THE PROJECT IS FINANCED BY THE EUROPEAN UNION AND AUSTRIAN DEVELOPMENT AGENCY
The Project is implemented by the UN Industrial Development Organization and UN Development Programme
European Neighborhood Program for Agriculture and Rural Development (ENPARD)
“Producer Group and Value Chain Development”
APPLICATION FORM
Lori marz
(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. Union (association)
6.2. Cooperative
6.3. Economic partnership: OJSC, CJSC, LLC, other (indicate __________________________________________________)
6.4. Non-governmental organization
6.5. Non-registered group (a group which performs joint activities, but is not a legal entity)
6.6. Newly established group
6.7. Other (please specify)_______________________________________________________________________________)
7.
Group registration date (if not registered please indicate the year when the group started working
together):_____________________________________________________________________________________________
8.
Number of group members:
8.1. In total______________
8.2. Women______________
8.3. Youth (aged 35 or younger) __________________
9.
Financial resources for the establishment and operation of the group (underline):
9.1. Self-financed
9.2. Donor organizations (specify the name _________________________________________________________________)
9.3. Loans
9.4. Other (specify)____________________________________________________________________________________)
3.
10. Area of your group activities (underline):
10.1. Primary production
10.2. Processing
10.3. Other (refrigeration, packaging, transportation or other,
specify_________________________________________________________________________________________)
1
11. If your group is engaged in primary production please specify 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):
12. If your group is engaged in processing, please specify 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):
7
Other dairy products (specify):
8
Herbs and tea (specify):
9
Other (specify):
13. Joint ownership of the group members (in case the group consists of more than 5 members, please fill in the data for those
5 members who own the largest land plots or head of 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
14. Results of the group joint activities in 2014:
Product of primary production or processing
Unit
Production
volume
Quantity sold
1
tons
2
3
Sales
revenue
(AMD)
4
1.
2.
3
3.
4.
5.
6.
15. Main sales channels (underline):
15.1. Export (indicate the country_______________________________________)
15.2. In the community
15.3. Yerevan markets
15.4. Markets of the marz capital or other towns
15.5. Supermarkets, shops
15.6. To the processors
15.7. To the intermediaries
15.8. On the roads
15.9. Other (specify_______________________________________________________)
16. Buildings, structures, machinery and equipment (production area, agricultural equipment, refrigerator, greenhouse, solar and
artificial drying facility, processing capacity, etc.) owned by the group members:
Individual’s private property
1
Buildings, structures, production areas, m2
2
Refrigerator, 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
Agricultural equipment, piece
8
Wheeled and crawler tractors
9
Combine harvester
10
Truck
11
12
13
4
17. The group’s development goals for the next few years:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
18. The purpose of the application (support expected by the group):
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
19. The method of co-financing proposed by the group to achieve its objectives:
19.1. Cash including credit
19.2. Other (indicate __________________________________________________________________________________)
20. Please indicate how you learned about our project:
20.1. Governor’s office
20.2. Mayor’s office
20.3. Agricultural Support Center
20.4. Newspapers
20.5. Local TV
20.6. Acquaintances, friends, relatives
20.7. Other (specify __________________________________________________________________________________)
21. Any additional information about the 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], or deliver it to the UN office in Armenia, 14
Petros Adamyan Street, Yerevan. The deadline for applications is 15 May 2015.
If you have any questions, please call us at: 043 500105.
5