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Entity legal name
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Entity commercial name
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Entity address
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Entity email
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Email
Confirm Email
Links to Social Media Accounts (e.g. Facebook, Instagram, LinkedIn, Twitter, etc.)
First Name of Point of Contact:
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Last Name of Point of Contact:
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Title of Point of Contact:
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Where was your company founded?
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Years to date in operation:
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Where is it registered?
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Where are your enterprise/organization’s locations?
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HQ and satellite offices or plants, etc.
In which of the following countries do you have operations? Please check all that apply
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Antigua and Barbuda
The Bahamas
Barbados
Dominica
Grenada
Guyana
Jamaica
St Kitts and Nevis
St. Lucia
St. Vincent and the Grenadines
Trinidad and Tobago
Suriname
Will you be expanding to any of the above countries in the near future? If yes, which ones?
Please list all related companies and ownership information.
Is your organization women owned or led?
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Yes
No
This means your business is at least 51% owned, operated and actively managed on a daily basis by one or more women
Is your organization youth owned or led (ages 15 – 29)?
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Yes
No
Total number of employees
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Number of Female employees
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Number of Youth employees (ages 15-29)
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Please describe your organization. What is your mission and history? What are your activities, product(s), or service(s)? Who is your target market/clientele? (Limit 200 words)
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Describe your management team. Who are the lead managers, what are their duties and responsibilities? What are the specific skills that each brings to the company? (Limit 200 words)
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I agree to allow CCIR Blended Finance Mechanism to conduct a background check on key personnel. Please note that your response to this question will affect your eligibility. Only applicants that agree to have a background check conducted on key personnel will be reviewed.
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I agree
I disagree
Do you have relationships with any of the following stakeholders? Please check all that apply:
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Banks
Chambers of Commerce
Local Professional Network
Business-to-business (B2B)
None
How have natural disasters affected your organization? Please explain. (Limit 100 words)
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How does your business/organization monitor disaster risks and/or receive information about disasters? (Limit 100 words)
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Do you have an emergency management plan in place? If yes, what kinds of disasters does this emergency plan cover? When is the last time you conducted a drill with the emergency management plan? (Limit 100 words)
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Do you have a business continuity plan in place? If yes, give an example of the type of information included in your business continuity plan. ( Limit 50 words)
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For your organization’s location, what is covered by your landlord’s insurance? Is it sufficient or do you need additional insurance? (For home-run businesses, home insurance typically different from business insurance) (Limit 50 words)
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What support do/would you offer employees in the event of a disaster? (Limit 50 words)
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Do you have back-up copies of important documents?
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Yes
No
Do you have an inventory of your assets, with photos, videos, and records to prove ownership?
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Yes
No
Does your organization have a cybersecurity plan?
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Yes
No
Does your organization have a Climate Resilience Strategy?
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Yes
No
What outside support, if any, does your organization need to make investments in its business resilience
In which industrial/commercial sector do you operate?
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Agriculture
Business Process Outsourcing (BPO)
Business or professional services
Creative Industries
Energy / Renewables
Fisheries/Aquaculture
Financial services
Logistics/Distribution
Manufacturing/Agro-processing
Technology
Tourism, hospitality, and/or travel
Transport
Waste Management
Utilities
Other
Please fill this textbox if you select other
Please describe your sector in more detail. Where has the industry been and where is it projected to go?
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What are the greatest risks affecting your organization/industry? Examples may include policy risks, issues with customers or suppliers, risks with shareholders or employees, etc.
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Tell us about your business/organizational context pre-COVID.
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How did COVID impact your business/organization? (Limit 100 words)
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In what way(s), if any, was your organization able to adapt to the impacts of COVID-19? (Limit 150 words)
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What was your net revenue in 2019 and 2020 in USD (approx.)?
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Have you received any relief funding?
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Yes
No
If yes, please explain:
Please describe your proposed project and activities for which you will use the requested funding.
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Define deliverables and due dates and ensure that your goals are SMART (Specific, Measurable, Achievable, Realistic, and Timebound).
Why is this project needed and how was that need identified?
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Did you conduct research to identify this need? Do you live in this community and have you seen this need first hand?
What is the amount of funding sought?
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Use the project budget template to help you create a more detailed budget then enter the total amount requested here.
