lBt1 UNIVERSITI SAiNS MALAYSIA

Tarikh 31 Julai 201 2

Semua Dekan PenyelidikanDekanPengarahPenyelaras Pejabat PelantarPusat PengajianPusaUI nstituUUnit Kampus IndukKampus KejuruteraanKampus Kesihatan

Y Bhg DatoDatinTuanPuan

INVITATION FOR PROPOSALS FOR THE ICT DEVELOPMENT SUPPORTING ICT PILOT PROJECTS IN RURAL AREAS 2012

Bahagian Penyelidikan dan lnovasi

Division of Research and Innovation

(dlhcln

Universiti Sains Malaysia Aras 6 Bangunan Canselorl 11800 USM Pulau Pirang Malaysia T 16)04-6533108317839885019 F (6)04-656 64668470

(6104 653 2350

wwwresearchlismmy wwwusmmv

PROGRAMME FOR

Dengan segala hormatnya perkara di atas dirujuk dan surat dar pad a Kementerian Penerangan Komunikasi dan Kebudayaan Malaysia bertarikh 26 Julai 20 12 adalClh berkaitan

2 Sukacita dimaklumkan bahawa The Asia-Pacific TelecommJnity (APT) menawarkan kepada pihak yang berminat untuk menyertai program penyelidikan bagi projek program pembangunan leT Pihak yang berminat bolehlah mengemukakan cadangan dengan melengkapkan borang yang disediakan seperti di lampiran atau ianya boleh diperolehi dengan melayari laman web httpwwwaptinUICT-J3 dan borang penyertaan hendaklah dikemukakan kepada Cik Sarina Alisaputri melalui emel sarinakpkkgovmy pegawai di Bahagicln Dasar Sektor Komunikasi di Kementerian Penerangan Komunikasi dan Kebudayaan Malaysia sEbelum 6 Og05 2012

3 Sehubungan itu kerjasama dan bantuan daripada pihaL Y Bhg DatoDatintuanpuan dipohon untuk menghebahkan makluman ini kepada penyelidik yang berminat dan bersama-sama Ini dilampirkan surat daripada Secretary General of The Asia Pc1cific Telecommunity (APT) Ruj APTPRSICT-DevUPP untuk rujukan dan perhatian Y Bhg Dato[atintuanpuan

Sekian terima kasih

BERKHIDMAT UNTUK NEGARA Memastikan Kelestarian Hari Esok

Yang menjalankan tug as

sk Timbalan Naib Canselor Penyelidikan amp Inovasi

Ketua PenDlong Pendaftar Pejabat Pengurusan dan Kreativiti Penyelidikan Bahagian Penyelidikan dan Inovasi

ABHNAOIsm _ Hfballn IHWTATION f OR PROPOSALS FOR THE leT DEVELOPMENT PROGRAMME FOR SUPPORTING ICT PILOT PROJEC TS IN RURAL AREAS 2( 12

G~middotmiddot

~~ ~

T HE AS IA-PACIFIC TELECOMMUNJTY 1249 Soi 5 Chaengwa ttana Road Bangkok 10210 Thailand

Our Ref APTPR8I1CT-DevUPP 18May201 2

Invitation for Proposals for the ICT Development Frogra mme For Supporting ICT Pilot Projects in Rura l Arelt S 2012

Dear SirMadam

I am pleased to inform you thai the Asia-Pacific Telecommunity is ngtw inviting appl ications for the ICT Development Programme for Supporting Pilot Projects in Rural Areas funded Ily the Extra Budgetary Contribution from Japan

The objective of this programme is to narrow the digital divide in the As ia-Pacific region by establishing pilot projects to ensure the access to ICT in rural areas of APT Member countries and to promote and develop ICT and Broadband development in Ihe region

This programme was launched in 2005 Since then the criteria ras been updated to reflect rapid technological changes and the changing requirements of the industry and the L sers

Interested APT members are requested to submit proposals for Hie pilot project by completing the Application Form and the Accounting Form which are attached to this letter In case of Affiliate Members the proposals sh ou ld be subm itted through the concerned APT Member or Associate Member When there are more than one proposal from a Member we wou ld appreciate it if such Member could prioritize the project proposals upon submission Proposals submitted for the last year s selection may be sJbmitted again with the necessary updates

The main conditions of this program are

The m aximum amo unt of the APT support available for one Jroject is US$150OOO However th e appropriate amo un t of the budget for the project will i e determined based o n carefu l examination of the proposal at the time of selection

The proj ect is to be completed within 11 m onths from th( date of ann ouncement of the selection made by the APT Secretariat

Priority will be given to the project with financial support from the proposing APT Member

Priority will be given to the project in the fields of environmem and disas ter communications

For more details please see the attached documents or visit APT web~ ite at httpwwwaptintiICTJ3

The project proposals should be submitted to the APT Secreta riat though th e APT Members contact point by the 15th August 2012 bye-mail aptictaptint or fax no +66 2 573 7479 or +66 2 574 4226

Yours faithfull y

[C riginal Signed]

To ~ h iyuki Yamada Se~retary General

TKJpm Attachment Altachment 1 - Scheme of the Programme Altachmen t 2 - Application Form Attachment 3 - Accounting Form and Budget Pm To All APT Developing Members and Associate Members Cc All Affiliate Members of Developing Members and Associate Members Japan

E-mai l aptmailaptint Veb Site wwwaptint Teleph one + 66 2 57300~ 4 Telefax + 6625737479

J3 Attachment-1

Scheme of ICT Development Pre gramme

for Supporting ICT Pilot Projects in RL ral Areas 2012

Recognizing the importance of establishing ICT infrastructure in rural areas as expres sed in the Bali Statement and Plan of )ction that was adopted at the APT Ministerial Meeting on Strengthen ing I~egional Collaboration towards a Broadband Economy in the Asia-Pacific hE Id in Bali in November 2009 and the Strategic Plan of the APT 2012-201~ adopted at the 1ih Session of General Assembly held in Jeju in November 2011 APT will be implementing the ICT Development Programme for Supporting ICT Pilot Projects in Rural Areas This programme is funded ty the Extra Budgetary Contribution from Japan An outline of this programme is as follows

1 O BJ ECTIV E The objective of this programme is to narrow the digital divide in the Asia-Pacific region through the promotion of pil)t projects to support access to ICT in rural areas of each country and to promote and develop ICT and Broadband in the region

