Applicant Information

Your First Name (required)

Your Last Name (required)

Email (required)

Contact number(required)

Age

Gender
FemaleMalenon binaryOtherprefer not to say

Disability
YesNo

Community

Municipality
Steve TshweteeMalahleniMsukaligwaGovan Mbeki

How long have you been residing in the municipality?

Province

Enterprise Information

Which one of the following industries does your enterprise fall under?
AgricultureEnergyWater purificationWaste ManagementSustainable TransportSustainable Tourism

Do you have a registered business
YesNo

Trading name of your enterprise

CIPC Registration Number:

How long has your enterprise been in operation?
Less than 3 monthsBetween 1 and 3 yearsMore than 3 years

What is the current annual turnover?

Are you currently part of any enterprise development programme or incubation? If so, please specify:

Is this enterprise the only source of income?
YesNo

If no, which sector do you work in?
Private sectorGovernmentNGOConsultancyOther

Have you worked in a coal value chain (mining, electricity generation, fly ash management, etc) previously or retrenched or is there anyone in your personnel that has worked in the coal value chain?
YesNo

Team Composition and Partnerships

Name of business partner or another director of the enterprise:

Indicate number of team members or personnel:

Does the team have prior business experience? Yes/No, if yes elaborate:

Do the team skills complement each other and is it beneficial for the business? Yes/No, if yes please mention the various skills

Does the enterprise have other partners or stakeholder besides other directors? Yes/No, if yes please mention partners

Equality & Youth Empowerment

Does the business ownership comprise of youth,women or persons with disability? Yes/No, if yes please elaborate

Job Creation Potential

What are the growth prospects of your enterprise?

Based on your business plan, how many people can your enterprise employ over a period of 12 months given adequate resources?

Sustainable Development Goals

Which of the undermentioned SDGs does your enterprise address directly or indirectly?
No povertyZero hungerGood health and well beingQuality EducationGender EqualityClean Water and SanitationAffordable and Clean EnergyDecent work and economic growthIndustry, Innovation and InfrastructureReduced InequalitiesSustainable cities and communitiesResponsible Consumption and ProductionClimate ActionLife below waterLife on landPeace, Justice and Strong InstitutionsPartnerships for the goals

Green and Climate Impact

Do your enterprise efforts or innovation contribute to mitigation or adaptation of climate change?
YesNo

If yes, how is your enterprise contributing to climate change mitigation and/or contribution to co-benefits of climate change response measures such environmental, economic, or social impacts?

If your enterprise also contributes to climate change adaptation, in what way does it help communities to build resilience to climate change

Business Model

Short Description of your innovation and services or products you offer(200 words max)

What problem are you solving with your innovation or solution?

Who are your customers?

What are your current challenges in growing or expanding your enterprise?

Describe your value proposition?

How does your enterprise create social, economic and environmental benefits or impacts?

How would you measure impact?

Have you conducted market research? If so what were the results of the market research?

What were the results of the market research?

Have you sold your products to some customers? Elaborate:

Have you received application from persons working or previously employed in coal mining and if yes how many

Ability to scale and replicate

Is your business model replicable and can it be easily implemented elsewhere? Yes/No, if yes please elaborate

Motivation

Why are you applying for technical and financial support under this programme? What do you expect to achieve during the programme and after receiving the support through the programme (300 words)?

Any other information that you would like to share on how your business support communities in the area where it is operational?

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