BPI SINAG In Collaboration With

ACCELERATE 2017
APPLICATION FORM

PERSONAL INFORMATION

LAST NAME FIRST NAME MIDDLE NAME NICKNAME

AGE BIRTH DATE (MM/DD/YYYY) GENDER CIVIL STATUS

( ) MALE ( ) FEMALE ( ) SINGLE ( ) MARRIED

PERMANENT ADDRESS PROVINCIAL ADDRESS

LANDLINE NO. MOBILE NO. EMAIL ADDRESS NATIONALITY

EDUCATIONAL ATTAINMENT (INDICATE SPECIFIC DEGREE OR FIELD OF STUDY)

( ) ELEMENTARY ( ) VOCATIONAL ( ) POSTGRADUATE
________________________ ___________________________
( ) HIGH SCHOOL ( ) COLLEGE ( ) UNDERGRADUATE
___________________________
NAME OF SCHOOL DATE GRADUATED (MM/DD/YYYY)

SOCIAL ENTREPRENEUR INFORMATION

CURRENT POSITION HELD SCOPE OF WORK NO. OF YEARS IN THE SOCIAL ANNUAL SALARY
ENTERPRISE

NAMES OF PREVIOUS/OTHER SOCIAL ENTERPRISE/S INVOLVED WITH

SOCIAL ENTERPRISE INFORMATION

NAME OF ENTERPRISE ADDRESS OF ENTERPRISE

LANDLINE NO. MOBILE NO. EMAIL ADDRESS WEBSITE

TYPE OF ORGANIZATION INDUSTRY

( ) SOLE PROPRIETORSHIP ( ) ASSOCIATION ( ) ADVERTISING AND MEDIA ( ) DISTRIBUTION (IMPORT/EXPORT)
( ) PARTNERSHIP ( ) COOPERATIVE ( ) AGRICULTURE, LIVESTOCK, FISHERY ( ) MANUFACTURING
( ) CORPORATION ( ) SELF-HELP ( ) BANKING AND FINANCE ( ) OIL PETROLEUM
( ) NGO ( ) OTHERS ( ) CONSTRUCTION ( ) REAL ESTATE
( ) FOUNDATION ________________ ( ) EDUCATION ( ) RETAIL
( ) ENTERTAINMENT AND LEISURE ( ) TRADING
( ) EVENTS ( ) TRAVEL AND TOURISM
( ) FOOD AND BEVERAGE ( ) PUBLIC UTILITIES
( ) HEALTH AND WELLNESS ( ) OTHERS __________________
( ) HOTEL AND RESORTS
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YEARS IN OPERATION NO. OF EMPLOYEES AT PRESENT NO. OF EMPLOYEES DIRECTLY MANAGED

ANNUAL GROSS REVENUE (BASED ON PREVIOUS YEAR) VALUE OF TOTAL ASSETS (BASED ON PREVIOUS YEAR)

AREA/COMMUNITY BEING SERVED SECTOR/S BEING SERVED

( ) WOMEN ( ) FISHERMEN
( ) YOUTH ( ) OFWS AND DEPENDENTS
( ) CHILDREN ( ) PERSONS WITH DISABILITIES
NO. OF BENEFICIARIES BEING SERVED ( ) SENIOR CITIZENS ( ) INDIGENOUS PEOPLES
( ) INFORMAL WORKERS ( ) OTHERS ______________________
( ) FARMERS

DESCRIBE THE PRODUCT OR SERVICE BEING OFFERED TO CUSTOMERS

DESCRIBE THE CUSTOMERS OR TARGET MARKET OF THE PRODUCT OR SERVICE

DESCRIBE THE PROGRAM BEING PROVIDED TO BENEFICIARIES AND WHAT PROBLEMS IT INTENDS TO ADDRESS

SOCIAL IMPACT MEASUREMENT

( ) LEVEL OF INCOME ( ) LEVEL OF HEALTH
( ) LEVEL OF LITERACY ( ) LEVEL OF EMPLOYMENT
( ) LEVEL OF MALNUTRITION ( ) LEVEL OF WATER SUPPLY
( ) LEVEL OF ENVIRONMENTAL CONSERVATION ( ) LEVEL OF SANITATION
( ) LEVEL OF ENVIRONMENTAL PROTECTION ( ) OTHERS
( ) LEVEL OF ACCESS __________________________________________
NAMES OF SOCIAL ENTERPRISE AFFILIATIONS/MEMBERSHIPS

