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Ministry of Investment and International Cooperation Egypt’s First CSR Excellence Awards

Application Form

Please answer all sections of the application form to preclude disqualification. Please submit this application form together with as many enclosed documents, pictures and videos of the CSR projects.

This form is sent in an editable format to enable you to fill in and have it printed, sighed and duly stamped then to be sent back both in hard copy and soft copy formats via email.

In no case shall any modification, deletion or addition be permitted to the main headings and contents of this form, except for the CSR Project Section which you can duplicate with the same heading and contents in that section, General Authority for Investment and Free Zones reserves the right to exclude any Application Form if an amendment, deletion and/or addition is made to this form.

N.B(*) indicate that it is a mandatory field.

The application form is divided into below parts

1. Terms & Conditions and Declaration

2. Applicant Profile

3. Company’s CSR Overview

4. Company’s CSR Projects

1/1/2019

1. Terms & Conditions and Declaration

These terms of use represent a liable obligation that entail the following responsibilities:1. Accurate registration details of an accountable officer/employee of your organization.2. Submission of a true and accurate username and email address.3. Submission of true and accurate information/data of your organization.4. Full responsibility of ensuring that the information/data is checked prior to submission and are accurate and truthful.5. Declaration that none of the mentioned CSR activities is used for political, partisan and or religious or corruption purposes or discriminatory or violation of human rights and or civil rights.6. Consent that in the case of proven faulty information submitted by the company, the administrative team of the award has the full legal right to disqualify the participating company in question.7. Administrative team of the award reserve the right to contact participating companies for further clarifications, and additional validation requirements if needed.8. Applying company should understand and agree that by merely applying and filling the application, it is not entitled to any award or form of consideration.9. All disputes relating to or arising out of the Awards shall be subject to the laws of Egypt, and shall be subject to the exclusive jurisdiction of relevant Egyptian courts. 10. All Intellectual Property Rights generated during the Awards shall be property of the Ministry of Investment and international cooperation.11. The final selection of the awards by the judging panel is considered binding on all participating companies and cannot be contested.

I agree to Terms & Conditions

I declare (Name of applicant) *

That I understand, comply and agree to all terms and conditions assigned to this award scheme set forth here, and all the information given is true and correct.

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3 Salah Salem Road – Fairgrounds, Nasr City- Cairo 11562 – Egypt, Tel: +202 24055452, Email: [email protected]

mailto:[email protected]

1. Applicant Profile1.1. Company InformationCompany Name *(Full Name)(Please do not use acronym)

Company’s main economic activity*(according to establishment contract)

Agricultural C.I.T Construction Financial Industrial Services Tourism

Establishment number and date *(according to establishment contract)

No.

Date

Commercial registration number* No.Date

Legal form * Single Member Company Solidarity Company Simple Recommendation Company Joint Stock Company Limited Liability Company Stock Partnership Sole Proprietorship Company

Employment Size* (0-10) employees (10-50) employees (50-250) employees (more than 250) employees

Total capital of the company*

Currency*

American Dollars Egyptian pound Euro Sterling pound Saudi Arabian Riyal

1.2. Company’s HeadquarterRegion* Alex. Frontier

Asyut and New Valley Canal Delta Greater Cairo Northern Upper Egypt Southern Upper Egypt




Governorate*

City*

Address*

Contact No. *

Company’s website

1.3. Company's Factories/ plants(Please add all the company’s factories/plants)Region * Alex. Frontier


No. of factories/plants in the region*Governorate*

City*

Address*

Contact No.

1.4. Company’s CEO/President/Director

Full Name: *Last First

Tel No. *

Mobile No. *

Email

Address

2. Company’s CSR Overview2.1. Company’s CSR GovernancePlease select all relevant CSR elements that the company endorses* (according to establishment contract)

CSR or Sustainability Department(The organizational unit and or function under the management model of the company. This could be an entirely dedicated department/unit for CSR or a function under communication and or marketing for example)




CSR or Sustainability Manager(Employee assigned the responsibility of managing and implementing the CSR strategy of the company. Title could vary from one company to the other)

CSR Strategy(Planning Document that presents the mission, vision, and direction, in addition to the focus areas and details of projects /activities that promote and define CSR for a company)