2 OUT LI NE

(1) This programme will provide financial support 01 up to US$150000 for each pilot project to establish ICT access points and telecenters in the rural areas of APT Members and Associate M~mbers However the appropriate amount of the budget for the proj~ct will be determined based on careful examination of the proposal at the time of selection

(2) The results of the projects will be reported at th APT meeting related to ICT development and will be posted on the re evant APT web sites

3 EXAMPLE OF PILOT PROJECTS Under the pilot projects supported by this programme demonstration experiments on below topics can be conducted for verification of its effectiveness and validity

(1) Constru ction of multi-purpose telecenters in ural areas

(2) Introduction of new wireless technologies sytems in rural areas

(3) Other topics for contributing to ICT development in rural areas employing emerging technologies

4 FUNDING RESOU RCES APT Extra-Budgetary Contribution from Japanese GJvernment (EBC-J3)

5 REQ UIREMENTS

(1) Applications are to be submitted through APT lv1embers or Associate Members

(2) Those wishing to participate in thi s programme should have sufficient ability to complete the project in time

(3) Organizationsinstitutions and researchersengineers for the collaborative research should be well coordinated with each other in advance by the respective organizationsinstitl tions All collaborative entities must be listed in the application form wlich is requested to be sent to the APT Secretariat with the signatL re of supporting APT member

(4) The organizations involved in the project are requested to ensure that experts nominated for the project will be available for the full period of the project

(5) The project shall be carried out within the APT ~~ember countries

(6) The project shall be undertaken speedily effect ively and efficiently

(7) The project should be completed within eleven months from the date of announcement of selection by the APT Secretar iat

6 SELECTION (1) Proposed projects will be selected by APT Secretariat in consultation

with the Government of Japan based on the aforementioned requirements and the criteria stated below

(2) APT Members or Associate Members who have submitted the applications will receive notification from APT S ~cretariat on the result of the selection The selected project will also )e posted on the APT website

(3) During the selection process of the proposed project proposals the APT Secretariat may interview persons involved in the projects in order to examine the conformity with the aforementioned requirements and the criteria stated below

(4) During or after the implementation of the project~ APT Secretariat may conduct investigation to monitor the progress or successful completion of the project

7 SELECTION CRITERIA The following points will be considered in the se ection procedure

(1) Contribution to the implementation of tile Bali Statement and Plan of Action

The APT Ministerial Meeting on St engthening Regional Collaboration towards a Broadband Economy in the Asia-Pacific was held in November 20C 9 in Bali and adopted the Bali Statement and Plan of Acticn (For more details please see our website at httpwwwapLint ) In order to promote development in the Asia-Pacif c region based on its needs for Broadband and ICT APT is Expected to implement and support actions contained in the Blii Statement and Plan of Action with the APT Members

a The project shall directly or indirectly promote access to leT in rural areas as indicated in the Ba i Statement and Plan of Action

2

(3) Organizationsinstitutions and researchersengineers for the collaborative research should be well coordinated with each other in advance by the respective organizationsinstitl tions All collaborative entities must be listed in the application form wlich is requested to be sent to the APT Secretariat with the signatL re of supporting APT member

(4) The organizations involved in the project are requested to ensure that experts nominated for the project will be available for the full period of the project

(5) The project shall be carried out within the APT ~~ember countries

(6) The project shall be undertaken speedily effect ively and efficiently

(7) The project should be completed within eleven months from the date of announcement of selection by the APT Secretar iat

6 SELECTION (1) Proposed projects will be selected by APT Secretariat in consultation

with the Government of Japan based on the aforementioned requirements and the criteria stated below

(2) APT Members or Associate Members who have submitted the applications will receive notification from APT S ~cretariat on the result of the selection The selected project will also )e posted on the APT website

(3) During the selection process of the proposed project proposals the APT Secretariat may interview persons involved in the projects in order to examine the conformity with the aforementioned requirements and the criteria stated below

(4) During or after the implementation of the project~ APT Secretariat may conduct investigation to monitor the progress or successful completion of the project

7 SELECTION CRITERIA The following points will be considered in the se ection procedure

(1) Contribution to the implementation of tile Bali Statement and Plan of Action

The APT Ministerial Meeting on St engthening Regional Collaboration towards a Broadband Economy in the Asia-Pacific was held in November 20C 9 in Bali and adopted the Bali Statement and Plan of Acticn (For more details please see our website at httpwwwapLint ) In order to promote development in the Asia-Pacif c region based on its needs for Broadband and ICT APT is Expected to implement and support actions contained in the Blii Statement and Plan of Action with the APT Members

a The project shall directly or indirectly promote access to leT in rural areas as indicated in the Ba i Statement and Plan of Action

2

b The project shall be beneficial to the APT Members

c Priority will be given to the projects i 1 the field of environment and disaster communications mentioied below

-to improve energy efficiency and addressing climate change

- to manage harmful waste in the ICl industry

-to improve the infrastructure and use of ICT for publi c safety and disaster management including disaster preparedness relief and recovery effort

(2) Financial support from the Governments of APT Members The purpose of this programme is to nlrrow the digital divide in the Asia-Pacific region In order to ac complish this purpose it is essential that the Governments of APT Members

participate actively and continuously i 1 the operation of the project Therefore the proposed projecls will be given a higher priority if the proposing government pre vides financial support and intends to continue the support after the APTs project is completed

(3) Sustainability of the projects In order to enhance development of CT infrastructure the sustainability of operation and maintenclnce of the established infrastructure is crucial Therefore the proposed projects will be given a higher priority depending 1m the extent that the project could be sustained

(4) Involvement of APT Membership In selecting projects of this programme priority will be given to proposed projects with the involvemer t and support of APT

members

(5) New ICT technologies A higher priority will be given to proposed projects which deploy new ICT technologies

(6) Specific proposal content The application form and accounting form should be written as descriptively as possible The proposal Tlay not be recognized for evaluation and selection if it does nJt contain the detailed information required for proper implementation

3

8 FINANCIAL SUPPORT

I he Items to be supported tlnanclally are as oil )ws

Item Out ine

Planning and Costs for planning and inve~ tigation for imp lementing Investigation project

Equipment Costs for procuring necessary equipment required by procurement the project

Postal charges and shippin~ costs related to Shipping fee

transportation of materials for the projects

Travel expenses accommo lation fees etc (The mostBusiness trips

econom ica l airfare shall be applied)

