RA Ministry of Agriculture
THE PROJECT IS FINANCED BY THE EUROPEAN UNION AND AUSTRIAN DEVELOPMENT AGENCY
The Project is implemented by the UN Industrial Development Organization (UNIDO) and UN Development Programme (UNDP)
European Neighborhood Program for Agriculture and Rural Development (ENPARD)
“Producer Group and Value Chain Development”
APPLICATION FORM
(for legal entities or informal groups consisting of not less than 5 members / shareholders)
1.
Name of the group: ____________________________________________________________________________________
2.
4.
Group coordinator (contact person): ______________________________________________________________________
name, surname
Address:______________________________________________________________________________________________
marz, community
E-mail (if available): ____________________________________________________________________________________
5.
Date of submission: ____________________________________________________________________________________
6.
Organizational form of the group (circle):
6.1. Cooperative
6.2. Non-registered group (a group which performs joint activities, but is not a legal entity)
6.3. Newly established group
7.
State registration date of the cooperative (if not registered please indicate the year when the group started working
together):_____________________________________________________________________________________________
8.
Number of cooperative/group members:
8.1. In total______________
8.2. Women______________
8.3. Youth (aged 35 or younger) __________________
9.
How many members are registered and reside in the given community_________________________________________
3.
10. How many members perform agricultural or processing activities_____________________________________________
11. Financial resources for the establishment and operation of the cooperative/group (underline):
11.1.
Self-financed
11.2.
Donor organizations (specify the name __________________________________________________________)
11.3.
Loans
11.4.
Other (specify)______________________________________________________________________________)
12. Area of your cooperative/group activities (underline):
12.1. Primary production
12.2. Processing
12.3. Other (cooling, packaging, transportation or other,
specify___________________________________________________________________________________________)
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13. If your cooperative/group is engaged in primary production please specify the names of the products and quantities
produced as a result of the group work:
Product
Quantity
produced in
2014 (tons)
1
Fruit (specify):
2
Nut (specify):
3
Berry (specify):
4
Grape
5
Vegetable (specify):
6
Potato
7
Grain and cereals (specify):
8
Herbs and tea (specify):
9
Honey
10
Milk
11
Cheese
12
Other dairy (specify):
13
Meat (specify):
14
Meat product (specify):
15
Other (specify):
14. If your cooperative/group is engaged in processing, please specify the names of the products and quantities produced as
a result of the group work:
Product
1
Fruit processing: jam, puree, juice, other (specify):
2
Berries processing: jam, puree, juice, other (specify):
Quantity
produced in
2014 (tons)
2
3
Vegetables: canned, marinade, puree, other (specify):
4
Alcoholic beverages: wine, cognac, vodka, other (specify):
5
Dried fruits (specify):
6
Cheese production (specify the types of cheese):
7
Other dairy products (specify):
8
Herbs and tea (specify):
9
Other (specify):
15. Joint ownership of the cooperative/group members (if the group consists of more than 5 members, please fill in the data
for those 5 members who own the largest land plots or livestock):
Group member (name and surname)
Land area (ha)
Arable land
Orchard
area
(ha)
1
2
Backyard
plot
Cattle
3
4
Livestock (head)
Cow
Sheep and
goat
5
6
1.
2.
3.
4.
5.
Total for other group members
Overall
16. Results of the cooperative/group joint activities in 2014:
Product of primary production and processing
Unit
Scale
produced
Quantity sold
1
tons
2
3
Sales
revenue
(AMD)
4
1.
2.
3
3.
4.
5.
6.
17. Main sales channels (underline):
17.1. Export (indicate the country__________________________________________________________________________)
17.2. In the community
17.3. Yerevan markets
17.4. Markets of the marz capital or other towns
17.5. Supermarkets, shops
17.6. To the processors
17.7. To the intermediaries
17.8. On the roads
17.9. Other (specify_____________________________________________________________________________________)
18. Buildings, premises, machinery and equipment owned by the cooperative/group members (production area, agricultural
machinery, cooling facility, greenhouse, sun and artificial drying facility, processing capacity, etc.):
Private property of the group members
1
Buildings, premises, production areas, m2
2
Cooling facility, m2
3
Greenhouse, m2
4
Sun dryer, մ2
5
Artificial dryer,
Property under joint
ownership of the
group members
capacity, kg
6
Processing capacity, kg/hour
7
Wheeled and crawler tractor, piece
8
Combine harvester, piece
9
Truck, piece
10
Other agricultural machinery, piece
11
Agricultural equipment, piece
12
13
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19. The development goals of the cooperative/group for the next few years:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
20. The purpose of submitting the application (support expected by the cooperative/group):
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
21. Do the members of the cooperative/group have the need for training (underline):
Yes
22. Are the group members of the cooperative/group willing to co-finance to achieve the set goal (underline):
No
Yes
No
23. Please indicate how you learned about our project:
23.1. Governor’s office
23.2. Mayor’s office
23.3. Agricultural Support Center
23.4. Acquaintances, friends, relatives
23.5. Other (specify __________________________________________________________________________________)
24. Any additional information about the cooperative/group. If you wish you can attach additional documents to this
application form, such as contracts, business plans, etc.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Please send the application form to [email protected], [email protected], or deliver it to the UN
House in Armenia, 14 Petros Adamyan Street, Yerevan. The deadline for applications is 15 July 2015.
The
deadline has no restriction on the groups who apply with best innovative ideas.
If you have any questions, please call us at: 043 500 105 or 091 213 487.
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