REQUEST FOR EXPRESSION OF INTEREST - APPLICATION FORM

Request for Expression of Interest

from

Service Providers

Ref: ESF-03-16

October 2016

TABLE OF CONTENTS

SECTION A: ABOUT YOUR COMPANY...... 4

SECTION B: WHAT THE COMPANY DOES...... 5

SECTION C: COMPANY OBJECTIVES AND ACTIVITIES IN THE SUNFLOWER VALUE CHAIN...... 6

SECTION D: PREVIOUS DEVELOPMENT SUPPORT...... 8

IMPORTANT NOTES

  1. Before filling this form, please take note that there are number of downloadable documents that accompany this form, which provide important information and guidance to help you in completing the form. The documents are: (i) The Selection Criteria that will be used in assessing your Expression of Interest, (ii) Intervention Summaries, which provide details on the specific interventions for which AMDT is seeking partners to implement. You are encouraged to refer to these documents while you fill in the forms.
  2. All the information requested in this Application Form is required for the Expression of Interest (EoI) to be considered. Please ensure you have filled in all the sections as requested. Application forms with sections that are not filled will not be processed. Please provide as much information as is useful to enhance your EoI. No additional documents or attachments are necessary, as such additional documents may be requested by AMDT while processing of the EoI is under way or once you are selected as a Partner.
  3. Please use the form that has been provided by AMDT. Applications on form that are not provided by AMDT will not be processed.
  4. When submitting the completed form, please email it to by 21th October 2016. Please make sure to submit the completed form in the same Microsoft Word format in which it was downloaded. When sending the email to submit the EoI, please enter ‘Request for Expression of Interest – Ref ESF-03-16’ in the subject line of the email. AMDT will acknowledge receipt of your email by replying to email address from which the application was sent.
  5. Please note that for all subsequent communication, after the email acknowledging receipt of your submitted Application form, the contact email provided in 1.8.3 will be used.
  6. Your application will be processed immediately after the closing date. Only successful applicants will be contacted.
  7. AMDT may contact you to provide some further information during the processing of your application. The email provided in 1.8.3 will be used for this communication.
  8. If you have any problems with this Application Form, please email AMDT at .

SECTION A:ABOUT YOUR COMPANY

  1. Company Details

1.1 / Company Registered Name
1.2 / P.O Box No.
1.3 / Physical Address
1.4 / City / Town / Area Country
1.5 / Company Telephone No.
1.6 / Email Address
1.7 / Company Website
1.8 / Contact Person
1.8.1 / Job Title of Contact Person
1.8.2 / Phone No. of Contact Person
(preferably Mobile Number)
1.8.3 / Email of Contact Person
1.9 / Company Registration
1.9.1 / Type of the firm
1.9.2 / Year of Establishment
1.9.3 / Registration Number
1.9.4 / Country of Registration

SECTION B:WHAT THE COMPANY DOES

  1. Organisation’s Core Business

2.1 / Describe the organisation’s core business
2.2 / Describe the organisation’s key services/products/offers
2.3 / Describe the organisation’s target clientele or customers, and a brief profile of their key characteristics, with gender breakdowns on profiles of women and men segments.
2.3.1 / Please provide the size of the annual budget/turnover of your organisation for the past three years
2.3.2 / Please provide the budget/annual expenditure of the organisation for the past three years, and also confirm the availability of the latest company audited financial report.
2.4 / Describe the major areas of operation for the organisation in Tanzania
2.5 / Briefly describe the Governance and Management structure of the organisation
2.5.1 / Briefly describe the company’s policy on gender, and how the company addresses gender equality in its work; please confirm if the company has a gender strategy
2.5.2 / Describe how your management structure, in particular, relates to your offered service / products, especially the services and products targeting AMDT target beneficiaries (Smallholder farmers and MSMEs/ women and youth) - also provide information on organization’s staff size and expertise

SECTION C:COMPANY OBJECTIVES AND ACTIVITIES IN THE SUNFLOWER VALUE CHAIN

  1. Company Objectives and Engagement with Value Chain Stakeholders

3.1 / Describe the company’s Strategic Objectives
3.1.1 / Describe the specific objectives or results the company intends to achieve in seeking to partner with AMDT in these interventions
3.2 / Please describe the company’s past and current activities with AMDT target beneficiaries (smallholder farmers and agricultural MSMEs, women and youth) in the sunflower value chain
3.2.1 / AMDT prioritize engagements of women and youth to the value chain we are working, Please describe any special initiative, policy, service or product that is designed to work with women or youth as suppliers of goods and services, customers or employees.
3.2.2 / Please describe the nature of commercial linkages the organisation currently facilitates with smallholder farmers in sunflower or other agricultural value chain, and facilitation with smallholder farmers, in a likely future partnership with AMDT in this intervention (Please, refer to the intervention summaries downloadable at AMDT website)
3.2.3 / Please estimate the number of smallholder farmers that the company has engaged in commercial linkages in the sunflower value chain or other agricultural value chains, with gender breakdowns showing the number of women and men. Please highlight the geographic areas where the smallholder farmers in these commercial linkages with the company are located or will likely be located, when the organisation partners with AMDT in this intervention
3.2.4 / Please describe the current nature of commercial linkages or relationships that the company has with other trading partners (whether large businesses or MSMEs) in the sunflower value chain.
3.3 / In the commercial linkages that the company has with smallholder farmers, please describe how smallholder farmers and other agricultural MSMEs are currently benefiting, and/or will likely benefit in a future partnership with AMDT in this intervention, with gender breakdowns for different kinds of benefits (e.g. know how; increased incomes; creating jobs; better access to services / markets; predictability of future revenues; and higher quality and more timely input)
3.4 / Please describe the kind of investments the company has made in the sunflower value chain in the last 3 years towards working with AMDT target beneficiaries and/or intends to invest in the intended partnership with AMDT in this intervention, and their outcomes for smallholder farmers and MSMEs (women and men)
3.5 / Please describe the company’s experience in working successfully in commercial partnerships with smallholder farmers and other agricultural MSMEs or in other consortia (Public-Private-Partnerships) that involve smallholder farmers(e.g. what works; what doesn’t work; why does it work / not work; what is the nature of the relationships that have developed; have these relationships endured; and has the monitoring and reporting system improved and does is better support learning and knowledge sharing).

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REQUEST FOR EXPRESSION OF INTEREST - APPLICATION FORM

SECTION D:PREVIOUS DEVELOPMENT SUPPORT

  1. Previous Development Support received by the Company[1]

4.1 / Has the Company received any donor support in seeking to work with smallholder farmers and/or agricultural MSMEs in the sunflower value chain or another agricultural value chain, in the last 3 years? If so, please state the following in the sections below:
Donor 1 / Donor 2 / Donor 3
4.1.1 / The name of the funding or donor organisations
4.1.2 / The size of funding
4.1.3 / The period of support
4.1.4 / The specific geographic areas where this support was targeted
4.1.5 / What parts or aspects of the sunflower value chain or other agricultural value chain were targeted
4.1.6 / What outcomes for women and men small scale producers and/or MSMEs?

Please email the completed form (in the format it was downloaded) to: . When sending the email to submit the form, please enter ‘Request for Expression of InterestESF-03-16’ in the subject line of the email. AMDT will acknowledge receipt of your email by replying to email address from which this application was sent.

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[1]If you have worked with more than 3 donors please expand the table and provide information accordingly