Application Form (by an Organisation)
Part 1
/ Information about the Applicant Organisation/ Please enter the details of the lead organisation even if the project may involve collaboration with other person(s).
Name of Organisation:
Telephone Number:
Fax Number:
Address:
E-mail Address:
Chairperson or Head of the Organisation:
Name of Contact Person:
Post Title:
Telephone Number:
Fax Number:
E-mail Address:
1. The organisation is (please insert ü where appropriate, in some cases, more than one box will apply): / □ a company incorporated under the Companies Ordinance
□ a society registered under the Societies Ordinance[1]
2. Please attach all relevant documents as evidence of its legal status. / □ a school registered under the Education Ordinance[2]
□ exempt from tax as an approved charitable institution or trust of a public character under section 88 of the Inland Revenue Ordinance
□ registered or incorporated under another Ordinance
(Please specify: ______)
□ a partnership
□ an organisation (other than a school or a society) not being a legal person and each of the following individual(s) will be applying in his or her own capacity: (Please specify name and title: ______)
Please briefly describe the background of your organisation, such as aims, history, membership profile and core activities.
Please submit for reference either / 1. the latest audited accounts of your organisation, or
2. if your organisation is not incorporated or otherwise not subject to mandatory accounting requirements, management accounts or unaudited accounts covering a period of at least 12 months ending no earlier than 3 months prior to the date of this application. The accounts must be certified by the chairperson or head of the organisation or by a certified public accountant.
/ For application involving collaboration with other person(s) (who are not project staff, paid or voluntary)
Name of Collaborating Person(s):
Role and Responsibility of Collaborating Person(s):
Telephone Number(s):
Fax Number(s):
E-mail Address(es):
Name of Contact Person(s):
Note: Collaborating persons should have no pecuniary interest in the project and if there are exceptional circumstances making this impracticable, the applicant shall set out clearly details of the interest involved and explain why such interest could not be avoided, and attach such details to this application.
/ Experience of Implementing Projects
Please describe briefly any relevant projects implemented in the past 2 years (if the project involves more than one group, relevant projects implemented by groups other than the lead organisation should also be included).
If you have submitted any other applications in the current round of SDF application, please give the title of the other projects and the relative priority of this application.
Part 2
/ Project Proposal/ Project Details
Name of the Project (in both English and Chinese):
Proposed Project Commencement and Completion Dates:
Proposed Number of Participants in the Project (please separately state the number of direct and indirect participants[3]):
Proposed Number of Project Staff (Paid and Voluntary) (If paid staff will be employed, please complete the “Information of Paid Staff” on page9 of this form):
Project Nature and Target Groups:
Details of Specific Activities or Programmes:
Deliverables of the Project:
/ Objectives of the Project
Objective(s) of the Project:
Please clarify how the project can achieve these objectives and how you would measure the effectiveness of the project (for example, you may wish to outline the targets that your proposed project is intended to achieve).
Please explain how these objectives relate to the purpose of the SDF and how the project would satisfy the assessment criteria set out for SDF applications, and clarify which of the three aspects of sustainable development the project would integrate and how.
Please clarify whether, and if so, how the project will be sustained after support from SDF ends.
Part 3
/ BudgetThe Amount of Grant Sought from the SDF:
Please provide a budget summary and projected cash flow for the project in accordance with the format on page 8 of this form.
Please indicate whether the project is currently receiving a grant from any Government fund or private sponsorship (in kind or in cash).
If yes, please provide details (e.g., name of fund, amount of grant and items supported by the fund, etc.). / ¨ Yes ¨ No
Please indicate whether the project is the subject of a separate application for Government fund or any other form of private funding.
If yes, please provide details (e.g., name of fund, amount sought and progress of application, etc.). / ¨ Yes ¨ No
Part 4
/ Other Information/ Please provide any other information relevant to the project proposal that you consider should be taken into account in processing the application.
/ Declaration by the Organisation (where it is a legal person)
We certify that all the information given in this application is true, accurate and complete. We understand that if we willfully give any false information or withhold any material information, the application will become void and any grant approved will be withheld and any payment made with interest must be refunded by us to the Government. In the event that our application is successful, and without prejudice to other rights and powers of the Government, we consent to the disclosure from time to time by the Government of details of the project.
Signed by an Authorised Person For and on Behalf of the Applicant:
Name and Title of the Authorised Person Acting Duly Authorised by the Board of Directors (or Equivalent Organ) of the Organisation:
Hong Kong Identity Card Number:
Date:
/ Declaration by the Deemed Applicant (where the organisation is not a legal person)
I/Each of us acknowledge that I/each of us submit this application in my/our own personal capacity. I /Each of us certify that all the information given in this application is true, accurate and complete. I/Each of us understand that if I/any of us willfully give any false information or withhold any material information, the application will become void and any grant approved will be withheld and any payment made with interest must be refunded by me/each of us to the Government. In the event that my/our application is successful, and without prejudice to other rights and powers of the Government, I/each of us consent to the disclosure from time to time by the Government of details of the project.
Signed by the Deemed Applicant:
Name of the Deemed Applicant:
Hong Kong Identity Card Number:
Date:
Signed by the Deemed Applicant:
Name of the Deemed Applicant:
Hong Kong Identity Card Number:
Date:
Please copy the above declaration and sign on a separate sheet if the above space is not sufficient.
