PART A (KAROLO YA NTLHA)

LIMID 5
GUINEA FOWL AND TSWANA CHICKEN SUPPORT PROGRAMME
(THUSO TSA DIKGAKA LE DIKOKO TSA SETSWANA)
PART A (KAROLO YA NTLHA)
APPLICATION FORM
(FOROMO YA IKOPELO)
To be completed in triplicate
APPLICANT’S PARTICULAR (MAELE A MOKOPO)
1. Name of Applicant ___________________________________ Signature _________________________
(Leina lo Mokopi)
(Monwana)
2. Marital Status ___________________ Age ___________ Omang No. _____________________
(A o nyetse/nyetswe?) (Dingwaga) (nomore ya Omang)
3. Male/Female _________________
(Rre/Mme)
4. Address _______________________________________________________________________________
Aterese)
________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
5. Village ______________________________ Ward _______________________________________
(Motse)
(Kgotla)
6. Name of Headman ______________________________________________________________________
(Leina la Kgosana)
7. Extension Area ____________________________________ District ___________________
(lefelo)
(Kgaolo)
8. Name of Extension agent ________________________________________________________________
(Leina la modirela puso wa kgaolo)
9. Region __________________________________________________________________________________
(Kgaolo Kgolo)

PART B (KGAOLO YA BOBEDI)
THE PROJECT’S ATTRIBUTES (TSE DI AMANANG LE KGWEBO)
1. Project applied for: (tick the appropriate box) Tshwaya lebokoso le le lebanyeng.
(O kopa thuo ya eng)
Tswana Chickens
(Dikoko tsa Setswana)
Guinea fowls
(Dikgaka)
2. Briefly describe how the project will be operated___________________________________________
(Ka bokhutshwane tlhalosa gore o ya go tsamaisa kgwebo ya gago jang)
3. How many goats/sheep do you have? _____________________________________________________
(O na le dipudi/dinku di le kae?)
4. How many cattle do you have? ____________________________________________________________
(O na le dikgomo di le kae?
5. How many birds (chickens, guinea fowls, ducks e.t.c) do you have? _______________________
PART C (KAROLO YA BORARO)
ANNUAL INCOME (MADI A O A BONING KA NGWAGA)
1. Self-Employed P ________________________________
(Madi a go ipereka)
2. Formal Employment P ________________________________
(Madi a pereko ao a amogelang)
3. Crop/Livestock Sales P ________________________________
(Madi a a tswang mo thekisong ya
Temo-thuo)
4. Other Sources P_________________________________
(Motswedi e mengwwe e o bonag madi
Ka yone)
Annual income of spouse (Madi a monna/mosadi ka ngwaga)
1. Self-Employed P ________________________________
(Madi a go ipereka)
2. Formal Employment P ________________________________
(Madi a pereko ao a amogelang)
3. Crop/Livestock Sales P ________________________________
(Madi a a tswang mo thekisong ya
Temo-thuo)
4. Other Sources P_________________________________
(Motswedi e mengwwe e o bonag madi
Ka yone)

PART D (KAROLO YA BONE)
APPLICANT’S CONTRIBUTION (SEABE SA MOKOPI)
1. How do you intent to contribute towards the project? Cash In Kind
(O ikaelela go ntsha seabe sa gago jang?)
Madi
Mokgwa mongwe
If contribution is in cash, how much money can you contribute towards the project?
(Fa seabe e le madi ke bokae?)
PART E (KAROLO YA BOTLHANO)
MATERIALS NEEDED FOR THE PROJECT (DIDIRISIWA TSOTLHE TSE DI TLHAKAFALANG
MO KWEBONG)
(a) Fixed Assets
Items
Building materials for the chicken
house/shed
(Didirisiwa tsa dikago)
Building labour (Baagi)
Drinkers (Dinwelo)
Feeders (Dijelo)
Unit Price
(Pula)
Total Amount
(Pula)
(b) Variable Costs (Dithoto tsa nakwana)
Variable Costs
(Dithoto)
Water (Metsi)
Feed (Dijo)
Veterinary Requisites (tsa kalafi)
Unit Price
(Pula)
Total Amount (Madi
Otlhe)
Pula)
TOTAL PROJECT COST (a + b) = P _______________________________
(MADI OTLHE A KGWEBO)

PART F (KGAOLO YA BORATARO)
APPLICANT’S DECLARATION (MAIKANO A MOKOPI)
I certify that the information provided is true to the best of my knowledge. I am also aware that
if the information provided is not true, it may be used against me in a Court of Law. (Ke
rurifatsa fa se se kwadilweng e le nnete go ya ka kitso yame. Ke itse sentle gore fa se e se
boammaruri ke ka tseelwa kikgato tse di lebaneng ka fa molaong).
Applicant’s Signature _____________________ Date of Application _____________
(Monwana wa mokopi)
(Letsati la ikopelo)
PART G (KAROLO YA BOSUPA)
EXTENSION OFFICER’S COMMENTS
(DIKAKGELO KA BADIRELO PUSO KWA DOKGAOLONG)
I certify that the information supplied has been verified and that eligibility conditions have
observed. (Ke rurifatsa fa se se kwadilweng se netefaditswe e bile le mabaka a a letlang gore
mokopi o ka thusiwa a lebeletswe)
T/As Comments
(Kakgelo ka modirela puso ______________________________________________________________
____________________________________________________________________________________________
________________________________________________________________________________________
Name ___________________________________
(Leina)
Omang No _____________________________
(Nomore ya Omang)
Designation _______________________________
(Maemo mo tirong)
Date _____________________________________
(Letsati)
Poultry Officer’s Comments _____________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
________________________________________________________________________________________
PART H (KAROLO YA BOROBABOBEDI)
DECISION BY THE APPLICATION REVIEW COMMITTEE HEAD QUARTERS
The application is Approved
Rejected
Reasons for rejection ________________________________________________________
Chairperson __________________________ Signature ______________________
Omang No ________________________ Date ______________________
Secretary ________________________ Signature ______________________
Omong No ________________________ Date ______________________