SERSP Application Form

Section 1

1. Applicant Information

Full Name

Gender

Male Female

Date of Birth

National ID Number

Phone Number

Region

District/City

Jamoat (sub-district)

Village

Household Size

Are you part of a Rogun resettled household?

Yes No

Section 2

2. Applicant Category

Please mark all that apply:

Preference will be given to applicants from these categories

Select applicant categories

Youth (18–35 years) Woman Unemployed Person with disability Single-parent household Low-income household Returning Migrant from Russia

Section 3

3. Current Business Experience

Do you have experience of running a business?

Yes No

Please provide details about your business experience

How long? (years)

Do you run this business alone?

Yes No

Is your business registered with tax authorities?

Yes No

Do you have a bank account?

Yes No

How long have you been running this business?

Have you taken part in any government program supporting livelihoods?

Yes No

What support did you receive and in which year?

Have you taken part in any technical vocational training program?

Yes No

Which training courses did you take and in which year?

Have you taken part in any livelihood support program run by NGOs?

Yes No

What support did you receive and in which year?

Have you ever taken loan from a Bank or Micro Finance Institution?

Yes No

Section 4

4. Plans for Business Initiation/Expansion

200 business plans will be selected for in-kind grants (tools & equipment)

1. Business Type (choose one)

Agriculture Livestock Food processing Retail/shop Services Handicrafts Other

Please specify:

2. Is this:

A new business An existing business to be expanded

3. Describe your business idea (what you sell? Is it a product or a service?):

4. Who will be your primary customer? (at Jamoat level, Mahalla Level, Regional level):

5. If a new business, do you have relevant experience of running/working in similar enterprise before?

6. Are you ready to attend all days of the training?

Yes No

If yes, please provide any comments:

7. Have you ever sold products or services online/using the Internet in Tajikistan (including through social media such as WhatsApp or Instagram) as an individual or as a business?

Yes, currently Yes, but stopped No, never

8. If yes, through which channels?

Select channels used:

Messengers (WhatsApp, Facebook, Telegram) Instagram Tajik marketplaces (LakLak, Alif Shop, AVVAL, Obbo, Somon.tj) Other

9. Would you be interested in learning how to sell your products or services online in Tajikistan and explore how this could help increase your income?

Yes No

10. If selected, would you be willing to receive support to register on an online marketplace and start selling online in Tajikistan?

Yes No Not sure

Section 5

5. Expected Results

1. How will this business improve your income?

2. Will this business create any new jobs?

Yes No

If yes, how many?

3. Will women or youth be involved?

Yes No

Section 6

6. Training & Mentorship

Important: Absence in any training will lead to automatic rejection

Are you willing to participate in:

Business training Financial management Mentorship for 12 months

Section 7

7. Declaration

I confirm that the information provided is correct and I agree to follow SERSP grant rules. I also confirm that I will take part in the full livelihoods program, including trainings, preparing business plans, adhering to the contractual requirements if given business grants and actively participating in the 12-month mentoring program after receiving business grant.

Name

Signature

Date