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New Zealand Partnerships

for International Development Fund

Concept Application Template

Activity title:[Enter text here]

Round 10: Applications due middayFriday 31 March 2017

How to complete this document

The International Development Advisory and Selection Panel (the Panel) and the Ministry of Foreign Affairs and Trade (MFAT) uses the information you provide in this form to determine which Partnerships Fund concept applications should be developed into an Activity Design Document. It is importantthat you provide all the information as completely yet concisely as you can.

Please read the New Zealand Partnerships for International Development Fund (Partnerships Fund) Guidelines and this concept applicationtemplate in its entirety before starting to fill it out.

Only applications using this concept applicationtemplate will be accepted. The completed concept application must comply with the indicated word limits. Only enter information where prompted by [Enter text here]or in the tables provided.

Please delete all of the guidance notes in blue italic writing before submitting this application.

Additional material, including attachments to the concept application template, will be accepted within the one document.

Alignment with New Zealand development objectives

Partnerships Fund concept applications must align to the New Zealand Aid Programme’s strategy country focus and investment priorities as identified through the following link The New Zealand Aid Programme Strategic Plan 2015-19 and Investment Priorities Alignment to the New Zealand Aid programme priorities should be described in section 1 of the concept application.

Once you have completed this concept applicationtemplate, do not convert it to PDF. Email the completed Word document by the due date to:

For guidance on the application process, see the Partnerships Fund Guidelines and supporting material at

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1Summary

Activity title
Name of New Zealand organisation submitting this application
Postal address
Details of main contact for this application
Name and Position
Phone number
Email address
Details of Chief Executive Officer (or equivalent)
Name and Position
Phone number
Email address
Name of New Zealand partner organisation(s) [1]
(Joint applications only)
Name of in-country/developing partner organisation(s)
Country(s) of implementation
Duration of activity
(Years) and proposed start date?
MFAT funding requested
(NZD, excluding GST)
Applicant matched funding
(NZD, excluding GST)
Total budget
(NZD, excluding GST)
Activity summary (150 wordsmaximum)
This section should explain clearly what this Activity will deliver and achieve. The summary should outline the essence of the concept you are proposing (i.e., what is the issue, what is the proposed solution, how will this be implemented).

1.Why: Activity Rationale

This section should clearly and succinctly describe the development need or opportunity.

1.1Development need/opportunity (800 word maximum)

  • Describe the development need or opportunity that the Activity will address.
  • Use evidence or data, where available, such askey learnings from earlier activities. How will the learnings contribute to achieving the expected results of this Activity?
  • How was this need or opportunity identified? How does this Activity align to the New Zealand aid programme’s investment priorities and other commitments, such as the Joint Commitments for Development?
  • What is the additional impact/ value achieved through New Zealand’s involvement in this Activity? How does the Activity demonstrate New Zealand’s know how and skills?
  • How does this Activity relate to the national development and/or sector plans of the partner country(s)?

[Enter text here]

2.What: Activity Purpose and Description

This section should clearly and succinctly describe what the Activity will deliver.

2.1Expected results

  • List a concise set of expected outcomes and outputs (‘results’) that the Activity aims to achieve in the Results Table below. Nb: a more comprehensive description of results will be developed during design.
  • Limit the outputs to no more than five. State these in the past tense (e.g. ‘Training workshop delivered’).
  • For additional information to help you to complete this table refer to ‘MFAT guidance on developing a results framework’

Goal / The goal is the overall aspirational impact that the Activity is expected to contribute towards
Goal: To …
Outcomes / Outcomes are the short, medium, and long-term changes or effects that are intended as a result of this Activity
Long Term
  • …
  • ….

Medium Term
  • …
  • ….
  • …

Short Term
  • …
  • ….
  • ….

Outputs / Outputs are the products, goods and services that will be delivered to achieve the outcomes
1.
2.
3.
4.
5.

Results diagram

  • The results diagram should clearly illustrate how the Activity’s outputs lead to the intended outcomes, and how outcomes contribute to the Activity’s goal. Where gender, human rights or environment are central to activity design these should be included in the outputs and/or outcomes. Modify the template to reflect the number of outputs and outcomes expected of this Activity, and show the links between them

2.2Assumptions (3-4 bullet points)

  • Describe the key assumptions you have made when developing the expected outcomes (e.g. what are the context or delivery assumptions you have made that success depends on).

[Enter text here]

2.3Activity purpose (800 words maximum)

Briefly describe the purpose for this Activity:

  • What will the Activity deliver?
  • How will the Activity achieve the outcomes/results proposed in the table above?
  • Why was this particular intervention chosen? Were other options considered?
  • How will this Activity complement (and not duplicate) existing or planned activities undertaken by other organisations working in-country in the same sector and geographical focus area?
  • Who benefits from this Activity in the developing country?
  • What are the potential impacts, positive or negative, on gender equality and women’s empowerment, human rights, and protection of the environment?
  • For complex commercial activities, succinctly describe the target market, growth potential, factors leading to success, and how proposed changes in the value chain will lead to outcomes being achieved.

[Enter text here]

2.4Risks (3-4 bullet points)

  • What are the key risks to achieving the proposed outcomes? (including potential environmental and social impacts and any major health and safety concerns)
  • How will you manage these risks?

[Enter text here]

2.5Profit (3-4 bullet points) (Refer Section 3 of the Guidelines)

  • Is it expected that the Activity will generate a profit?
  • If so, within what timeframe?
  • What will happen to profits (e.g. will they be retained by the organisation, reinvested in the Activity, used to off-set future contributions by the Partnerships Fund, shared with partners)?

