Application Form for Request for Proposals to Facilitate Mission Zero Hunger Drive 1. APPLICAN’ Organization Name: Registration Number with the date of registration: Representative’s Details: ‘Name of the person entitled to enter into legally binding commitments on behalf of the implementing partner Designation: ‘Contact information (tel, email, ete.): Full Address: 2._BANK DETAILS Bank Name: Branch Name: ‘Address of the bank ‘Account holder name ‘Account No, IFSC Code: 3._APPLICANT’S PROFESSIONAL CAPACITY, 3.1. Describe the organization’s activities in relation to providing Food and Nutrition to the target Community. Indicate your experience in providing Catering/Canteen services during the Tast 5 years with an overall turnover of at least Rs.10 lakhs /year for catering/canteen services. (Please give details about your experience in providing hot cooked meals and dry rations under the Mission Zero Hunger drive) (max 300 words) Supported by Audited Balance Sheet and Profit/Loss Account or Income & Expenditure Account; CA certificate certifying tumover from social consulting / Govt. Advisory projects/ Work order with Verified Deliverable Proof (Attached Annexure-2) 3.2, Staff involved in the project (Please provide information on the number and the expertise of the staff involved. Please attach the CV of the person who will be the focal point of the project and a link to your organization's website.) 3.3. Prior experience in working with JSP Foundation or any other Organisations (Please mention any project(s) in the last 5 years that were funded either by JSP Foundation or any other agencies for providing hot cooked food and dry rations to the underprivileged community members. Provide the name of the donor organization, the size of the grant received, the date, duration, and location of the project, and a brief description, Ref. Supported by Work Order/ Contract Documents and Annexure-1) I[Pae3.4, The ISO 9001-2008 / ISO 22000 certification (shall be preferred).: Copies of Certification attached as Annexure-3, 4, APPLICANT’S OPERATIONAL CAPACITY 41. Indicate below how the applicant intends to implement the proposed activities (Mission Zero Hunger) and please attach the Statute of your Organisation, CSR Form-1, Form 0G, and Form 12A, PAN, GST, IT Returns (last 3 FY) and cancelled cheque to this application form (Attached as Annexure-4) Please explain your available resources and needed resources to implement the project 4.2. Indicate below how the applicant intends to contribute to the project (either by way of its ‘own resources or by contribution from third parties). 5. PROPOSED BUDGET 4.1. The amounts quoted in the commercial offer (per meal cost which includes Rice/ Millet/ Roti, Dalma i.e. Dal with vegetable, and Khata/ Chatni/ Pickle) should be INR and inclusive of all taxes and inclusive of GST. Base price and admissible GST need to be separately quoted. All other levies, Duties, Charges, freight, insurance, packing, loading and unloading, etc. should be included in the bid price 6. DECLARATION i. By signing this form I, the undersigned, authorized to represent the applicant, hereby certify that the information contained in this application is correct and true to my knowledge and understanding pursuant to carrying out the proposed activity which is the subject of this grant application. ii, I, the undersigned, agree with the proposed project and my role in its implementation as provided in the Project Proposal Form and authorize the implementing partner in charge to sign the Project Proposal Form in my name, iii, I certify on my honor that the organization is not engaged in any kind of activities like corruption, fraud, money laundering, or any sort of activities contravening the issues of race, caste, and religion. iv. The organization. is not in a situation of bankruptcy, liquidation, termination of activity, insolvency or arrangement with creditors or any like situation arising from a procedure of the same kind, or is not subject to a procedure of the same kind; v. The organization has not received a judgment with res judicata force, finding an offense that affects its professional integrity or constitutes serious professional misconduct; vi. The organisation complies with its obligations regarding payment of social security contributions, taxes, and dues, according to the statutory provisions of the country where it is established. I. SIGNATURE Name of the Signatory Designation inthe organization (implementing partner) submitting the proposal, Place of signature Date of signature ‘Organization Seal 2|PazFINANCIAL YEAR: 2022-23 Annexure-1 Project Title Project Objective Project Period Location of the project Project Demographic Picture Beneficiaries Covered (Type and No.) ‘Achievement Impact Generated Grant amount received from which organization (The amount requested in INR) Total Project Cost (in INR) FINANCIAL YEAR: 2021-22 Project Title Project Objective Project Period Location of the project Project Demographic Picture Beneficiaries Covered (Type and No.) ‘Achievement Impact Generated Grant amount received from which organization (The amount requested in INR) Total Project Cost (in INR) FINANCIAL YEAR: 2020-21 Project Title Project Objective Project Period Location of the project Project Demographic Picture Beneficiaries Covered (Type and No. ‘Achievement Impact Generated Grant amount received from which organization (The amount requested in INR) Total Project Cost (in INR) 3|PagFINANCIAL YEAR: 2019-20 Project Title Project Objective Project Period Location of the project Project Demographic Picture ‘Beneficiaries Covered (Type and No.) ‘Achievement Impact Generated Grant amount received from which organization (The amount requested in INR ‘Total Project Cost (in INR) FINANCIAL YEAR: 2018-19 Project Title Project Objective Project Period Location of the project Project Demographic Picture Beneficiaries Covered (Type and No. ‘Achievement Impact Generated Grant amount received from which organization (The amount requested in INR, Total Project Cost (in INR) 4|Pag