Clean Cooking Loan Fund Application

Please read the Call Guide before you begin. This can be found at: http://carbonfinanceforcookstoves.org/clean-cooking-loan-fund-application/ Note that this Registration Form has no 'Save and Resume' function. Please be prepared to fill out everything in one sitting.

1. Name of the project *This question is required.

2. Organization name *This question is required.

3. Role in project (Lead Applicant/Co-Applicant/Partner …) *This question is required.

4. Organization type (Non-profit/Private/Social Enterprise …) *This question is required.

5. Registered Address *This question is required.

6. Website (if no website, enter "none") *This question is required.

7. Contact details: *This question is required.

First Name

Last Name

Title

Email Address

Phone Number

Skype ID (if no skype ID, enter "none")

8. Project Partners (if any) and their role

9. Does the project disseminate improved cooking stoves (or fuels) for household use? Note that if the answer to this question is "No", you are not eligible for the CCLF and you should cease completing this Registration Form.

10. How many cookstoves do you plan to disseminate per year?

Questions 11 - 19 ask you to provide details of your stove model(s). You may add details of up to three stoves.

11. Please state the name of stove model 1.

12. Please attach technical specifications or a picture of stove model 1.

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13. Please state the indicative consumer/retail price for stove model 1 (in US $).

Additional stove model(s) (if applicable)

14. Please state the name of stove model 2.

15. Please attach technical specifications or a picture of stove model 2.

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16. Please state the indicative consumer/retail price for stove model 2 (in US $).

17. Please state the name of stove model 3.

18. Please attach technical specifications or a picture of stove model 3.

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19. Please state the indicative consumer/retail price for stove model 3 (in US $).

20. If more than one stove model is being used, please specify how many stoves will be disseminated overall and in what proportions for each stove.

21. Please state the Project Start Date (MM/DD/YYYY). If the project has not yet started, please state this. Note that this is defined as: ""the date when expenditures related to the implementation or construction has started, e.g. signing of contracts for equipment or construction/operation services. Minor expenses such as feasibility studies or preliminary surveys are considered pre-project and are not included."

22. If the project has started: Please state what type of evidence for the start date can be provided e.g. type of contracts signed, Board meeting minutes etc… .

23. If the project has started: Please state whether the "prior consideration of the CDM" form has been submitted to the UNFCCC, and include the link to this if applicable.

24. Please give a brief description of the project (no more than 300 words).

25. Please indicate what preferred carbon standard will be applied to the project (if known).

For Question 26, the following definitions apply:
- LOW INCOME: people living above the poverty line established by the national government but below the national median income.
- POOR: people living below a recognized poverty line. Includes persons living below the poverty line established by the national government, or persons living on less than US $2.00 per day in daily per-capita expenditures at 1993 Purchasing Power Parity (PPP).
- VERY POOR: people living below a recognized absolute extreme poverty line. Includes persons in the bottom 50% of those living below the poverty line established by the national government or persons living on less than US $1.00 per day (technically US $1.08 per day per capita at 1993 Purchasing Power Parity (PPP) or on less than US $1.25 per day at 2005 PPP).
- RURAL: Rural areas are characterized by low population densities with a strong presence of a farm economy. Use guidelines as defined by the area’s national government.
- URBAN: Urban areas are characterized by higher population density and vast human features in comparison to areas surrounding it. Use guidelines as defined by the area’s national government.

26. Please describe the type of consumers predominantly targeted by this project (select all that apply):

Questions 27 - 35 relate to the test results of your stove model(s). You may add details of up to three stoves.

27. Please state the name of stove model 1.

28. Has the stove been tested by an independent third party, based on IWA tiers of performance?

Space Cell	Not tested	Tier 1	Tier 2	Tier 3 or higher
Efficiency
Indoor Emissions
Safety

29. Please attach official testing results in ISO IWA reporting template.

File: {{filename}} delete

Additional stove models (if applicable)

30. Please state the name of stove model 2.

31. Has the stove been tested by an independent third party, based on IWA tiers of performance?

Space Cell	Not tested	Tier 1	Tier 2	Tier 3 or higher
Efficiency
Indoor Emissions
Safety

32. Please attach official testing results in ISO IWA reporting template.

File: {{filename}} delete

33. Please state the name of stove model 3.

34. Has the stove been tested by an independent third party, based on IWA tiers of performance?

Space Cell	Not tested	Tier 1	Tier 2	Tier 3 or higher
Efficiency
Indoor Emissions
Safety

35. Please attach official testing results in ISO IWA reporting template.

File: {{filename}} delete

36. Please state which country your key project activities will be located in. If there is more than 1 country, please specify which country the pilot project will be hosted in.

Host country 1
Additional host country (2 - if applicable)
Additional host country (3 - if applicable)
Additional host country (4 - if applicable)

37. Has the project established proof of concept (understood here as the project idea having been successfully tested in a specific market)? Specifically, proof of concept is established when demand has been identified for the given technology at the given price point and when the business model designed to meet this demand is deemed to become viable in the medium term (2-3 years).

38. Does the project dissemination strategy require selling the stove below cost (incl. manufacture, distribution and sales costs)?

39. If so, please specify the amount of the subsidy as a % of the customer selling price per unit.

40. What is the expected scale of CO2 reductions per year?

Clean Cooking Loan Fund Application

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