Private Infrastructure Development Group Pidg

Private Infrastructure Development Group

Technical Assistance Facility

PRIVATE INFRASTRUCTURE DEVELOPMENT GROUP “PIDG”

APPLICATION FOR GRANT FROM TECHNICAL ASSISTANCE FACILITY

Submission Date: ______

1)PIDG Facility

Name of PIDG Facility applying for grant :

2)Project Name

Project Name:

3)Geographic Focus

(a) Country/Countries:
(b) Region:
(c) DAC Status of Country:
(d) Fragile State Status:
(e) Project Coverage:
Nationwide
Other:

4)Sector

Sector (tick all that apply):
Agri-Infrastructure / Urban Development / Infrastructure
Capital Market Development / Transport - Rail
Water, Sewage and Sanitation / Transport - Ports
Energy Generation/T&D
If Renewable Specify: (i.e. Renewable – Wind or Renewable – Solar) / Transport - Road
Industrial Infrastructure / Transport - Air
Telecoms / Transport - General (i.e. more than one made)
Mining Infrastructure
Housing / Multi sector (i.e. for infrastructure in general)
Other

5)Nature of Proposed TAF-funded Activity

Tick box to specify the nature(s) of the proposed activity and include proposed amount of funding for that activity
(a) / $ / Provide capacity building support to enhance capacity of target groups in-country, to support economic and pro-poor development arising from PIDG project opportunities
(b) / $ / Up-front funding of pre-feasibility studies aimed at facilitating and mobilising private investment for infrastructure
(c) / $ / Developmental Additions - provided to design and implement pro-poor, developmental "add-ons" to projects supported by PIDG facilities
(d) / $ / Post Transaction Support - Financial support to Facilities and/or directly to governments and/or private investors post-financial close
(e) / $ / Capital Market Development -Fund the design and implementation of innovative deals aimed at strengthening the capacity of local financial markets and institutions

6)Summary of Underlying Project and Proposed TAF-Activities

(A)Background:
(B)Summary ofUnderlying PIDG Project:
(C)Summary of TAF-funded Activities:
(D)Role of PIDG Facilities in the Underlying Project:

7)Dissemination of Results

8)Rationale for the use of TAF funds:

9)Consistency with PIDG mission(to mobilise private sector financing to improve infrastructure and so facilitate economic development and alleviate poverty):

10)Detail ofUnderlying PIDG Facility Project

a) Rationale for PIDG Support:
Expanded Access / Improve Affordability
Facilitate Transition / Other (please specify):
b) Expected Beneficiaries (direct and indirect):
c)Expected Outputs and Impacts:
g) Other Relevant Design/Scheme Issues:
h) Summary of Underlying PIDG Project:
-Additionality:
-Development Impact:
-Poverty focus:

11)Host Government Support

a) Has the host government approved the project outlined above, including the PIDG aspects?
b) How will the project contribute to government’s broader sector objectives and the objectives outlined in the government’s Poverty Reduction Strategy (if applicable)?
c) Responsive Government Official(s) (Also provide information on local officials when local government(s) involved):
Name:
Position:
Ministry/Agency:
Name:
Position:
Ministry/Agency:

12)Detail of Activities to be Funded by TAF

a) Major Deliverables:

Key Success Indicator:

Key Success Indicator:
b) Implementation Schedule:
c) Expected Start Date of TAF-funded Activities: [if not within 3m of date of application, explain why]
d) Expected End Date of TAF-funded Activities:
e) Expected Start and End Date of each Major Deliverable:
1. ... To commence in ...
2. ... To commence in ...
3. ... To commence in...
f) Expected Service Providers and Selection Process:
g) Expected Disbursement Criteria:
h) Expected Performance Monitoring Strategy:
i) Principal risks to timely implementation of grant-funded activities:

13) Type of TAF Grant Requested

a) Proposed Grant Structure:
Technical Assistance Grant (Non Returnable) / Returnable TAF Grant
Proactive Upstream TAF Grant / Other (please specify):
b) Rationale for proposed grant structure:
c) Outlineproposed structure of any returnable element (if applicable):
d) Outline any administrative cost coverage:
e) Grant Disbursement Schedule
[Please insert expected dates, noting that TAF disburses funds in six monthly tranches to cover costs expected to be incurred in the subsequent six month period]
Grant Approval Date / Grant Letter Execution Date / First Disbursement Date / Second Disbursement Date / [Add in Columns for additional disbursemen] / Grant Closure Date
[This should be within 1m of grant approval or a note included below to justify variance] / [This should be at grant execution or within 1m or a note included below to explain variance] / [This should be 6m after previous grant disbursement or a note included below to justify variance] / [Date by which TAF-funded activities have finished and all TAF funds have been spent by grant receipient]
Notes:

14)Funding Request and Co-Financing Details

a) Financing Plan:
Major Components (Please Breakdown Major Deliverables from 13a) / PIDG
Request
(US$) / Co-financing / Total Cost
(US$)
US$ / Details
(i.e. government cash or in-kind contributions, donor funds, status of approval, etc.)
Total Financing/Costs

15)PIDG Facility Task Management

Name:
Position:
Unit:
Telephone: / Fax: / Email:

16)Supporting Material

Supporting Material

/ Date and Form of Transmission to PIDG

Please return completed Application Form and supporting materials to the PIDG CMO:

C/o MDY Legal

Kings Buildings

16 Smith Square

London SW1P 3HQ

United Kingdom

Attention: James Leigland, TAF Technical Adviser