Unforeseen expenses not mentioned aboveMiscellaneous

(Up to 10 of the total amOlmt of the financial support )

9 FINANCIAL SUPPORT DETAIL

A Costs in the Country of Project Implementation1

(1 ) It is expected that any local costs related to this prcject are to be borne by applicants organization or other collaborative orga lizations in the country of project implementation as far as possible APT rnay consider providing financial suppon on a case-by-case basis

(2) Above-mentioned local costs include daily allow3nce accommodation and transportation in the country of project implerr entation costs related to the office space and equipment (such as table chair and communication costs )

(3) Salary for staff in the proposing APT Members sha ll not be borne by APT

(4) APTs financia l support cannot be used to covel the custom duties if charged

1 country of project implementation is a developing membE r country where the project

is impl emented exclud ing the expert s country

B Costs of Business Trips to a Foreign Country

(1) For a staff travel ing to experts country2 the da il y allowance of 80USD and the actua l rate of the hote l accommodation up to 50 of the UN DSA rate as of May 2012 are to be used for the propo~ als Actual rate will be applied while implementing the proJect Necessc ry local transponation costs in the experts country2 attached to the OVE rseas trip can also be covered by the APT financial support

4

(2) For an expert traveling to developing countries of )roject implementation the UN DSA rate as of May 2012 is to be used for project proposals Actual rate will be applied while implementing th 3 project This amount covers both the daily allowance and the hotel accommodation In addition the expert may receive an expert fee The APT SEcretariat will determine the exact expert fee taking into consideration the location and the situation of the project

2 experts country is an advanced country where experts participating in the project reside

(Please ask APT Secretariat on the latest UN DSA Rate)

C Payment Method of APT Financial Support

(1) In receiving the financial report including documel1tary evidence such as

receipts the APT Secretariat will determine the tctal amount of the APT financial support for the project

(2) Upon request up to 60 of the approved budget vill be provided prior to the project implementation

(3) In principle the balance will be paid after the corlpletion of the project However the balance can be paid earlier if requested in the interim report that is to be submitted 5 months after the commenlement of the project

(4) If the total cost of the project is less than the amou 1t provided prior to the project completion the balance shall be returned to APT

(5) Any project cost in excess of the approved budge shall be borne by the Member administrations or the Institutions involved

D Other Costs

If an applicant awards a major part of the project 0 the third party the consultation fee or any fee related to the outsourcing to any organization IS

not supported

10 OWNERSHIP OF TH E PROJECT OUTCOMES

(1) After the completion of the project the equipments will become the assets of the organizations institutions involved in the project

(2) APT will share 50 of the copyright of any outce me including software produced by the project

11 REPORTING TO THE APT SECRETARIAT

(1) An interim project report and an interim accoullting report should be submitted to the APT Secretariat five months aft3r the commencement

of the project (2) The following reports should be submitted to the APT Secretariat within

one month after the project completion

5

8 The project completion report showing the detailed output and analysis of the project results

b The accounting repolis attached with the original certification or original receipts

(3) In case any changes are needed to the initial project plan or budget such changes shall be immediately reported to the APT Secretariat for approval

(4) Further information may be requested by the APT Secretariat if deemed necessary

(5) The final project reports will be posted on the APT website

(6) The results of the projects shall be reported at APT meetings related to ICT development in order to share the result with the APT members

12 LIABiliTY

(1) APT will not be responsible for any accidents personal injury or any form of liability or loss during the implementation of the projects under this programme

(2) APT is not liable for any legal implications arising from the implementation and operation of the projects

13 CONTACT DETAIL

(1) If you have any questions please do not hesitate to contact the APT Secretariat at e-mail address to aptictapLint or fax no +662 573 7479 or 5744226

(2) Additional information and forms can be downloaded from the APT website at httpwwwapLintIlCT-J3

6

8 FINANCIAL SUPPORT

I he Items to be supported tlnanclally are as oil )ws

Item Out ine

Planning and Costs for planning and inve~ tigation for imp lementing Investigation project

Equipment Costs for procuring necessary equipment required by procurement the project

Postal charges and shippin~ costs related to Shipping fee

transportation of materials for the projects

Travel expenses accommo lation fees etc (The mostBusiness trips

econom ica l airfare shall be applied)

Unforeseen expenses not mentioned aboveMiscellaneous

(Up to 10 of the total amOlmt of the financial support )

9 FINANCIAL SUPPORT DETAIL

A Costs in the Country of Project Implementation1

(1 ) It is expected that any local costs related to this prcject are to be borne by applicants organization or other collaborative orga lizations in the country of project implementation as far as possible APT rnay consider providing financial suppon on a case-by-case basis

(2) Above-mentioned local costs include daily allow3nce accommodation and transportation in the country of project implerr entation costs related to the office space and equipment (such as table chair and communication costs )

(3) Salary for staff in the proposing APT Members sha ll not be borne by APT

(4) APTs financia l support cannot be used to covel the custom duties if charged

1 country of project implementation is a developing membE r country where the project

is impl emented exclud ing the expert s country

B Costs of Business Trips to a Foreign Country

(1) For a staff travel ing to experts country2 the da il y allowance of 80USD and the actua l rate of the hote l accommodation up to 50 of the UN DSA rate as of May 2012 are to be used for the propo~ als Actual rate will be applied while implementing the proJect Necessc ry local transponation costs in the experts country2 attached to the OVE rseas trip can also be covered by the APT financial support

4

(2) For an expert traveling to developing countries of )roject implementation the UN DSA rate as of May 2012 is to be used for project proposals Actual rate will be applied while implementing th 3 project This amount covers both the daily allowance and the hotel accommodation In addition the expert may receive an expert fee The APT SEcretariat will determine the exact expert fee taking into consideration the location and the situation of the project

2 experts country is an advanced country where experts participating in the project reside

(Please ask APT Secretariat on the latest UN DSA Rate)

C Payment Method of APT Financial Support

(1) In receiving the financial report including documel1tary evidence such as

receipts the APT Secretariat will determine the tctal amount of the APT financial support for the project

(2) Upon request up to 60 of the approved budget vill be provided prior to the project implementation

(3) In principle the balance will be paid after the corlpletion of the project However the balance can be paid earlier if requested in the interim report that is to be submitted 5 months after the commenlement of the project

(4) If the total cost of the project is less than the amou 1t provided prior to the project completion the balance shall be returned to APT

