NGO TYPE National NGO International NGO CSO CBO Name of Organization Acronym Date of Establishment Who are you partner(s) in Liberia Source of Funding Address: Contact Number Email Name of International NGO Acronym Date established Address of international NGO in Liberia Country State / Province City Street Address1 Postcode / Zip International Headquarters Address In-Country Contact Numbers: Email Address Year Established in Liberia Who are you partners in Liberia (if any)? Source of Funding or Support (a) List the Board Members of your organization along with their contact information( in the following format: Name, Sex, Age, Nationality, PLWD, Position, Qualification, Contact No.) (b) List the number of staff(s) employed by your organization ( in the following format: Name, Sex, Age, Nationality, PLWD, Position, Qualification, Contact No.) a. Type of service provided ( specific area of focus) b. Who are your target beneficiaries ( those you provide service for) to be disaggregated by sex and age? 2. Age Range In which county(ies) are you carrying out your interventions? Please select the thematic area(s) of intervention. d. Name of district(s) where your organization is providing service(s) e. Name of community(ies) where your organization providing service(s) f. which Policy(ies) is your organization using as an implementation guide? a. Does Your organization have a bank account(s) b. If Yes, which banks(s) ? and Account number c. Please attached account statement ( Recent/three month.) d. Please upload Resource mobilization( Financial Strategy. Project/Program implemented. If Any, Please indicate Most recent ones.( example: Programs/Projects, Partner(s) Target Group(Male/Female), Project/program Location, start & end date.
Please ensure that the necessary documents and information are attached:
i. Letter of Application for Sector Clearance to MGCSP ii. Articles of incorporation notarized iii. Valid Liberia Business Registration- (original copy and a photo copy) iv. Previous accreditation certificate from Ministry of Finance and Development Planning (if established more than a year) v. Last activities report (if established more than a year); vi. Current work plan; vii. Resource mobilization (financial) strategy or how you get funding and other support. viii. Copy of your child protection policy (for NGOs targeting children). ix. Bank statement
I/We hereby certify that the information provided herein is true and accurate to the best of my/ our knowledge and anything to the contrary may lead to denial of clearance.
Name of organization’s head Position: Date:
IMPORTANT: Please be informed that your organization has the responsibility to provide comprehensive quarterly reports on activities carried out with emphasis on the following:
Targeted counties and communities
Targeted beneficiaries to be disaggregated by sex and age.
Note also that the M&E Division is authorized to pay quarterly visitation to your organization to follow up on information provided this Ministry. In addition, the Ministry requests that you provide annual performance report.