CSR Projects(All initiatives/projects that the company has designed and implemented under its corporate social responsibility agenda)

Please describe the management structure of the CSR/sustainability Department ( if exists) * (Max. 250 word)Please give a brief about the company’s CSR vision, mission and strategy*(Max. 250 word)(Please attach the strategy document if available in addition to the brief description)

2.2. Contact Information of the Company’s responsible that oversee CSR

Full Name *Last First

Position*

Tel No. *

Ext. *

Mobile No. *EmailAddress

2.3. General approach to Social Responsibility and SustainabilityHow do you align your social responsibility and sustainability strategy with the company’s VMV (vision, mission, values) and operations? *(Max 250 words)

2.4. CSR Focus AreasWhat are the main CSR focus areas of the company, please select from the following: *

Environment Healthcare Social care Culture care Education Training Scientific Research Other




Please specify if other: *(Max 250 words)2.5. CSR Projects Geographic outreach(Please add all geographical locations for the CSR projects)CSR Projects Geographic outreach* Alex. Frontier


Governorate: *

City:

Village:

2.6. CSR implementation partnershipsWho is implementing the CSR activity for the company? *

It’s own CSR Foundation Other implementing partners

Please specify if other CSR Foundation: *

Please specify if other bodies: *

2.7. Staff Volunteering PolicyIs there a staff volunteering policy? * Yes

NoIf yes, please provide a brief description*(Max 250 words)2.8. CSR/sustainability reportDoes your company publish an annual CSR/sustainability report *

Yes No

If yes, please provide a brief description*(Max 250 words)If yes, please attach the latest report*

2.9.What is the annual average CSR budget of the company on average*Currency* American Dollars

Egyptian pound Euro Sterling pound Saudi Arabian Riyal

Please indicate the number of CSR projects that the company is currently engaged in: *




3.

4. Company’s CSR Projects1

4.1. Project OverviewProject Name*

4.2. Project DurationProject Start Date: *DD/MM/YYProject End Date: *DD/MM/YY4.3. Rational of the ProjectWhy this project is selected and what are the main concerns/challenges, this project seeks to address? *(Max 250 words)How widespread is this concern? (e.g. number of people in project location, across the value chain or nationwide) *(Max 250 words)4.4. CSR PillarsWhat are the main CSR focus areas of the company, please select from the following: *

Environment Healthcare Social care Culture care Education Training Scientific Research Other

Please specify if other:4.5. Project Description Enumerate the project’s general goals and measurable objectives. Include specific measures, and achievement time frame*(Max 700 words)Explain the development and design of the project. The activities planned and the tools and techniques used for the project*(Max 250 words)What is the budget of the project? *Currency * American Dollars

Egyptian pound Euro Sterling pound Saudi Arabian Riyal

4.6. Project Geographic CoverageCSR Projects Geographic outreach* Alex. Frontier

Asyut and New Valley Canal Delta

1 In case of several projects, please replicate the table and fill all required information for each project.7

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Greater Cairo Northern Upper Egypt Southern Upper Egypt

Governorate: *

City:

Village:

4.7. Who are the other partners/institutional engagements in the project? (Please duplicate in case of multiple partners)Name: *(Name of implementing partners, NGO’S, Community bodies … etc.).Role: *(The Partner’s function in the project).Responsibility: *(The partner’s duties in implementing the project).Contribution: *(The achievements of partners’ involvement).4.8. Staff VolunteeringHow many staff of the company were involved in the project through Volunteering? *4.9. Project ImpactTotal no. of beneficiaries the project intended to reach*Explain how and why the beneficiaries selected

Project social and economic achievements and impact (economic, social, and or environmental) *4.10. Monitoring and evaluation mechanism- Is there a monitoring and evaluation mechanism? *

Yes No

- Who is responsible for and involved in the monitoring and evaluation of the project (internal or external group)? *

- What is the frequency of project a monitoring and evaluation? *

- Please briefly describe (or attach) the monitoring and evaluation framework used in assessing the project. *

4.11. Project Sustainability- Do you want replicate your project in other sites/locations in the future? *

Yes No

- How will the outcomes and efforts be sustained if the company project ends? *

- How does the organization ensure the long-term impact of the project? *




- How do you see this project evolve in the next five years? Please explain. *




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