(5) Any project cost in excess of the approved budge shall be borne by the Member administrations or the Institutions involved

D Other Costs

If an applicant awards a major part of the project 0 the third party the consultation fee or any fee related to the outsourcing to any organization IS

not supported

10 OWNERSHIP OF TH E PROJECT OUTCOMES

(1) After the completion of the project the equipments will become the assets of the organizations institutions involved in the project

(2) APT will share 50 of the copyright of any outce me including software produced by the project

11 REPORTING TO THE APT SECRETARIAT

(1) An interim project report and an interim accoullting report should be submitted to the APT Secretariat five months aft3r the commencement

of the project (2) The following reports should be submitted to the APT Secretariat within

one month after the project completion

5

8 The project completion report showing the detailed output and analysis of the project results

b The accounting repolis attached with the original certification or original receipts

(3) In case any changes are needed to the initial project plan or budget such changes shall be immediately reported to the APT Secretariat for approval

(4) Further information may be requested by the APT Secretariat if deemed necessary

(5) The final project reports will be posted on the APT website

(6) The results of the projects shall be reported at APT meetings related to ICT development in order to share the result with the APT members

12 LIABiliTY

(1) APT will not be responsible for any accidents personal injury or any form of liability or loss during the implementation of the projects under this programme

(2) APT is not liable for any legal implications arising from the implementation and operation of the projects

13 CONTACT DETAIL

(1) If you have any questions please do not hesitate to contact the APT Secretariat at e-mail address to aptictapLint or fax no +662 573 7479 or 5744226

(2) Additional information and forms can be downloaded from the APT website at httpwwwapLintIlCT-J3

6

(2) For an expert traveling to developing countries of )roject implementation the UN DSA rate as of May 2012 is to be used for project proposals Actual rate will be applied while implementing th 3 project This amount covers both the daily allowance and the hotel accommodation In addition the expert may receive an expert fee The APT SEcretariat will determine the exact expert fee taking into consideration the location and the situation of the project

2 experts country is an advanced country where experts participating in the project reside

(Please ask APT Secretariat on the latest UN DSA Rate)

C Payment Method of APT Financial Support

(1) In receiving the financial report including documel1tary evidence such as

receipts the APT Secretariat will determine the tctal amount of the APT financial support for the project

(2) Upon request up to 60 of the approved budget vill be provided prior to the project implementation

(3) In principle the balance will be paid after the corlpletion of the project However the balance can be paid earlier if requested in the interim report that is to be submitted 5 months after the commenlement of the project

(4) If the total cost of the project is less than the amou 1t provided prior to the project completion the balance shall be returned to APT

(5) Any project cost in excess of the approved budge shall be borne by the Member administrations or the Institutions involved

D Other Costs

If an applicant awards a major part of the project 0 the third party the consultation fee or any fee related to the outsourcing to any organization IS

not supported

10 OWNERSHIP OF TH E PROJECT OUTCOMES

(1) After the completion of the project the equipments will become the assets of the organizations institutions involved in the project

(2) APT will share 50 of the copyright of any outce me including software produced by the project

11 REPORTING TO THE APT SECRETARIAT

(1) An interim project report and an interim accoullting report should be submitted to the APT Secretariat five months aft3r the commencement

of the project (2) The following reports should be submitted to the APT Secretariat within

one month after the project completion

5

8 The project completion report showing the detailed output and analysis of the project results

b The accounting repolis attached with the original certification or original receipts

(3) In case any changes are needed to the initial project plan or budget such changes shall be immediately reported to the APT Secretariat for approval

(4) Further information may be requested by the APT Secretariat if deemed necessary

(5) The final project reports will be posted on the APT website

(6) The results of the projects shall be reported at APT meetings related to ICT development in order to share the result with the APT members

12 LIABiliTY

(1) APT will not be responsible for any accidents personal injury or any form of liability or loss during the implementation of the projects under this programme

(2) APT is not liable for any legal implications arising from the implementation and operation of the projects

13 CONTACT DETAIL

(1) If you have any questions please do not hesitate to contact the APT Secretariat at e-mail address to aptictapLint or fax no +662 573 7479 or 5744226

(2) Additional information and forms can be downloaded from the APT website at httpwwwapLintIlCT-J3

6

8 The project completion report showing the detailed output and analysis of the project results

b The accounting repolis attached with the original certification or original receipts

(3) In case any changes are needed to the initial project plan or budget such changes shall be immediately reported to the APT Secretariat for approval

(4) Further information may be requested by the APT Secretariat if deemed necessary

(5) The final project reports will be posted on the APT website

(6) The results of the projects shall be reported at APT meetings related to ICT development in order to share the result with the APT members

12 LIABiliTY

(1) APT will not be responsible for any accidents personal injury or any form of liability or loss during the implementation of the projects under this programme

(2) APT is not liable for any legal implications arising from the implementation and operation of the projects

13 CONTACT DETAIL

(1) If you have any questions please do not hesitate to contact the APT Secretariat at e-mail address to aptictapLint or fax no +662 573 7479 or 5744226

(2) Additional information and forms can be downloaded from the APT website at httpwwwapLintIlCT-J3

