For FY 2019

JFKL Small Grant Programme

Application Form

(Day) (Month (Year)

Date: / ) /

Note: This is the “Application Form.” Applicants should submit all of the supporting
documents listed in the “Programme Guidelines”.

1. Title of the Project:

2. Category of the Project:

Category A & B:

□ Performance □ Exhibition □ Film Screening

□ Conference/Workshop/Master-class □ Publication □ Other

Category C:

□ Conference □ Teacher Training □ Publication of Teaching Resources

□ Support for Resource Centre/ Library □ Other

3. Project Period:
(Day) (Month) (Year) (Day) (Month) (Year)
From / / To / /

4. Project Venue(s):

5. Organisation Information:

Name of Organisation

Name of Section Section (e.g. Faculty, Division etc.):

that conducts
the Project
Legal status
Registration number
Year of registration

Office address

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 Office number Tel: Fax:

Contact Person:
Name
Position
Contact
number
Fax
E-mail
address
Signature
___________________________________________

Project Director Company Stamp

Title
Name
Position
E-mail
address
Signature
___________________________________________

Bursar

Title
Name * If submitted by email,
please scan this page with
Position the original signatures and
E-mail company stamp. The
original copy of the
address application form is required
Signature to be sent to JFKL
thereafter.
___________________________________________
*The Project Director and the Bursar must be two different individuals.

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6. Organisation Background:

* For private organisation, please submit the registration certificate and recent audited financial report.

7. Objectives of the Project:

Please state how your project can contribute to the objective of the grant.

8. Project Description:
Please clarify how you will achieve the expected outcome described below through the proposed
project.

* Please submit the supporting documents with detailed descriptions of the project, as stated in the

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“Application Instruction”.

9. Major Collaborators / Collaborating Institutions:

Country, Name of Institutions / Roles

* Please submit the supporting documents (i.e. letters from major Collaborators / Collaborating
institutions) if possible, as stated in the “Programme Guideline”.

10. Proposed Schedule:

Please use a separate sheet if the space provided below is not enough.
Date Activities Project Site or Venues

11. Expected outcome:

Please state how the project can contribute to the larger audience/participants and public.

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12. Public relation (PR) plan for the project:

** Checklist for Ticketing Events

Ticket price / Number of Will you apply for visa for the artist
Participation fees estimated audience and permit for performance?

______ people □ Yes.

Adult RM_______
x ______ □ No, because:
Concessions
performance ________________________________________
RM_______
= ______ total _______

13. Supporting Documents:

(Please attach and check)

 Eligibility check list

 Detailed Project Proposal (including a report of past similar project, if any)
 Information on the applicant’s organisation
 Organisation registration certificate
 Profile or biography of guest/collaborator (artist, researcher, collaborating institution, etc.)
 Agreement with the guest/collaborator (in the form of letter, email or contract
 Quotations as per request in the budget proposal

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 14. Budget Proposal (in Ringgit Malaysia):
Currency:
Budget Proposal Break Down of Cost Sharing
Breakdown Cost Coverage and in kind support
Items Specification Total Applicant’s own Other Funding Grant from
e.g. ＠×day×persons, etc. expenses Sources JFKL

(1) Honorarium

(2) Per diem

Route, Class
（3）Transportation

a.
International
Transportation

b.
Domestic Transportation
(Within Malaysia)

(4) Accommodation

(5) Publicity copies ×RM

(6) Rental Fees for Venue and

Equipment

(7) Report/Printing copies × RM

(8) ) Fee for VISA and permit

(9) Others

　Grand Total

* All budget items for the project, including those covered by applicant and other funding sources, should be included in “Total Project Cost”.

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 15. Bank Account:

Bank Name

Branch Name

Address
Account
number /
IBAN for 24
European
Bank Code
BIC / Swift Currency
Code for

Name of the
Account
Holder
Address of the
Account
Holder
* In case the name of the account holder differs from name of the applying organisation, a
letter of attorney which describes the reason of delegation is needed if JFKL decides to
award the grant.