Application form to apply for initial funding for a Programmatic Emission Reduction Initiative (Non-CDM)

Information on the Applicant
Name
Type of organisation
Description of role in the programme
Address
Contact Person (last name, first name)
Email
Telephone Number
Information on project partners
Host party/ parties
Involved Government institutions of the host country / Name, function, type of involvement/ role
Developer / Consultant / Name, description, definition of role
Implementing agent / local partner / Name, description, definition of role
Technology provider / Name, description, definition of role
Other (please specify) / Name, description, definition of role
Other (please specify) / Name, description, definition of role
Information on the Programme
Title of the Programme
Description of the Programme
Description of the policy environment (How is the programme embedded in national climate policies?)
Sectoral Scope/ type of technological intervention
Status of development/ implementation
Start date of crediting period for emission reductions
Description of crediting mechanism (type and methodology of certification)
Expected average amount of emission reductions per annum
[t CO2eq]
Overall investment costs of the programme [€]
Volume of initial funding required [€]
Purpose of initial funding
Other sources of funding / □ yes / □ no
If yes: source of funding
Volume of funding [€]
CDM aspects (only relevant in case of CDM registration)
Registration at UNFCCC EB / □ yes
Reference No: / □ no
Letter of Approval available / □ yes / □ no
Expected date of request for registration
Link to your PoA on UNFCCC website / NOTE: If the project is not already registered please attach the most recent versions of PoA- and CPA-DDs and Validation Protocol or Report
Further aspects of the Programme
Social and environmental impacts of the programme / Please attach a brief description of max. 1 to 2 pages!
Will there be any transfer of technology? / Please attach a brief description of max. 1 to 2 pages!
Is a business- or feasibility plan including a cash flow model available? / □ yes
(please attach) / □ no
References or track record of key partners / Please attach a brief description of max. 1 to 2 pages!
Next steps of implementation / Please attach a brief description of max. 1 to 2 pages!
Extension and development plans / Please attach a brief description of max. 1 to 2 pages!
Risks
Which risks do you see for the implementation of the programme? / Please attach a brief description of max. 1 to 2 pages!
Other risks: / Please attach a brief description of max. 1 to 2 pages!

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Place and date Signature

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