6

J3 Attach ment -2

~~~gti ~1 I -

~~ --~~ ~leT Development Programme

for Supporting leT Pilot Project in Rural Areas 2012

Application Form ]

1) Applicant Information I (Cou n try) (Name) (Organiza tionlins ti tu tion) (Posi tion) (Tell (Fa xl (E-m ail)

2) Title of the project I

3) Project summary I Please d escribe this summary within about 20 lines here As for the detm

4) Requested amount I 5) Duration of the r

(USji) (From YI Me Maximum 150000 USS)

(The research is to b bull Please fill in the aCCOlll1tll1g form also the date of annour

secretalia t )

6) Collaborative expertstaff I

I please fill in the Annex I

~ search J

To Yr_ Mo

~ concluded within 11 months from cement of selectlOn by the APT

Annex 1

middot Objectives

i Current status

middot Purpose of pilot IJro]ect

Outline the pjlot prowct (Please describe the image of wholt networks i sYstems You may attach iJ1other shevt if neClss(u

middot Partner organizationsilllstitutlOIls

M ilestone (significH n t oftlll

Expected outPHt

9) E ndorsement of the Application

The foregoing application to the APT lCT Development Programme for Supporting rCT Pilot P roject in Rural Areas is hereby endorsed by this Administration

Dat e bull ____~____~~__~ (day) (month) (yea r )

(N ame of Ad mini s tgration)---------- - --- ----1

(Title or P ositio n)

(Na me2

(Slgna ture)

(a dd ress)

(country) (Tel) (Fax) (website) (E-ma~

(address)

(country) (Tel) (Fax) (website) -(E -mail)

(a ddress)

(cou ntry) (Tel) (Fax) (website) (E -mail)

7) Contact Point Inform a tion If contact point is deferent from the applicant please fill in follows_

(Country) (Na me2 (Organiza tioninstltu tion) (Position) (Tel) (Fax) (E-mail)

is) Affirmation tamp-of the veracity of the information--tamp-be-tFue-a-namp-e9ffeet [In ri Rmooth l mn-l+4l

1 hereby affirm that all inform a tion and description in this application form are true and correct_ If this project is selected by the APT I promise to implement it together with collaborative expertsstaffs as mentioned in this application form and related documents based on scheme of the programme approved_

Date _ I (da y) (month) (year)

(Applican t--s--na--me--)________________ __--l

(Signa ture)

Please fill in the followmg i nforma tion regarding eolJaborativ-e--expertEistaffs to be involved in the project after necessity adjustmentsauang emen ts ffi-adclition to thiS As for their careel and their organizationslinstitutions please fiUm the Annex 2 and the Ann ex 3 r eE l ectively

-Name of

Name of Organizations

expertsstaffs insti tutJOns

[Chief ExpertJ

- - -~~--

-(address) -

-(countrYl -(Ten -(Fax) -(website2 (E-mail)

middot

middot

(addr essL middot

(countryL (Tel) (Fax) (websi te) (E-ma ll)

(a ddressL

(cnuntry) (Tel) (F ax) (website) ~E - majl)

(address)

~country2 ~TeJL (Fax) (web site) (E -mad)

(address)

(countrv) (Tel) (Fax) (w ebsite) (E -mail)

2) Please describe pilot project implementation plan (schedule) n detail (date period place mission etc)

- Reporting procedure

middot Contribution How will the project contribute to implementation of the Bali Stat ement and P lan ofAction (Please exp lain the linkage of the pilot project to tle Bali Statement and Plan of Action or relevant APT activities indicating relatE d articles or paragraphs)

middot Financial support from the Governments of your country How will the pilot project supported by the Govemments of your country (Please describe the linkage of the pilot project te the initiatives policies of your country and the budgetary contribution from your country)

middot SustainabIhty of the projects How to ensure the sustainability of operation of the systems after t his project ends And how the results of thIS project may be used for enhancll1g development of lCT infrastructure in your count y

Annex 3

Overview of organizationJin~titution

Please describe history sH3eactivities facilities number of =mployees and etc of the

Iorga nization involved in the proposed project One sheet for each organization institution or

(Country ) _____ ___ _ _

(Name of organiza tioniinstitution) ___ ___ _______ _______ ____________

attach brochures bull Further information may be requested if deemed necessary

Annex 2

[EXpertStaffs Career Background I One sheet for each expert

-1) Na m e

J

-2) OrganizationlInstitution I

(TItle position)

(N ame)

(Country)

(Website address if not available please attach a sheet describing the out ne of the organizatlOnlinstltution in Annex 3)

3) Date of birth 4) Sex _I

5) E ducation

I (U niversi tylI ns titution)

(Degree)

(Dale of acquisition)

(lVIajor)

- G) Employment Record

I

7) Experiences related to the l e T projects bull You may attach other sheets jf necessnry I

(P roje ct title)

(Location)

(Duration)

(Outline)

o 1 hereby grant and au thorize APT Secretariat permission to transmit share or release my information on this application form on APT website in order tv facilitate the preparation of potential future proposals from APT member countries (P lease place a check mark in the box w-in case you give your consent) bull Further information may be requested if deemed necessary

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

Annex 1

middot Objectives

i Current status

middot Purpose of pilot IJro]ect

Outline the pjlot prowct (Please describe the image of wholt networks i sYstems You may attach iJ1other shevt if neClss(u

middot Partner organizationsilllstitutlOIls

M ilestone (significH n t oftlll

Expected outPHt

9) E ndorsement of the Application

The foregoing application to the APT lCT Development Programme for Supporting rCT Pilot P roject in Rural Areas is hereby endorsed by this Administration

Dat e bull ____~____~~__~ (day) (month) (yea r )

(N ame of Ad mini s tgration)---------- - --- ----1

(Title or P ositio n)

(Na me2

(Slgna ture)

(a dd ress)

(country) (Tel) (Fax) (website) (E-ma~

(address)

(country) (Tel) (Fax) (website) -(E -mail)

(a ddress)

(cou ntry) (Tel) (Fax) (website) (E -mail)

7) Contact Point Inform a tion If contact point is deferent from the applicant please fill in follows_

(Country) (Na me2 (Organiza tioninstltu tion) (Position) (Tel) (Fax) (E-mail)

is) Affirmation tamp-of the veracity of the information--tamp-be-tFue-a-namp-e9ffeet [In ri Rmooth l mn-l+4l

1 hereby affirm that all inform a tion and description in this application form are true and correct_ If this project is selected by the APT I promise to implement it together with collaborative expertsstaffs as mentioned in this application form and related documents based on scheme of the programme approved_

Date _ I (da y) (month) (year)

(Applican t--s--na--me--)________________ __--l

(Signa ture)

Please fill in the followmg i nforma tion regarding eolJaborativ-e--expertEistaffs to be involved in the project after necessity adjustmentsauang emen ts ffi-adclition to thiS As for their careel and their organizationslinstitutions please fiUm the Annex 2 and the Ann ex 3 r eE l ectively

-Name of

Name of Organizations

expertsstaffs insti tutJOns

[Chief ExpertJ

- - -~~--

-(address) -

-(countrYl -(Ten -(Fax) -(website2 (E-mail)

