Application Form of Civil Society Platform (Mozambique)

1	Information on your organisation *Pleaes explainin why your organisation is eligible to be a Member Organisation for C-CfA.				(e.g. aim, history, membership, member organisations, activities, network, budget, human resource, etc.)
	§       Civil Society Platform §       The main aim is to facilitate the participation of Civil Society Organizations in policy dialogue leading to poverty alleviation, though involvement in planning, implementation, monitoring and evaluation of the national development plan, at all levels; §       More than one hundred members (Private Sector, trade Unions, Networks of non Governmental Organisations (NGOs), Technical and Professional Organizations, Academic and Research Institutions, Specific Organizations (which can also be NGOs), Interested Individuals) §       The main activities are: 1) elaboration of the Annual Report on Poverty (RAP); 2) facilitation of dialogue between Government, Civil Society and Donors around poverty reduction and development and 3) building of capacity of civil society at local level.
2	Name, position and contact of a person who is in charge of this commission
	Name: (Mr. / Ms.): Paulo Cuinica Position within the organization: Executive Secretary e-mail address: [e-mail] Telephone: + 258 21 355312                          Fax: + 258 21 355333 Skype name: *Please attach her/his CV.
	Reason why he/she is eligible to be in charge of a representative of your organization
	Currently is the Executive Secretary and in charge of representing the Platform with other parties.
3	Budget allocation for becoming a Member Organisation of C-CfA					e.g. its amount and how to be spent (in USDollar) USD2,000
4	List of NGOs that recommend your organisation to represent them		*Please fill out at least 10 names of organizations. *Contact should be postal address, telephone number and e-mail address (Website URL, if there is).
	Name1	CCM	Contact	Av. Agostinho Neto 1584 Phone: [phone]    Fax:[phone] E-mail: [e-mail]
	Name2	UNAC	Contact	Rua Valentim Siti, 39 Phone: [phone]   Fax: + 258 21 306738 E-mail: [e-mail]
	Name3	CTA	Contact	Rua de Castanheda, 120, Bairro da Summershild Phone: [phone]    E-mail: [e-mail]
	Name4	GMD	Contact	Av. Olof Palm, 236 Phone: [phone]    Fax: + 258 21 303867 E-mail: [e-mail]
	Name5	ABIODES	Contact	Rua Joaquim Lapa, 192 – 1º andar C.P. 2146 Phone: [phone]    Fax: + 258 21 314854 E-mail: [e-mail]
	Name6	FDC	Contact	Av. 25 de Setembro, Time Squere Bloco II – 3ºandar Phone: [phone]    Fax: + 258 21 355355 E-mail: [e-mail]
	Name7	Cruzeiro do Sul	Contact	Av. 24 de Julho, 285, 2º andar Phone: [phone]   Fax: + 258 21 493561 E-mail: [e-mail]
	Name8	Fórum Mulher	Contact	Rua Pereira do Lago, nº147 – 3º Dto Phone: [phone]    Fax: + 258 21 493437 E-mail: [e-mail]
	Name9	APOSEMO	Contact	Rua Francisco Matange, nº191 Phone: [phone] E-mail: [e-mail]
	Name10	CIP	Contact	Av. Amilcar Cabral 903 Phone: [phone] E-mail: [e-mail]
	Name11	KULIMA		Av. Karl Marx, 1452 R/C Maputo Mocambique Tel: [phone] 431665 Fax: [phone] Cel: [phone] E-mail: [e-mail]
	Name12	TEIA	Contact	Patrice Lumumba , 850, 1º andar Phone: [phone] E-mail: [e-mail]
	Name13		Contact
	Name14		Contact
	Name15		Contact
	Name16		Contact
	Name17		Contact
	Name18		Contact
	Name19		Contact
	Name20		Contact
* You may add more names of organizations if there are more organizations that are recommending your organization.