APPLICATION FOR A DONATION, CONTRIBUTION OR SPONSORSHIP

Transcription

1 APPLICATION FO A DONATION, CONTIBUTION O SPONSOSHIP OFFICIAL USE NOT TO BE COMPLETED BY THE APPLICANT Date eference Number FOM GUIDELINES 1. Answer all applicable questions. If a question is not applicable or relevant, please write N/A 2. Print clearly and use black ink. Incomplete forms will not be considered 3. Copies of all supporting documents (as set out below) must be submitted 4. If you wish to give any additional information (not covered in this form), please do so on a separate sheet SUPPOTING DOCUMENTS TO BE SUBMITTED Project/Organisation plan Copy of registration certificate Copy of SAS tax exemption 18A certificate (if applicable) List of current directors, members or trustees and their professional affiliations Copy of latest audited financial statements Copy of latest bank statement Confirmation of banking details from bank Please ensure that all documents are submitted as failure to do so may result in your application being rejected. If you are unable to supply any of the above documents, kindly advice reasons below: Project/Organisation Name egistration Number (if registered) Contact Person Position in Project/Organisation Type of Project/Organisation Postal Address POJECT/OGANISATION DETAILS EIC AND SHEILA SAMSON FOUNDATION 1/5

2 Postal Code Street Address Postal Code Phone Number Cellphone Number Fax Number Address Copies to be submitted (mark where applicable) POJECT/OGANISATION BACKGOUND Community-based organization Company/(Pty Limited) Closed corporation (CC) Sole Proprietor Trust Partnership Does the project/organisation have a constitution? (If yes, enclose a copy) When was the project/organisation established? Who are the project/organisation s auditors Firm Name Contact Person Postal Address ADMINISTATION Postal Code Phone Number Cellphone Number Fax Number Address PEVIOUS FUNDING Have you previously applied for a donation? (If yes, please give date and amount or attach donor list) Date Amount equested Type of Support Amount Funded BENEFICIAIES How many people are directly involved in the project/directly employed by the organisation? Female Male Total number of children EIC AND SHEILA SAMSON FOUNDATION 2/5

3 Total number of out-of-school youths (16>24) Total number of adults (24>65) Total number of educators Total number of senior citizens (65+) How many new jobs will be created by this project/organisation? AUDIT AND ACCOUNTABILITY Have the organisation s books or accounts been audited? (If not, state reasons) POJECT/OGANISATION DESCIPTION List the project/organisation objectives. Explain why the project/organisation was started (e.g. make bricks to build houses) How are the needs of the community/clients satisfied by this project/organisation? (e.g. Do you provide a needed service or product to the community? How is the community informed of the project/organisation and its services and/or products? Has the project/organisation ever been formally evaluated by government, any external person, donor, funder, or any other development organisation? (If yes, give details) List the products/services supplied by the project/organisation EIC AND SHEILA SAMSON FOUNDATION 3/5

4 Which geographical area will be served by the project? Describe Training, Equipment, Material or Other: FUNDING EQUIED: BEAKDOWN Estimated and Value TOTAL DECLAATION I hereby certify the correctness of figures/data/information/documents furnished herewith I also undertake to give further particulars as required by the Eric and Sheila Samson Foundation Signature: Initials and Surname: Designation: Date: Please return to: The Eric & Sheila Samson Foundation PO Box 7560, oggebaai, 8012, SA T +27 (0) F +27 (0) E trustees@samsonfoundation.org W Thank you for completing this Application Form A response will be sent to you as soon as your application has been reviewed If your application was successful you will be requested to supply us with an invoice EIC AND SHEILA SAMSON FOUNDATION 4/5

5 FUNDING CITEIA AND PINCIPLES 1. The Eric and Sheila Samson Foundation Trust does not provide funding for individuals or groups of individuals. 2. It is imperative that organisations wishing to apply for financial support have received PBO status from SAS. 3. The Trustees will only consider proposals prepared in the prescribed format. 4. The Trustees have the final decision as to each award and each award is made at their sole discretion. 5. The Trustees reserve the right to request more detailed information with regard to such funding, where deemed necessary. 6. Each project funded by the Trust will be evaluated and monitored by the Trust periodically. The Trust explicitly reserves the right to request progress reports and to visit any premises of the applicant (or the project) at any given time, if deemed necessary, either by the Trustees themselves, or by the Administrators of the Trust, or by agents or auditors appointed by the Trust. 7. The Trust, when an application is approved for funding, reserves the right to impose such conditions or to lay down such rules relating to the funding as the Trustees in their discretion might deem necessary for that particular project. 8. The Trust reserves the right to use the services of any technical or research advisers, or any experts, to assist in the consideration and monitoring of research projects that are submitted to or funded by the Trust. 9. If a funded project is terminated or delayed for whatsoever reason, or if there is a surplus of funds in relation to a project a) The beneficiary must immediately declare and pay the funding or balance thereof back to the Trust. 10. Supporting documents to be submitted: Project / Organisation plan Copy of registration certificate Copy of SAS letter confirming PBO status List of current directors, members or trustees and their professional affiliations Copy of latest audited financial statements Copy of latest bank statements Confirmation of banking details from bank Provide reasons if any of the above documents are not attached EIC AND SHEILA SAMSON FOUNDATION 5/5