middot

middot

(addr essL middot

(countryL (Tel) (Fax) (websi te) (E-ma ll)

(a ddressL

(cnuntry) (Tel) (F ax) (website) ~E - majl)

(address)

~country2 ~TeJL (Fax) (web site) (E -mad)

(address)

(countrv) (Tel) (Fax) (w ebsite) (E -mail)

2) Please describe pilot project implementation plan (schedule) n detail (date period place mission etc)

- Reporting procedure

middot Contribution How will the project contribute to implementation of the Bali Stat ement and P lan ofAction (Please exp lain the linkage of the pilot project to tle Bali Statement and Plan of Action or relevant APT activities indicating relatE d articles or paragraphs)

middot Financial support from the Governments of your country How will the pilot project supported by the Govemments of your country (Please describe the linkage of the pilot project te the initiatives policies of your country and the budgetary contribution from your country)

middot SustainabIhty of the projects How to ensure the sustainability of operation of the systems after t his project ends And how the results of thIS project may be used for enhancll1g development of lCT infrastructure in your count y

Annex 3

Overview of organizationJin~titution

Please describe history sH3eactivities facilities number of =mployees and etc of the

Iorga nization involved in the proposed project One sheet for each organization institution or

(Country ) _____ ___ _ _

(Name of organiza tioniinstitution) ___ ___ _______ _______ ____________

attach brochures bull Further information may be requested if deemed necessary

Annex 2

[EXpertStaffs Career Background I One sheet for each expert

-1) Na m e

J

-2) OrganizationlInstitution I

(TItle position)

(N ame)

(Country)

(Website address if not available please attach a sheet describing the out ne of the organizatlOnlinstltution in Annex 3)

3) Date of birth 4) Sex _I

5) E ducation

I (U niversi tylI ns titution)

(Degree)

(Dale of acquisition)

(lVIajor)

- G) Employment Record

I

7) Experiences related to the l e T projects bull You may attach other sheets jf necessnry I

(P roje ct title)

(Location)

(Duration)

(Outline)

o 1 hereby grant and au thorize APT Secretariat permission to transmit share or release my information on this application form on APT website in order tv facilitate the preparation of potential future proposals from APT member countries (P lease place a check mark in the box w-in case you give your consent) bull Further information may be requested if deemed necessary

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

9) E ndorsement of the Application

The foregoing application to the APT lCT Development Programme for Supporting rCT Pilot P roject in Rural Areas is hereby endorsed by this Administration

Dat e bull ____~____~~__~ (day) (month) (yea r )

(N ame of Ad mini s tgration)---------- - --- ----1

(Title or P ositio n)

(Na me2

(Slgna ture)

(a dd ress)

(country) (Tel) (Fax) (website) (E-ma~

(address)

(country) (Tel) (Fax) (website) -(E -mail)

(a ddress)

(cou ntry) (Tel) (Fax) (website) (E -mail)

7) Contact Point Inform a tion If contact point is deferent from the applicant please fill in follows_

(Country) (Na me2 (Organiza tioninstltu tion) (Position) (Tel) (Fax) (E-mail)

is) Affirmation tamp-of the veracity of the information--tamp-be-tFue-a-namp-e9ffeet [In ri Rmooth l mn-l+4l

1 hereby affirm that all inform a tion and description in this application form are true and correct_ If this project is selected by the APT I promise to implement it together with collaborative expertsstaffs as mentioned in this application form and related documents based on scheme of the programme approved_

Date _ I (da y) (month) (year)

(Applican t--s--na--me--)________________ __--l

(Signa ture)

Please fill in the followmg i nforma tion regarding eolJaborativ-e--expertEistaffs to be involved in the project after necessity adjustmentsauang emen ts ffi-adclition to thiS As for their careel and their organizationslinstitutions please fiUm the Annex 2 and the Ann ex 3 r eE l ectively

-Name of

Name of Organizations

expertsstaffs insti tutJOns

[Chief ExpertJ

- - -~~--

-(address) -

-(countrYl -(Ten -(Fax) -(website2 (E-mail)

middot

middot

(addr essL middot

(countryL (Tel) (Fax) (websi te) (E-ma ll)

(a ddressL

(cnuntry) (Tel) (F ax) (website) ~E - majl)

(address)

~country2 ~TeJL (Fax) (web site) (E -mad)

(address)

(countrv) (Tel) (Fax) (w ebsite) (E -mail)

2) Please describe pilot project implementation plan (schedule) n detail (date period place mission etc)

- Reporting procedure

middot Contribution How will the project contribute to implementation of the Bali Stat ement and P lan ofAction (Please exp lain the linkage of the pilot project to tle Bali Statement and Plan of Action or relevant APT activities indicating relatE d articles or paragraphs)

middot Financial support from the Governments of your country How will the pilot project supported by the Govemments of your country (Please describe the linkage of the pilot project te the initiatives policies of your country and the budgetary contribution from your country)

middot SustainabIhty of the projects How to ensure the sustainability of operation of the systems after t his project ends And how the results of thIS project may be used for enhancll1g development of lCT infrastructure in your count y

Annex 3

Overview of organizationJin~titution

Please describe history sH3eactivities facilities number of =mployees and etc of the

Iorga nization involved in the proposed project One sheet for each organization institution or

(Country ) _____ ___ _ _

(Name of organiza tioniinstitution) ___ ___ _______ _______ ____________

attach brochures bull Further information may be requested if deemed necessary

Annex 2

[EXpertStaffs Career Background I One sheet for each expert

-1) Na m e

J

-2) OrganizationlInstitution I

(TItle position)

(N ame)

(Country)

(Website address if not available please attach a sheet describing the out ne of the organizatlOnlinstltution in Annex 3)

3) Date of birth 4) Sex _I

5) E ducation

I (U niversi tylI ns titution)

(Degree)

(Dale of acquisition)

(lVIajor)

- G) Employment Record

I

7) Experiences related to the l e T projects bull You may attach other sheets jf necessnry I

(P roje ct title)

(Location)

(Duration)

(Outline)

o 1 hereby grant and au thorize APT Secretariat permission to transmit share or release my information on this application form on APT website in order tv facilitate the preparation of potential future proposals from APT member countries (P lease place a check mark in the box w-in case you give your consent) bull Further information may be requested if deemed necessary

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

(a dd ress)

(country) (Tel) (Fax) (website) (E-ma~

(address)

(country) (Tel) (Fax) (website) -(E -mail)

(a ddress)

(cou ntry) (Tel) (Fax) (website) (E -mail)

7) Contact Point Inform a tion If contact point is deferent from the applicant please fill in follows_

(Country) (Na me2 (Organiza tioninstltu tion) (Position) (Tel) (Fax) (E-mail)