NAMES OF FUNDING ORGANIZATIONS/AGENCIES (IF ANY)

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APPLICATION OF CRITERIA TO SOCIAL ENTERPRISE

BENEFICIARY NET BUSINESS INCOME OR TAKE HOME PAY

Please discuss how much is your stakeholders benefitting from your social enterprise.
For Example:
Palengke ni Juan uplifted the lives of its vendors in Calauan, Laguna. A census of the 30 stores as of February 2015, revealed
that the overall NET income amounted to PhP 426,300 per month. The highest earning stall was a fish stall which earned PhP
36,000 monthly, while the lowest earning stall was a dry goods stall which earned PhP 4,000 a month. On the average, the 30
stalls earned PhP 14,210 each. Compared to what the store owners were earning before they started operations, the total
added monthly income because of Palengke ni Juan was PhP 179,100.

SOCIAL ENTERPRISE CONTINUITY AND SUSTAINABILITY

Please discuss the long term potential of your social enterprise including the preservation of natural assets of the community.
For Example:
SMP-mpc's water refilling station in Tondo proved to be a financially feasible operation, with 2014 sales at PhP 1,314,063 and a
net income at PhP 281,977. The operation had remained profitable from 2010 to 2014. Net sales increased by a little less than
14% over five years. As of February, 2015, the SMP-mpc prepared plans to expand their operations by purchasing a new water
processing system that was not dependent on electricity to function. This would enable operations at the water station to
continue through the sporadic brownouts that left Smokey Mountain without electricity and potable water for five to ten hours
at a time. SMP-mpc and SPM expected it to reduce the electrical costs at the water refilling station by 2/3.

SOCIAL ENTERPRISE IMPACT

Please discuss how the investments in the social enterprise yielded the expected business returns as well as social returns.
For Example:
Given the infrastructure investment in Palengke ni Juan of only PhP 2.5 million by DMCI plus the capacity building investment
of Bayan, the financial rate of return alone (PhP 426,300 per month for the vendors and PhP 126,000 per month for the
helpers or a total of PhP 552,300 per month) could easily justify the livelihood intervention. The yearly net financial return to
vendors and the helpers of PhP 6.6 million could readily offset the investments made. The economic and social rates of return
would be higher since the palengke reduced the transportation and meal costs of both the buyers and the vendors/helpers. If
the palengke were enlarged and it became a major destination, the prices of the goods sold may further, yield more cost
savings for the BNJ residents.

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REPLICABILITY AND SCALABILITY
Please discuss how your social enterprise model can be replicated and can be scalable.
For Example:
Palengke ni Juan did not only cater to BayaniJuan residents but its reach had brought regular shoppers from the Calauan town
proper and nine other barangays from three adjacent towns. This effectively gave the public market a catchment market of
around 11,295 households.

COMPETITIVE ADVANTAGE
Please discuss your competitive advantage. Describe the technology and innovation being utilized by your social enterprise to
meet expected outcomes.
For Example:
The shoppers frequented Palengke ni Juan for reasons such as its proximity to their homes, better quality of goods offered (an
observation that came from the shoppers themselves), the walkways which were wider, the natural lighting of the whole place,
the pleasant smell of the place (compared to general public market standards), and the general cleanliness of the area.

REQUIREMENTS FOR SUBMISSION

( ) UPDATED CURRICULUM VITAE OF THE APPLICANT, INDICATING PRESENT ROLE AND RESPONSIBILITIES IN THE SOCIAL ENTERPRISE
( ) NARRATIVE DESCRIPTION/PROFILE OF THE SOCIAL ENTERPRISE
( ) ACCOMPLISHED APPLICATION FORM
( ) INCOME STATEMENT FOR THE PAST TWO YEARS

TERMS AND CONDITIONS

Your information will be used for pre-assessment of the Screening Committee and will be kept with STRICT CONFIDENTIALITY.

This application is valid for the 2017 batch run.

I certify that all of the above information is valid and correct.

(Signature Over Printed Name)

LEARNED THROUGH

( ) EMAIL INVITE ( ) EVENTS ( ) OTHERS

( ) WEBSITE ( ) WALK-IN __________________________
( ) SOCIAL MEDIA (FACEBOOK, ETC) ( ) FAMILY
( ) PRINT ADS ( ) FRIENDS
( ) DIRECT MAIL ( ) RELATIVES

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