[Enter text here]

3.Who: Activity Implementation

This section should describe who will be involved in Activity design and implementation, and why.

3.1Roles and responsibilities

  • Outline the proposed roles and responsibilities of each partner that will be involved in designing and/or implementing the Activity. Include:

- your organisation

- your partner organisation/s in the developing country(s),

- any other New Zealand-based organisations included in this application (as a joint partner) and

- what was the due diligence process for selecting partner organisations,

  • Copy and paste this table as many times as you need to.

Name of organisation
Roles and responsibilities
Skills and resources
Capacity and experience
Current activities in partner country (e.g. other business, religious or political activities which are not the subject of this application)
Value the organisation will add to this Activity

3.2Jointapplications (New Zealand-based partners only) (150 words maximum)

  • A joint application is where two or more New Zealand-based organisations are planning to partner, either formally or informally, to deliver a development activity in a developing country through the Partnerships Fund.
  • If this is a joint application, briefly describe the nature of the arrangement between the New Zealand organisations involved (e.g. partnership, joint venture, Memorandum of Agreement, no formal agreement etc)
  • Any New Zealand organisation named as a partner here or under Section 1 of this concept application template is also required to sign the declaration under Section 5.
  • The New Zealand lead applicant will need to seek permission from MFAT to include a partner organisation from another developed country (e.g. Australia) in their Partnerships Fund application.

[Enter text here]

3.3Additionality (150 words maximum) (refer Section 3 of the Partnerships Fund Guidelines)

  • Briefly describe how this Activity is in addition to your existing initiatives and work programmes (i.e., is not business as usual).
  • Alternatively identify if this is a phase two or extension of an existing Partnerships Fund activity.

[Enter text here]

3.4Sustainability (250 words maximum)

  • Describe what will happen when Partnerships Fund support ends.
  • How will benefits from this Activity be sustained beyond the period of funding?
  • How will recurrent costs, ongoing maintenance, or new Activity costs be met going forward?

[Enter text here]

4.How much: Budget

  • Complete the tables below to show:

- the indicative cost – by output - of the Activity for the entire period

- the financial contributions from all partners

- the maximum amount of funding requested from the Partnerships Fund.

  • The output statements must align with those listed in Section2.1.
  • Refer to the Partnerships Fund Guidelines for definitions and descriptions of in-country and New Zealand-based support costs, matched funding requirements, and in-kind contributions.
  • While a high level budget is required at this stage, the expectation is that the figures provided have been well considered and are realistic and justifiable. MFAT reserves the right to enquire about costings during the selection process.

Budget / Indicative costs (NZD, excluding GST) / TOTAL
Year one / Year two / Year three / Year four / Year five / $ / %
1 / Output:
[Enter text here]
2 / Output:
[Enter text here]
3 / Output:
[Enter text here]
4 / Output:
[Enter text here]
5 / Output:
[Enter text here]
Output costs sub-total
6 / In-country support costs
7 / New Zealand based support costs
Support costs sub-total
Total Activity costs

4.1Funding Sources

Funding sources / Yearone / Yeartwo / Year three / Yearfour / Yearfive / TOTAL ($)
Applicant(s) cash contribution
Applicant(s) in-kind contribution
Total funding required from Partnerships Fund
Any other contributions (where relevant)
Funding sources sub-total

4.2 Explanatory notes to the budget

  • Provide explanatory notes to the budget, including exchange rate used at time of concept and the assets that the activity planned to purchase.
  • Explain how value for money has been taken into consideration.

[Enter text here]

5. Declaration

NEW ZEALAND (LEAD) APPLICANT ORGANISATION

I confirm and declare that:

I have read the New Zealand Partnerships for International Development Fund (Partnerships Fund) Guidelines that outline the procedures, terms, conditions and criteria and I understand and agree to these;

None of the organisations that are part of the application are in receivership, or liquidation;

The application is not being made by an undischarged bankrupt or someone prohibited from managing a business;

Should MFAT agree that this concept proceed to design, this organisation commits to being responsible for the provision of the required matched funding over the life of the activity;

I acknowledge that MFAT may promote any successes that result from this application (while respecting commercial confidentiality);

I consent to MFAT undertaking due diligence on this application and the organisations associated with it;

The information contained in the attached application is true and correct and there have been no misleading statements, omission of any relevant facts nor any misrepresentation made;

At the date of this Declaration, I am not aware of anything that may prevent my organisation from completing the Activity. I have notified MFAT of any information that may affect MFAT’s decision to fund the Activity;

I am authorised to make this application on behalf of the parties identified in Section 3.

Name of authorised signatory: / Signature:
Position:
Organisation: / Date:

This declaration must be signed by a person with the legal authority to commit your organisation to a transaction.

UNCLASSIFIED

UNCLASSIFIED

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NEW ZEALAND-BASED ORGANISATION(S) IDENTIFIED AS A JOINT PARTNER SUBMITTING THIS APPLICATION

  • Copy and paste this signatory box as many times as needed (i.e. for multiple New Zealand partners)

<NEW ZEALAND PARTNER ORGANISATION NAME>confirms it is jointly submitting this Partnerships Fund application with <NEW ZEALAND LEAD APPLICANT ORGANISATION>.

I am authorised to sign on behalf of my organisation as identified in Section 3.

Name of authorised signatory: / Signature:
Position:
Organisation: / Date:

INTD-125-585

UNCLASSIFIED

[1]Any New Zealand organisation named here as a partner submitting a joint application is also required to sign the declaration under Section 5 of this concept application template.