is) Affirmation tamp-of the veracity of the information--tamp-be-tFue-a-namp-e9ffeet [In ri Rmooth l mn-l+4l

1 hereby affirm that all inform a tion and description in this application form are true and correct_ If this project is selected by the APT I promise to implement it together with collaborative expertsstaffs as mentioned in this application form and related documents based on scheme of the programme approved_

Date _ I (da y) (month) (year)

(Applican t--s--na--me--)________________ __--l

(Signa ture)

Please fill in the followmg i nforma tion regarding eolJaborativ-e--expertEistaffs to be involved in the project after necessity adjustmentsauang emen ts ffi-adclition to thiS As for their careel and their organizationslinstitutions please fiUm the Annex 2 and the Ann ex 3 r eE l ectively

-Name of

Name of Organizations

expertsstaffs insti tutJOns

[Chief ExpertJ

- - -~~--

-(address) -

-(countrYl -(Ten -(Fax) -(website2 (E-mail)

middot

middot

(addr essL middot

(countryL (Tel) (Fax) (websi te) (E-ma ll)

(a ddressL

(cnuntry) (Tel) (F ax) (website) ~E - majl)

(address)

~country2 ~TeJL (Fax) (web site) (E -mad)

(address)

(countrv) (Tel) (Fax) (w ebsite) (E -mail)

2) Please describe pilot project implementation plan (schedule) n detail (date period place mission etc)

- Reporting procedure

middot Contribution How will the project contribute to implementation of the Bali Stat ement and P lan ofAction (Please exp lain the linkage of the pilot project to tle Bali Statement and Plan of Action or relevant APT activities indicating relatE d articles or paragraphs)

middot Financial support from the Governments of your country How will the pilot project supported by the Govemments of your country (Please describe the linkage of the pilot project te the initiatives policies of your country and the budgetary contribution from your country)

middot SustainabIhty of the projects How to ensure the sustainability of operation of the systems after t his project ends And how the results of thIS project may be used for enhancll1g development of lCT infrastructure in your count y

Annex 3

Overview of organizationJin~titution

Please describe history sH3eactivities facilities number of =mployees and etc of the

Iorga nization involved in the proposed project One sheet for each organization institution or

(Country ) _____ ___ _ _

(Name of organiza tioniinstitution) ___ ___ _______ _______ ____________

attach brochures bull Further information may be requested if deemed necessary

Annex 2

[EXpertStaffs Career Background I One sheet for each expert

-1) Na m e

J

-2) OrganizationlInstitution I

(TItle position)

(N ame)

(Country)

(Website address if not available please attach a sheet describing the out ne of the organizatlOnlinstltution in Annex 3)

3) Date of birth 4) Sex _I

5) E ducation

I (U niversi tylI ns titution)

(Degree)

(Dale of acquisition)

(lVIajor)

- G) Employment Record

I

7) Experiences related to the l e T projects bull You may attach other sheets jf necessnry I

(P roje ct title)

(Location)

(Duration)

(Outline)

o 1 hereby grant and au thorize APT Secretariat permission to transmit share or release my information on this application form on APT website in order tv facilitate the preparation of potential future proposals from APT member countries (P lease place a check mark in the box w-in case you give your consent) bull Further information may be requested if deemed necessary

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

Please fill in the followmg i nforma tion regarding eolJaborativ-e--expertEistaffs to be involved in the project after necessity adjustmentsauang emen ts ffi-adclition to thiS As for their careel and their organizationslinstitutions please fiUm the Annex 2 and the Ann ex 3 r eE l ectively

-Name of

Name of Organizations

expertsstaffs insti tutJOns

[Chief ExpertJ

- - -~~--

-(address) -

-(countrYl -(Ten -(Fax) -(website2 (E-mail)

middot

middot

(addr essL middot

(countryL (Tel) (Fax) (websi te) (E-ma ll)

(a ddressL

(cnuntry) (Tel) (F ax) (website) ~E - majl)

(address)

~country2 ~TeJL (Fax) (web site) (E -mad)

(address)

(countrv) (Tel) (Fax) (w ebsite) (E -mail)

2) Please describe pilot project implementation plan (schedule) n detail (date period place mission etc)

- Reporting procedure

middot Contribution How will the project contribute to implementation of the Bali Stat ement and P lan ofAction (Please exp lain the linkage of the pilot project to tle Bali Statement and Plan of Action or relevant APT activities indicating relatE d articles or paragraphs)

middot Financial support from the Governments of your country How will the pilot project supported by the Govemments of your country (Please describe the linkage of the pilot project te the initiatives policies of your country and the budgetary contribution from your country)

middot SustainabIhty of the projects How to ensure the sustainability of operation of the systems after t his project ends And how the results of thIS project may be used for enhancll1g development of lCT infrastructure in your count y

Annex 3

Overview of organizationJin~titution

Please describe history sH3eactivities facilities number of =mployees and etc of the

Iorga nization involved in the proposed project One sheet for each organization institution or

(Country ) _____ ___ _ _

(Name of organiza tioniinstitution) ___ ___ _______ _______ ____________

attach brochures bull Further information may be requested if deemed necessary

Annex 2

[EXpertStaffs Career Background I One sheet for each expert

-1) Na m e

J

-2) OrganizationlInstitution I

(TItle position)

(N ame)

(Country)

(Website address if not available please attach a sheet describing the out ne of the organizatlOnlinstltution in Annex 3)

3) Date of birth 4) Sex _I

5) E ducation

I (U niversi tylI ns titution)

(Degree)

(Dale of acquisition)

(lVIajor)

- G) Employment Record

I

7) Experiences related to the l e T projects bull You may attach other sheets jf necessnry I

(P roje ct title)

(Location)

(Duration)

(Outline)

o 1 hereby grant and au thorize APT Secretariat permission to transmit share or release my information on this application form on APT website in order tv facilitate the preparation of potential future proposals from APT member countries (P lease place a check mark in the box w-in case you give your consent) bull Further information may be requested if deemed necessary

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

2) Please describe pilot project implementation plan (schedule) n detail (date period place mission etc)

- Reporting procedure

middot Contribution How will the project contribute to implementation of the Bali Stat ement and P lan ofAction (Please exp lain the linkage of the pilot project to tle Bali Statement and Plan of Action or relevant APT activities indicating relatE d articles or paragraphs)

middot Financial support from the Governments of your country How will the pilot project supported by the Govemments of your country (Please describe the linkage of the pilot project te the initiatives policies of your country and the budgetary contribution from your country)

