ENGIE

Regulatory Filings • Jun 19, 2017

APPLICATION FORM

The GDF SUEZ Rassembleurs d'Energies initiative (GSRE) offers three types of project development support to promote access to sustainable energy for all. These three drivers are: financial donation, investment and technical assistance.

The application form allows the GSRE Initiative to assess your project based on specific criteria. For associations and NGOs requesting a grant, this application form does not replace the application procedure developed by the GDF SUEZ Foundation.

Name of requesting entity :	How / Through whom did you learn about the
……….	GDF
Legal status : ……….	SUEZ
Contact : ……….	Rassembleurs
Telephone : ……….	d'Energies
E‐mail : ……….	Initiative?
Mailing address :	……….
……….	Request for : Investment Donation Technical assistance

Request made on : Calendar Fulfilled by : ……….

Brief Project Description :

……….

Selection Process:

• 1. Pre‐qualification is determined on the basis of the application form completed by the project leader.
• 1. If the project is pre‐qualified, it will be oriented to one or other of the following organizations, depending on the nature of the request:
• ‐ Investment : the GDF SUEZ Rassembleurs d'Energies socially responsible investment fund
• ‐ Donation: the GDF SUEZ Foundation
• ‐ Technical Assistance and managerial skills sponsorship: one of the three internal GDF SUEZ' NGOs
• 1. Then it will be submitted to the selection committee of the organization in question.
• 1. If a favorable response is given, an audit of the project will be undertaken before taking the final decision.

GENERAL CRITERIA FOR PROJECT SELECTION

		YES	NO
1.	Does your project promote energy access (hydraulics, solar systems, micro/mini‐grids, cooking stoves and so forth) and the reduction of energy poverty (low‐energy buildings, energy efficiency, etc.) for vulnerable populations in rural and/or urban area?
2.	Does your project have a significant social impact on the beneficiary populations, e.g. projects contributing highly and in a sustainable way to the improvement of their living conditions?
3.	Is it possible to adapt and replicate your project in different areas?
4.	Does your project use renewable energy sources or low carbon technologies well‐ adapted to the local conditions?
5.	Do you have some measures of the social, economic and environmental impacts of your business?
6.	Is your project already operational and viable?
7.	Do you have a detailed business plan?
8.	Is your project already supported by social entrepreneurs or by NGOs/Associations?
9.	May your project be conducted in partnership with development players?
	10. Does your project respect the laws of the host countries?

Nota Bene:

All project applications will be taken into consideration regardless of the country of origin. But special consideration will be given to the geographical zones where the GDF SUEZ Group operates (around 50 countries) and to the level of security and political stability in the country.

GUIDELINES TO FILL OUT THIS FORM:

The following pages will allow us to better know WHO you are, WHAT is your project about, HOW you manage it and what are its impacts. Here is some advice:

• ‐ Be specific and concise for each answer.
• ‐ Keep in mind that the social and environmental impacts of your project have to be highlighted and ‐ if possible ‐ quantified.
• ‐ Be clear on what you expect from us!

WHO ARE YOU?

Brief description of the entity, the project promoter(s) and the collaborators:

……….

Division of roles and responsibilities between each project promoter:

……….

Key figures:

……….

Has your project already been rewarded / recognized (when, by whom and what for)?

WHAT IS YOUR PROJECT ABOUT?

Context analysis:

……….

Description of the goal pursued by your project:

……….

How innovative is your project?

……….

Who are the beneficiaries and what are their needs?

HOW WILL YOU ACHIEVE YOUR GOAL?

Description of the business model:

Describe your strategy taking into account the market size, your main competitors, your value proposition, the distribution strategy, the way you create economic value, etc. What are your key processes (R&D, manufacturing, marketing, IT, etc.) ? Who are your main partners (suppliers, technical and financial partners)?

Charts are welcome in the appendix.

……….

How far along is the project at this time?

……….

Describe your management structure:

……….

Who are your main supporters and what is their contribution to your project?

WHAT ARE THE IMPACTS OF YOUR PROJECT?

Description of the social impacts:

Social impacts affect the beneficiaries' conditions of living: creation of income generating activities; access to essential services like health, education; empowerment of the communities, etc. ……….

Description of the economic impacts:

Direct economic benefits: job creation, increase of production and productivity, development of local infrastructures, etc.

……….

Description of the environmental impacts:

Positive environmental impacts result from reducing CO2 emissions, developing recycling channels, protecting the ecosystem, etc.

EXPRESS YOUR NEEDS!

Previous year's budget: ……….

Projected budget for current year: ……….

Request submitted to the GDF SUEZ Rassembleurs d'Energies Initiative:

donation investment technical assistance

For an amount of: ……….

For the purpose of: ……….

PLEASE ATTACH THE FOLLOWING DOCUMENTS TO YOUR APPLICATION:

• This application form duly completed
• The CV of the main project promoter(s)
• An organization chart of the entity
• The project's Action Plan
• A Business Plan
• All other documents you would like to communicate that will help us in better evaluating your project (project presentation, business case study, pictures, etc.)

PLEASE RETURN YOUR APPLICATION TO THE FOLLOWING E‐MAIL ADRESS:

celine.gross@gdfsuez.com