NATIONAL LOTTERY DISTRIBUTION TRUST FUND (NLDTF) SPORTS &RECREATION SECTOR SMALL GRANTS PROJECT BUSINESS PLAN, BUDGET AND PROJECT MOTIVATION

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NATIONAL LOTTERY DISTRIBUTION TRUST FUND (NLDTF) SPORTS &RECREATION SECTOR SMALL GRANTS PROJECT BUSINESS PLAN, BUDGET AND PROJECT MOTIVATION 1. IDENTIFYING PARTICULARS a) Name of organisation: b) Physical Address of Organisation: c) Province: d) Municipal Area: 2. AREA OF IMPLEMENTATION OF PROJECT/PROGRAMME a) Where will the project/programme/services you are applying for be implemented? Rural area Township Urban Semi-urban Semi-rural Informal settlement 3. WHAT WILL BE THE IMPACT OF THIS PROJECT/PROGRAMME? 4. RACIAL PROFILE OF BENEFICIARIES: Give the number of people who will benefit from this project/programme in the table below. Race Tick Number African Coloured Indian/Asian White NLDTF Sports & Recreation Small Grants Business Plan Application 2015

4.1 Please attach a comprehensive transformational plan to this application indicating inter alia the following details: Targets for elite athletes, number of participants, geographic spread, demographics (age group. gender, race) for development programmes, capacity building and management committee(s) as appropriate to your organization. 5. JOB CREATION OPPORTUNITY: a) Will there be any new jobs created through this project/programme? YES NO b) If yes, how many new jobs will be created: ---------------------------------- c) If yes, what would be the nature of the employment and number of jobs to be created? Please tick the appropriate box. Nature of Employment Full-time Part-time Volunteers Number of job opportunities to be created through this application. 6. REPRESENTIVITY OF THE ORGANISATION a) Is/are your project/programme meant for a specific group? If YES, give details and explain why: b) Do the founding documents of your organisation require you to provide services only to a particular group? If YES, give details and explain why? c) If your Management Committee is not representative of the race of your beneficiaries, explain why and explain what steps you have taken to rectify this: NLDTF Sports & Recreation Small Grants Business Plan Application 2015 2

7. OTHER DONORS /INITIATIVES CONTRIBUTING TO THE PROJECT Indicate if there are other donors/ initiatives contributing to the project and the value of the contribution, including significant value-in-kind donations. Donor/Initiative Amount 8. ORGANISATIONAL SUSTAINABILITY: Can you tell us how your organisation plans to ensure that your programme/project continues beyond funding from the NLDTF? NLDTF Sports & Recreation Small Grants Business Plan Application 2015 3

9. PROJECT MOTIVATION: Please motivate the need for the project. NLDTF Sports & Recreation Small Grants Business Plan Application 2015 4

BUDGET REQUESTED FROM NLDTF Please complete the information below in full: 10.1 BUDGET OF INCOME for 2015/2016 financial year (From whom or where does your organisation plan to receive funding in 2015/2016) Sources of Income National Lottery Distribution Trust Fund Subsidy and/or grant from Dept. of Sport & Recreation Government Department/s: SASCOC Confederations Other Bequests and/or Legacies Donations, Grants and Sponsorships Fees for Services paid by beneficiaries Fundraising and/or Events Income Income from Investments Income from Trading Activities Membership Fees Amount in Rand Source Other Income (please specify) 1. 2. 3. 4. TOTAL Amount in Rand R NLDTF Sports & Recreation Small Grants Business Plan Application 2015

10.2 BUDGET OF EXPENDITURE PLEASE NOTE: Each line item requested must be motivated in the notes column. If the space is not enough, use a separate sheet showing which item you are motivating for. Item Quantity Unit Cost Amount requested from NLDTF Notes for Budget Items 1. 2. 3. 4. 5. 6. 7. NLDTF Sports & Recreation Small Grants Business Plan Application 2015 6

Item Quantity Unit Cost Amount requested from NLDTF Notes for Budget Items 8. 9. 10. 11. 12. 13. 14. 15. TOTAL (Inclusive of VAT) R NLDTF Sports & Recreation Small Grants Business Plan Application 2015 7

10.3. REQUEST FOR CAPITAL EXPENDITURE If you are requesting a grant for capital expenditure including new facilities, upgrading existing facilities, sports equipment etc, please include the details below. NOTE: a) QUOTATIONS must be attached for all items (at least three from a credible local supplier) b) If ground and/ or buildings are requested, please submit the following: PROOF OF OWNERSHIP, OFFER TO PURCHASE, LEASE AGREEMENT, OR PERMISSION TO OCCUPY in the name of the organisation, (not an individual) PROOF OF REGISTRATION OF THE PREFERRED BUILDER with the relevant body BUILDING PLANS QUOTATIONS (three quotations for material must be submitted from credible suppliers. Two separate quotations must also be submitted for labour costs.) What is the total amount requested from the NLTDF (This must be the same as the total amount indicated in form B2). SIGNED BY: Full Name:. Position:. Signature: Date:. NLDTF Sports & Recreation Small Grants Business Plan Application 2015

SMALL GRANTS CHECK LIST FORM 2010/1 Proof of Registration as NPO, Non Profit Company (formerly Section 21 Company), Public Benefit Trust, Letter of Affiliation Founding documents [Constitution, Trust Deed, Memorandum & Articles of Association Project Business Plan, Budget & Project Motivation Certified copies of the IDs of the 2 Contact persons and the Members of the Management Committee listed on page 2 of application FORM 2010/1 Financial records (Refer to guidelines for description of requirements) Where applicable Proof of registration for services that requires registration in terms of any law, where applicable Quotations for all goods and services FOR CONDUITS/AGENTS: Form 2010/1 or Form 2010/2 for each organisation/community that will be assisted. Skills Transfer and Capacity Building Plan Relevant mandatory documents as indicated above Statement by the applicant providing reasons why it requires assistance Statement by the agent, representative or conduit on the nature of assistance it will provide to the applicant Other Conduit Documents: Supplementary Form for agent/ representative/conduit applying on behalf of beneficiary organisation/community NLDTF Sports & Recreation Small Grants Business Plan Application 2015 9