middot SustainabIhty of the projects How to ensure the sustainability of operation of the systems after t his project ends And how the results of thIS project may be used for enhancll1g development of lCT infrastructure in your count y

Annex 3

Overview of organizationJin~titution

Please describe history sH3eactivities facilities number of =mployees and etc of the

Iorga nization involved in the proposed project One sheet for each organization institution or

(Country ) _____ ___ _ _

(Name of organiza tioniinstitution) ___ ___ _______ _______ ____________

attach brochures bull Further information may be requested if deemed necessary

Annex 2

[EXpertStaffs Career Background I One sheet for each expert

-1) Na m e

J

-2) OrganizationlInstitution I

(TItle position)

(N ame)

(Country)

(Website address if not available please attach a sheet describing the out ne of the organizatlOnlinstltution in Annex 3)

3) Date of birth 4) Sex _I

5) E ducation

I (U niversi tylI ns titution)

(Degree)

(Dale of acquisition)

(lVIajor)

- G) Employment Record

I

7) Experiences related to the l e T projects bull You may attach other sheets jf necessnry I

(P roje ct title)

(Location)

(Duration)

(Outline)

o 1 hereby grant and au thorize APT Secretariat permission to transmit share or release my information on this application form on APT website in order tv facilitate the preparation of potential future proposals from APT member countries (P lease place a check mark in the box w-in case you give your consent) bull Further information may be requested if deemed necessary

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

- Reporting procedure

middot Contribution How will the project contribute to implementation of the Bali Stat ement and P lan ofAction (Please exp lain the linkage of the pilot project to tle Bali Statement and Plan of Action or relevant APT activities indicating relatE d articles or paragraphs)

middot Financial support from the Governments of your country How will the pilot project supported by the Govemments of your country (Please describe the linkage of the pilot project te the initiatives policies of your country and the budgetary contribution from your country)

middot SustainabIhty of the projects How to ensure the sustainability of operation of the systems after t his project ends And how the results of thIS project may be used for enhancll1g development of lCT infrastructure in your count y

Annex 3

Overview of organizationJin~titution

Please describe history sH3eactivities facilities number of =mployees and etc of the

Iorga nization involved in the proposed project One sheet for each organization institution or

(Country ) _____ ___ _ _

(Name of organiza tioniinstitution) ___ ___ _______ _______ ____________

attach brochures bull Further information may be requested if deemed necessary

Annex 2

[EXpertStaffs Career Background I One sheet for each expert

-1) Na m e

J

-2) OrganizationlInstitution I

(TItle position)

(N ame)

(Country)

(Website address if not available please attach a sheet describing the out ne of the organizatlOnlinstltution in Annex 3)

3) Date of birth 4) Sex _I

5) E ducation

I (U niversi tylI ns titution)

(Degree)

(Dale of acquisition)

(lVIajor)

- G) Employment Record

I

7) Experiences related to the l e T projects bull You may attach other sheets jf necessnry I

(P roje ct title)

(Location)

(Duration)

(Outline)

o 1 hereby grant and au thorize APT Secretariat permission to transmit share or release my information on this application form on APT website in order tv facilitate the preparation of potential future proposals from APT member countries (P lease place a check mark in the box w-in case you give your consent) bull Further information may be requested if deemed necessary

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

Annex 3

Overview of organizationJin~titution

Please describe history sH3eactivities facilities number of =mployees and etc of the

Iorga nization involved in the proposed project One sheet for each organization institution or

(Country ) _____ ___ _ _

(Name of organiza tioniinstitution) ___ ___ _______ _______ ____________

attach brochures bull Further information may be requested if deemed necessary

Annex 2

[EXpertStaffs Career Background I One sheet for each expert

-1) Na m e

J

-2) OrganizationlInstitution I

(TItle position)

(N ame)

(Country)

(Website address if not available please attach a sheet describing the out ne of the organizatlOnlinstltution in Annex 3)

3) Date of birth 4) Sex _I

5) E ducation

I (U niversi tylI ns titution)

(Degree)

(Dale of acquisition)

(lVIajor)

- G) Employment Record

I

7) Experiences related to the l e T projects bull You may attach other sheets jf necessnry I

(P roje ct title)

(Location)

(Duration)

(Outline)

o 1 hereby grant and au thorize APT Secretariat permission to transmit share or release my information on this application form on APT website in order tv facilitate the preparation of potential future proposals from APT member countries (P lease place a check mark in the box w-in case you give your consent) bull Further information may be requested if deemed necessary

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

Annex 2

[EXpertStaffs Career Background I One sheet for each expert

-1) Na m e

J

-2) OrganizationlInstitution I

(TItle position)

(N ame)

(Country)

(Website address if not available please attach a sheet describing the out ne of the organizatlOnlinstltution in Annex 3)

3) Date of birth 4) Sex _I

5) E ducation

I (U niversi tylI ns titution)

(Degree)

(Dale of acquisition)

(lVIajor)

- G) Employment Record

I

7) Experiences related to the l e T projects bull You may attach other sheets jf necessnry I

(P roje ct title)

(Location)

(Duration)

(Outline)

o 1 hereby grant and au thorize APT Secretariat permission to transmit share or release my information on this application form on APT website in order tv facilitate the preparation of potential future proposals from APT member countries (P lease place a check mark in the box w-in case you give your consent) bull Further information may be requested if deemed necessary

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

(E-mail)

ISummary of t he Budget I

Please read carefully the Section 8 on the FI NANCIAL SUPPORT and the Section 9 on the FINANCIAL SUPPORT DETAIL of the Scheme of leT Development Programme for Supporting leT Pilot Projects in Ru ral Anas as it provides detail information

( unit US$)

Item

1 Planning and Investigation

2 Equipment procurement

3 Shipping fee

4 Business trips

f-shy

5 Miscellaneous

Cost

l~

LIS$

1I~

LIS$

L~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~

J3 Attachment-3

~ _s- lt ~ i~~~

~ _ ~I ~ leT Development Programme

for Supporting reT Pilot Projects in Rural Areas 2012

Accounting Form

(for accounting coordinator) Title of the Project

Accounting Coordinator

(Name) (Signature)

I(Posit ion)

(Orqan lzationlnstitution)

(Country)

1( ddress

(Tel) (fax)

~matted No underline J

(--------------------------shyI Formatted Indent Flrsl li ne 0 ch ~