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Seed grant – EoI grant application form