Netherlands Embassy in Tbilisi / 2024
Project proposal form for projects with the budget above GEL 69,000
Please indicate under which instrument and focus area you are applying. (One organisation can submit only one proposal.)
 

MATRA		Human Rights Fund
Rule of Law		Freedom of expression
Public administration		Freedom of religion and belief
Public order and law enforcement		Equal rights for LGBTI persons
Stability and security		Human Rights Defenders
Democracy		Equal rights for women and girls

I. General

Name of the applicant organisation
Address of the organisation  Contact person: name, position, email and mobile number
Bank account information of the organisation in GEL (name and address of the bank, IBAN, name of the beneficiary organisation)
Person who is authorised to sign contracts on behalf of the organisation: name, position, email and mobile phone
Name of the project
Overall goal of the project
Brief description/ summary of the project. Please limit yourselves to 15 lines.	- Problem - Goal - Objectives - Activities - Result - Impact
Requested amount in GEL
Proposed start date and end date

II. PROBLEM, IMPACT, OBJECTIVES, RESULTS AND ACTIVITIES
Please be brief in your descriptions!

1. Problem Statement –
   1. What problem/issue will be addressed by the project?
   2. How does the project help to address this issue/problem?

 

1. Parties involved in this activity –
   1. Who is/are the target group(s) and why?
   2. Who are the other main stakeholders?
   3. To what extent have the stakeholders been involved in formulating the proposal?
   4. Is the intervention aimed at a specific geographical location, and if so, why?

 

1. Objectives, results and activities –

• What are the main outputs (services and products) that will be delivered through the activity? Describe briefly.

 

• What are the main outcomes (changes and effects for the target groups) that will be achieved through the activity? Describe briefly.

1. Overall goal and objectives

 

1. Goal of the project

 

1. Objectives

Objective 1
Result(s) under this objective
Output(s) under this objective
Activities that will lead to these results and outputs

(If there are more objectives, fill in the list below. If there are fewer objectives, delete what is not necessary.)

Objective 2
Result/output 2.1
Activities

Result/output 2.2
Activities

Objective 3
Result/output 3.1
Activities

Result/output 3.2
Activities

Result/output 3.2
Activities
Etc.
 

1. What will be the impact of the project?

 

1. Describe two other similar projects implemented by you or other international or local organisations.

7. Please include gender aspects in your project, and elaborate on how inclusive it will be.
8. Please elaborate on sustainability of the project

9. Please elaborate on the involvement of/engagement with state institution(s), if applicable.

III. IMPLEMENTING ORGANISATION
1. Short description of the organisation (including names of its chairperson, director and members of the board.)
2. Five current or most recent donors (organisation, project name, implementation period, amount.)
3. Main achievements of the organisation. (List five points that make you proud, briefly.)
4. Do you have any income other than donors’ contributions/grants (e.g. from sale of services, membership fees, donations, etc.)?

• Do you have plans to generate income from sources other than donors’ contributions/grants? If yes, what are your plans?

IV. RISK ANALYSIS
IV.1. Contextual risks

1. In the space below please briefly describe the context in which the activity will be implemented, i.e. country-specific situation relevant to the project.

Context:

1. Please list and analyse risks that the context may be posing to project objectives. (Add lines below.)

Risk	Potential impact on outputs of activity (Low/Medium/High + explanation)	Risk assessment (Low/Medium/High + explanation)	Mitigating measures

IV.2. Project risks
Please list and analyse risks that could affect the intended results of the project. Please also reflect on a potential for fraud or corruption in areas like personnel, liquid assets, and procurement. (Add lines below.)

Risk	Potential impact on outputs of activity (Low/Medium/High + explanation)	Risk assessment (Low/Medium/High + explanation)	Mitigating measures

IV.3. Organisational risk – any risks of fraud and corruption
Please list and analyse risks related to your organisation, such as continuity, expertise, degree of independence, internal control, etc. Please also analyse risks of fraud and inappropriate behavior within your organisation. (Add lines below.)
 

Risk	Potential impact on outputs of activity (Low/Medium/High + explanation)	Risk assessment (Low/Medium/High + explanation)	Mitigating measures

Please provide the following information and documentation. Indicate n/a when not applicable and explain why.

1. 1. Please send us two most recent annual reports including financial statements and independent auditor’s report;

                                                                                               

1. 1. Please provide details on income resources (if not mentioned in the financial statement);

 

1. 1. Please provide short details on work force (quantity and quality);

 

1. 1. Please shortly describe governance and organisational structure;

 

1. 1. Please shortly describe procurement policy;

 

1. 1. Please send us your code of conduct or code of ethics;

 

1. 1. Please send us your anti-fraud and anti-corruption policy;

 

1. 1. Does your organisation have a channel for reporting incidents, such as integrity adviser?

 

1. 1. Does your orgnisation have whistleblower regulations in place?

 

1. 1. Does your organisation report on incidents in any way?

VI. BUDGET
Please attach the project budget in Excel using the provided template keeping the following in mind:

• Overhead costs (costs not directly related to the project, such as office rent or utilities) may be max 7% of the total project budget.
• It is in principle not permitted to buy hardware (computers, printers, etc.) from the project budget. Exceptions to this rule need to be specifically argumented.