1. Organisation name and contact information

A1 – Name of Organisation:
A2 – Name, Title & Contact of person (primary contact in-country):
A3 - Country:
A4 - Area (Regions / Provinces) covered in this country presently by this organisation:
A5 - Membership level of IAPB[1] / A / B / C
B. Budget / staffing summary for organisation in this country for past 2 years and secured funds for next year.
Budget / years
Last Year / This Year / Next Year
Total staff numbers / year
C. How does your organisation presently link its work with the national eye care / VISION 2020 plans?
(200 words max)
D. Describe present focus of work / key achievements in this country.
(300 word max)
E. Who will manage the project in-country? Attach local organisational chart to explain your structure. (50 words max)
F. Describe any previous links with Seeing is Believing and Standard Chartered in this country (100 word max)
G. Describe proposed new project and why Seeing is Believing support is sought.
Project Title:
G1 – State the goal of the project and its key objectives.
(200 words max)
G2 – Provide the reasons for project, including key beneficiary groups, local data on unmet eye care needs for this population. Be clear about any previous work that this project will build on. Highlight specific barriers for vulnerable groups (including women and girls) that this project aims to address.
(500 words max)
G3 – Who will implement this project? Please clarify in terms of direct service delivery, as well as any local partners for related activities, eg Information, Education, Communication (IEC) activities.
(100 words max)
G4 – How will you measure success of this project?
(250 words max)
G5 – Explain any unique advantages your organisation has to deliver on the objectives of this project. Explain your organisation’s specific competencies or organisational focus.
(300 words max)
G6 – What are the risks / other pertinent issues for this project? (200 words max)
G7 – Describe other eyecare service provisions for this population. Will this project support others also working in this geographic or thematic area? How will it do so? What links are or will be put in place with other service providers?
(300 words max)
G8 – How will this project create a sustainable impact? Please include comment on any social (e.g. building of community ownership of services), financial (e.g. cost-recovery mechanisms) or other aspects of sustainability (e.g. how eye care capacity will be maintained).
(300 words max)
H. State total funding sought for this project – at 100%
Project budgets will be composed of a maximum of 80% from SIB and minimum 20% from NGOs other sources.
Use SiB Headings in USD / Year 1 / Year 2 / Year 3 / Total
Organisation costs
Partner support
Service delivery costs
Communications, Advocacy, Community awareness
Monitoring and Evaluation
Total Budget
I. What opportunities exist for Bank staff involvement?
(400 word max)
J. Provide any additional information that you feel is relevant to your Initial Proposal which you haven’t already stated in one of the section on this form (max 200 words).
Date Completed: / Name & Position:

Appendix A

The application process is will be in two stages:

  1. Initial Proposal stage
  2. Full proposal stage

For more details about these stages, please refer to the application guidance documents.

Once shortlisted at the Initial Proposal stage, NGOs will be requested to answer the following aspects of the full proposal form. The information will be requested to satisfy the Bank’s compliance requirements in line with the UK Bribery Act 2010.

A. Please list down the name of the Board members of your organisation.
(100 word max)
A1. What is the role of the Board and what type of decisions are made by the Board? (100 word max)
A2. Are clear and transparent minutes kept of the board’s meetings and decision making process? Please give example (100 word max)
A3. Are any individual board members permitted to become involved in decisions involving to whom/ where/ how benefits may be allocated? (100 word max)
A4. Please provide any documentation/ terms of reference that outline the role of the board members. (100 word max)
B. How are Board members selected? Please provide any documentation/ terms of reference that indicate how the Board members are appointed. What is the length of a Board member’s term? Is there a process by which any conflict of interest would be identified or disclosed? Is there a process and practice by which Board members are excluded during a decision making process in the event of a conflict?
(100 word max)
C. Does your organisation have a due diligence process in place when selecting the donors to determine whether there has ever been any accusations of bribery or corruption against them? Please provide details of how this process is managed.
(300 word max)
D. Does your organisation have a periodic or specific (ad hoc) audit conducted by external (independent) accountants to determine whether the accounting records accurate and complete, and whether the statements prepared from the accounts present fairly your organisation’s financial position and the result of your financial operations? If yes, what is the frequency of this exercise? If no, are there any future plans to conduct audit for your organisation.
(300 word max)


[1] For NGOs not a member of IAPB, please visit to find out more details on how to become a member.