A deemed applicant is: in the case of a registered society, each office-bearer of that society; in the case of a school registered under the Education Ordinance and that its management committee has not been incorporated, the principal of that school; and in other cases (other than a school or society) where an organisation is not a legal person, the persons named in Part 1.
/ Declaration by the Organisation (which is a partnership)We certify that all the information given in this application is true, accurate and complete. We understand that if we willfully give any false information or withhold any material information, the application will become void and any grant approved will be withheld and any payment made with interest must be refunded by us to the Government. In the event that our application is successful, and without prejudice to other rights and powers of the Government, we consent to the disclosure from time to time by the Government of details of the project.
Signed by a Partner in the Name of the Partnership:
Name of the Partner:
Hong Kong Identity Card Number:
Date:
/ Disclosure of Information
In the event that your application is not successful, and without prejudice to other rights and powers of the Government, please indicate whether you consent to the disclosure from time to time by the Government of your name, title of the project, and the amount of the grant applied for.
¨ Yes ¨ No
/ Checklist for Applicant
To help us process your application as quickly as possible, please kindly check that you have done the following:
1. Completed all sections of the application form.
2. Had the declaration signed by a duly authorised person of your organisation or by the deemed applicant in the case the organisation is not a legal person.
3. Attached the following documents:
i) copies of relevant registration documents;
ii) a set of the latest audited accounts or certified management accounts; and
iii) relevant supplementary information on the Project (if any).
You are reminded that failure to supply the required documents or information may result in the application being rejected.
/ Submission of Application
By e-mail: Submission of application forms by e-mail is preferred. Completed application forms can be e-mailed to . Please download application forms from www.enb.gov.hk/en/susdev/sdf/index.htm.
By post: Please forward the completed application form with supporting documents directly to:
The SDF Secretariat
Sustainable Development Division
Environment Bureau
46/F, Revenue Tower,
5 Gloucester Road,
Wanchai,
Hong Kong
Applications received by mail will be dated by the postmark. Late applications will not be accepted.
7
Budget Summary and Projected Cash Flow (Please attach detailed budget where necessary)
Projected Project Expenditure / Projected Project Income (please specify each source of income) / Amount requested from SDF(c)=(a)-(b)
Expenses Category / Item Description / Quantity / Unit Cost / Total
(a) / Fees & Charges / Internal Source / Other Sponsorship / Total Income
(b)
Programme Cost
Sub-total
Staff Cost Note 1
Sub-total
Administrative Overheads Note 2
Sub-total
Audit Cost
Total
Note: 1. If staff cost amounts to 50% or more of the total budget for the project, please provide justifications. If paid staff will be employed, please also complete the table on page 9 of this form.
2. Administrative overheads such as stationery, postage, photocopying charges, insurance, utilities, etc. are subject to a cap of 10% of the total expenditure of the project. Breakdown of such expenses should be provided. / Amount requested from the Fund: / 2018 / 2019 / 2020 / 2021
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Total
10
Information of Paid Staff
Position(Number of staff to be employed) / Experience and Qualification Required / Job Duties / Part-time/
Full-time Staff* / Equivalent Working Days/Hours
(for Part-time Staff only) (e.g. xx half-days/hours
per month or throughout the whole project period) / Salary
(including Mandatory Provident Fund)
*Please delete as appropriate.
10
Annex
Application for Sustainable Development Fund
Personal Information Collection Statement
Purpose of Collection
The personal data provided in this application will be used by the Government of the Hong Kong Special Administrative Region (“Government”) or the Sustainable Development Fund (“SDF”) Secretariat for the following purposes:
(a) processing and assessing the application;
(b) the daily operation of SDF;
(c) monitoring and evaluating the funded project;
(d) taking any remedial or follow-up action on the funded project;
(e) meeting the requirements to make disclosure under the requirements of any law;
(f) conducting research;
(g) recording and preparing statistics; and
(h) any purposes relating to any of the above.
2. Your provision of all the personal data requested in the application is voluntary. Your application may not be considered if you fail to provide all information as requested.
Classes of Transferees
3. The personal data provided in an application for SDF may be transferred or disclosed by the Government to any person for the purposes of verifying the particulars provided and other purposes relating to the application.
Access to Personal Data
4. The individuals whose personal data is provided in this application have the right of access and correction with respect to personal data as provided for in sections 18 and 22 as well as Principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance (Cap. 486) (“PDPO”). If you wish to exercise such a right, please contact Sustainable Development Division of the Environment Bureau. A fee may be charged in accordance with the PDPO for providing access to or correcting any data and for providing the information.
Enquiries
5. For correction of or access to personal data after submission of the application, please contact Executive Officer (Sustainable Development) 3 of the Environment Bureau:
Address: 46/F, Revenue Tower, 5 Gloucester Road,
Wan Chai, Hong Kong
Telephone: 3150 8166
Fax: 3150 8168
Email:
10
[1] In the case the organisation is a society registered under the Societies Ordinance, the applicant should be each office-bearer of the society (as defined in the Societies Ordinance).
[2] In the case the organisation is a school registered under the Education Ordinance, and that its management committee has not been incorporated, the principal of that school should be the applicant. Where the school’s management committee has been incorporated, the management committee should be the applicant.
[3] Direct participants refer to persons who are directly involved in the project activities. Indirect participants refer to those who do not participate in the project activities but may have access to the deliverables of the projects (e.g. visitors to exhibitions, targeted readers of publications and browsers of project website, etc.).