EUROPEAN UNION
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
Syunik 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. 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 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
1
12.3. Other (cooling, packaging, transportation or other,
specify___________________________________________________________________________________________)
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:
Quantity
Product
produced in
2016 (tons)
1
2
3
4
5
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:
Quantity
produced in
2016 (tons)
Product
1
2
3
4
5
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):
Group member (name and surname)
Arable
land
1
Land area (ha)
Orchard area
Backyard plot
2
3
1.
2.
3.
2
4.
5.
Total for other group members
Overall
16. Results of the cooperative/group joint activities in 2016:
Unit
Scale
produced
Quantity
sold
1
tons
2
3
Product of primary production and processing
Sales
revenue
(AMD)
4
1.
2.
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, processing capacity, etc.):
3
19. Please indicate how you learned
about our project:
1
Buildings, premises, production areas, m2
2
Cooling facility, m2
3
Greenhouse, m2
4
Processing capacity, kg/hour
5
Truck, piece
6
Other agricultural machinery, piece
7
Agricultural equipment, piece
20. Please indicate how you learned
about our project:
21. Please indicate
how you learned
about our
project:
8
9
22. The development goals of the cooperative/group for the next few years:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
23. The purpose of submitting the application (support expected by the cooperative/group):
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
24. Do the members of the cooperative/group have the need for training (underline):
Yes
No
25. Are the group members of the cooperative/group willing to co-finance to achieve the set goal (underline):
Yes
No
26. Please indicate how you learned about our project:
26.1. Governor’s office
26.2. Mayor’s office
26.3. Agricultural Support Center
26.4. Acquaintances, friends, relatives
26.5. Other (specify __________________________________________________________________________________)
4
27. 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], or deliver it to the UN House in Armenia, 14
Petros Adamyan Street, Yerevan. The deadline for applications is 8 June 2017.
If you have any questions, please call us at: 060 530000 (181) or 099 127471.
5