Facilitating the financing of Water and Sanitation market-based projects
This questionnaire is addressed to water/sanitation market-based project leaders and/or entrepreneurs.

In the context of this questionnaire, water / sanitation entrepreneurs are formal organisations delivering market-based activities in the water, sanitation, hygiene sectors and related topics (irrigation, hydro-electricity...). These activities can include (but are not limited to) the provision of water / sanitation operations services (collection, treatment, distribution…), the construction of small infrastructure (drilling, mini-grid, treatment plants, sanitation facilities…), or the sale of products (filters, pumps…).

The goal of this questionnaire is to facilitate the financing of the most promising projects.

Waterpreneurs aims at increasing visibility between the Water and Sanitation sector and the Impact Investing Community. All data used will be aggregated and remain confidential.

This questionnaire is articulated around 4 parts:
     - Organisation profile
     - Business information
     - Financial information
     - Impact

Please do not hesitate to contact us for details regarding the use of data.

                                                               Estimated time for completion: 20 minutes

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-- INTRODUCTION --
How did you hear about this questionnaire? *
Required
-- ORGANISATION PROFILE  --
Name of your organisation *
Website
Year established *
Country of origin *
Where the headquarters are located
Continent / Region of origin *
Where the headquarters are located
Country(ies) or region(s) of operation *
List countries or regions where you operate water/sanitation activities. Several answers are possible.
Legal structure
e.g.: Limited Liability Company (LLC), Public Limited Company, Association... In case of an hybrid organisation, please indicate both legal structures.
Name & title of main board members *
e.g.: John Smith (Director)
Name & title of key management members *
e.g.: John Smith (CEO)
Who owns your activity?
Several answers are possible.
Contact for follow-up (First name / Last name) *
e.g.: John Smith
Title of the contact *
e.g. : CEO, President, Director of operations...
Email *
Phone number
With international call prefix
-- BUSINESS INFORMATION --
In this section, we will gather information to characterise your activity
Field(s) of operations
Core market-based activities *
Please select your core water/sanitation market-based activity - economic system based on supply and demand
What is your activity? Please describe your business model in 140 characters *
Please describe your core water/sanitation business (140 characters max). e.g.: Water kiosk, Water treatment device, Sanitation facilities, Wastewater recycling, Water delivery, Pipe manufacturing, Pump manufacturing, Smart metering...
Mission of the organisation (specify your social mission if any)
Short description - 300 characters max.
For-profit / Not-for-profit *
Current development stage *
Background / history of the organisation
500 characters max.
Marketing and sales: business model *
To whom are you selling your products / services? - several answers are possible
Required
What is your direct clients' profile? *
To whom are you selling your products / services? - several answers are possible
Required
Number of direct clients
Precise type of clients - e.g. number of Communities, Retail, NGOs, Schools, Hospital, Cities, Public authorities (municipalities, local state, national state)... to whom you are providing your services - you may use data from last year
Number of units sold/installed - if relevant
e.g. number of water filters, purifiers, toilets, kiosks...
Number of employees in your organisation
Key partners - Private Sector *
Name a few key partners strengthening your organisation action  - e.g. local bank, corporation
Key partners - Public Sector *
Name a few key partners strengthening your organisation action  - e.g. Ministry, river basin agency, municipality
Key partners - Civil Society *
Name a few key partners strengthening your organisation action  - e.g. Networks, NGOs, Incubators
Zones of operation *
Several answers possible
Required
Technology used
For collection, treatment, distribution... - 140 characters max.
Key risks associated with your activity
e.g. technical, political, economic, competition... - 300 characters max.
Please share any other relevant information on your business profile
Please send any other relevant material or information to : info[@]waterpreneurs.net. Don't forget to include your organisation's name.
-- FINANCIAL INFORMATION --
In this section, we will gather information on your financing profile and needs.

All amounts are requested in USD. If needed use www.xe.com/currencyconverter
Revenue 2017 - in USD *
Amount derived from sales - as shown in latest financial statements (in USD) -  in the context of this study, all profite generated by market-based activities in the water, sanitation, hygiene sectors and related topics (irrigation, hydro-electricity...). These activities can include (but are not limited to) the provision of water / sanitation operations services (collection, treatment, distribution…), the construction of small infrastructure (drilling, mini-grid, treatment plants, sanitation facilities…), or the sale of products (filters, pumps…).
Net profit of your organisation 2017 - in USD
Gains derived from labour - as shown in latest financial statements (in USD).
Total assets 2017 - in USD *
Entire property of the organisation - as shown in latest financial statements (in USD)
Ratio: Total Debt / Total Equity (2017)
Current type of funding *
Several answers possible
Required
Current investors / donors
Please provide names of current investors or donors
Funding needs for the coming year ? - Amount in USD *
THIS QUESTION IS KEY - How much would you need to execute your strategic growth plan over the next 12 months (in USD)?
Funding needs -  preferred currency *
Based on your answer above in USD, what currency would you prefer to be financed-in?
Intended use of funds
What would you use the funds for? Please describe your project (capex, working capital, R&D, etc...)
What type of financing would you suit you best in the scaling-up of your organisation? *
Several answers possible
Required
Please precise your preferred structure *
Example: 50% Debt / 50 % Equity / 0 % Grant
Why ? Reason for funding preference *
300 characters max.
A/ If Debt - what interest and tenor can you offer ?
Example: 4% during 5 years
B/ If Equity - what exit would you envisage?
Example: 10% after 5 years
C/ If Grant - what monitoring can you offer?
300 characters max.
What difficulties do you currently encounter when seeking financing ?
Current hurdles to access finance
Please share any other relevant information on your financing needs
Please send any other relevant material or information to : info[@]waterpreneurs.net. Don't forget to include your organisation's name.
-- IMPACT --
In this section, we will gather information to assess your organisation's impact.

All information is necessary, and is confidential .
Water / Sanitation issues addressed *
Several answers possible
Required
Select the 3 most relevant Sustainable Development Goals corresponding to your activities *
Required
Broad description your organisation's impact
e.g. access to safe water improved; environmental benefits; gender balance benefits; jobs creation; ...  - 500 characters max.
How many persons have gained improved access to water or sanitation as a result of your intervention? *
Number of people reached (estimation)
Are you measuring or monitoring your impact ? *
Studies conducted by company or third party
If yes, which metrics are you using?
Please share any other relevant information on your impact
Please send any other relevant material or information to : info[@]waterpreneurs.net. Don't forget to include your organisation's name.
  -- Conclusion --  
Would you accept to have your record circulated to potential investors? *
If yes, we will provide you with the investor's name. If no, your data will only be aggregated and used for the market study and remain confidential.
Thank you for your participation!
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