<p> DAI - AWAAZ</p><p>RESPONSE FUND</p><p>I - Application Form</p><p>Proposal Number:(generated by RF/MO) AWWAZ OUTPUTS (Please tick only one output, which the project is primarily responding) 1) Community based initiatives for pre-emption of conflict and/or violence against women;</p><p>2) Fostering inclusion of differently abled (or disabled) persons;</p><p>3) Demonstration of innovative approaches in service delivery for health and education; Name of Applicant Organization:</p><p>Legal Status of the Organization:</p><p>Section 42 of Companies Ordinance, 1984</p><p>Trust Act, 1882</p><p>Voluntary Social Welfare Agencies Ordinance, 1961</p><p>Societies Registration Act, 1860</p><p>Partnership Act, 1932 </p><p>The co-operative societies act 1925</p><p>Non-profit public benefits organization (governance & support) act 1925</p><p>Other (please specify): </p><p>Organization Registration Number: Mailing Address:</p><p>Name &Title of Head of the Organization: Cell number: Email:</p><p>Name &Title of Contact Person for Proposal:</p><p>Cell number: Email: Brief description of the proposed project: Describe specific, measurable, achievable, realistic and time-bound (SMART) objectives</p><p>Direct Beneficiaries of the Project:(Name the specific beneficiary group, e.g. minorities, women, other excluded groups.-details to be included in Technical Proposal)</p><p>Total Number of Direct Beneficiaries: ______</p><p>Total number of direct male beneficiaries:______Total number of direct female beneficiaries: ______</p><p>Indirect Beneficiaries of the Project</p><p>Total number of Indirect Beneficiaries: ______</p><p>Total number of indirect male beneficiaries:_____ Total number of indirect female beneficiaries: ______</p><p>Geographical area of proposed Project:</p><p>List Major Activities associated with each Milestone: Milestones: Major Activities: Milestones 1 Activity 1a Activity 1b Activity 1c … n Milestones 2 Activity 2a Activity 2b Activity 2c … n Milestones 3 … n Activity 3a Activity 3b Activity 3c …n Project Duration (in Months): Please note that no extension will be allowed for project.</p><p>Planned Date of Project Commencement: Planned Date of Project Completion:</p><p>Budget Overview in PKR:´</p><p>Total Budget (PKR):</p><p>RF Contribution (PKR)</p><p>Applicant Contribution(PKR): (if any)</p><p>I hereby declare that the information provided is true and correct.</p><p>I hereby declare that I have not applied, obtained, or will be obtaining any other financial incentives for </p><p> this project.</p><p>Signature Date</p><p>Name of Applicant (Please print) Stamp of Organization</p><p>Application submission guideline:</p><p> RF application package comprises of RF application form, Technical Proposal and Financial Proposal. It should be submitted by (Date): ;</p><p> One organization can only submit one application;</p><p> One hard and soft copy of the proposal package should be provided. Soft copy to be provided in thumb drive/USB;</p><p> The RF Application Package should be submitted at the following address:</p><p>Strategic Learning Unit/Response Fund</p><p>House - 4A, Street no. 42, Sector F-7/1, Islamabad, Pakistan</p>