Annex d the Sir Robert Ho Tung Charitable Fund

Annex D

The Sir Robert Ho Tung Charitable Fund

Application FOR ALLOCATION

Note: Completed application form shall be submitted to relevant Government Bureaux/ Departments for nomination. Financial figures shall be rounded off to the nearest 100. Quotations shall be provided for the budget, if available. Application forms without indication of the nominating Government Department's (or Bureau's) level of support will not be considered. Results of the allocation, including the names of all or some recipient organisations and the amount of allocations, will be announced in press release and local newspapers.	To be used by LWB
	Allocation Exercise	2017
	Reference No.
	Item Code
	Amount allocated

Name of Agency	Cheque payable to (if different from the name of agency)		Application Submitted via
			Govt. Dept.		Govt. Bureau
In English (must be completed)
In Chinese (must be completed)
Address of Agency	Responsible Officer
		Applicant	Govt. Dept.	Govt. Bureau
	Name
	Tel. No.
	Fax No.

Title of application
Objective & Description

Budget (Set out on a separate sheet if necessary)
Breakdown of Items			Amount (HK$)		Supported Amount (HK$) (to be completed by the nominating Department)
Total =
Schedule of implementation		Alternative sources of funding		Consequence of this application not being approved
Start Date	End Date
Recurrent Implications
Annual Recurrent Cost	Source of Funds

Departmental assessment of the applicant (To be completed by the nominating Government Department)
The applicant is :	The applicant’s sources of funding:
(Please tick as appropriate) □ a Government-subvented organisation □ a member agency of the Community Chest □ a registered charitable organisation under section 88 of the Inland Revenue Ordinance
Track record of completing past projects	Other relevant information
(Please tick as appropriate) □ outstanding □ good □ poor □ N/A

Departmental assessment of the application (To be completed by the nominating Government Department)
Comments	Level of support	Priority No.^1 (only for applications ranked A & B)
	A – High B – Medium C – Low D – Not supported

FSTB’s comments on the application (To be completed by the nominating Government Department if the application has possible recurrent financial implications for the Government)

Bureau’s assessment of the application (To be completed by the nominating Government Bureau if the application costs HK$250,000 or over)
Comments	Level of support	Priority No. (only for applications ranked A & B)
	□ A - High B – Medium C – Low D – Not supported

1 All project applications nominated by the same bureau/ department should be consolidated and prioritised on one list.