What is unique or innovative about your organization and/or the proposed activity?
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What is your relevant experience and expertise? (including your management team, leaders, etc.).
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What risks, either positive or negative, have you identified in your proposed activities? What are potential threats or opportunities that could arise through your project? How will you respond to these risks? You can use the optional risk analysis template to identify relevant risks for this question.
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How will this financing contribute to increasing the disaster resilience of your business and/or community? Examples may include scalability/growth potential in a sector relevant to disaster resilience; disaster planning; logistics; business continuity planning; digitalization (cloud-based services, mobile payments, etc); infrastructure upgrades (Limit 300 words)
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Please select up to three Sustainable Development Goals that your project contributes to.
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GOAL 1: No Poverty
GOAL 2: Zero Hunger
GOAL 3: Good Health and Well-being
GOAL 4: Quality Education
GOAL 5: Gender Equality
GOAL 6: Clean Water and Sanitation
GOAL 7: Affordable and Clean Energy
GOAL 8: Decent Work and Economic Growth
GOAL 9: Industry, Innovation and Infrastructure
GOAL 10: Reduced Inequality
GOAL 11: Sustainable Cities and Communities
GOAL 12: Responsible Consumption and Production
GOAL 13: Climate Action
GOAL 14: Life Below Water
GOAL 15: Life on Land
GOAL 16: Peace and Justice Strong Institutions
GOAL 17: Partnerships to achieve the Goal
Pease specify how your project will contribute to the selected SDGs.
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Tell us about your organization’s current sustainability goals. Are you monitoring your environmental impact? Will this project contribute to you meeting your sustainability goals?
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Please identify any potential positive or negative environmental impacts that this project could have, and how you will mitigate against negative impacts and/or promote positive outcomes. Example metrics may include greater energy efficiency, greenhouse gas emissions avoided, mitigated, reduced; renewable energy; land area under more sustainable management; quantity of waste reduced, reused, and/or recycled; quantity of hazardous waste reduced, etc.
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Describe any potential social impacts of your project. Example metrics may include number of households benefiting, number of trainings provided, number of community facilities/infrastructure built or renovated, etc.
Identify any actions/results that will have an impact on women and/or minority populations, people with disabilities, LGBTQ, youth, etc. This may include the number of people benefiting who are people with disabilities, women, youth, indigenous and/or other historically marginalized groups.
Please identify any impacts of the project in value or supply chains in the Eastern Caribbean, including reducing blockages or filling gaps.
Identify any innovations that the project includes (products, processes, distribution, management, international standards, etc.).
Does this project promote exports and/or substitute for imports? If yes, please explain:
Equity
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Loans
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Assets
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Grants
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Total
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From which banks or other creditors have you received loans? What were these loans for? If not applicable, please write “Does not apply” in the box.
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Does your organization have any existing private equity investments/other outside ownership arrangements? If so, please provide names of these investors and the role that they play in your organization. If not applicable, please write “Does not apply” in the box.
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Please provide a breakdown of your revenue by domestic vs. international revenue. What proportion of your revenue is domestic and what proportion is international?
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When was your last audit? Who conducted the audit? If you have not been audited previously, please make note of this.
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Type of Funding Sought
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Seed
Trade Finance
Working Capital
Equipment
Infrastructure
Other
Please fill this textbox if you select other
Amount requested (in $USD)
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Matching funds amount ($ USD). Please note that it is not required to provide matching funds.
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Total project cost
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If you do not have these statements, please explain why. If you have historical financial information but it is not in the format of financial statements, we may be able to provide you with support in creating these statements. If you do not have historical financial information because your organization is a start-up, please make a note of this, and, if possible, provide the financial information of another company that you or your management team previously managed or currently manage.
Current Revenues (for existing operations)
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Year 1 Projection
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Year 2 Projection
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Year 3 Projection
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Briefly explain your assumptions and reasons for your projections (Limit 250 words)
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How did you learn about this challenge? Please check all that apply
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Chamber of Commerce
Business Association
Investment or Export promotion agency
National Youth Council or Youth Business Trust
Small Business Development Center
Other government ministry
CCIR Coalition
USAID
Google or other internet search/platform
Word of Mouth
Not Applicable
Other
If you selected any of the types of organizations listed above (Chamber of Commerce, business association, National youth council, etc.), please specify which:
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