Organisations complete part 1; individual applicants complete part 2.

Transcription

1 This form is to be completed by arts organisations only. Organisations complete part 1; individual applicants complete part 2. Business sponsors should use application form B. Please type in your answers or write clearly in block capitals. Please use extra sheets if you need to add any further information, numbering all answers and extra sheets. Please contact BASA if you need any help in completing this form. Telephone or fax INCOMPLETE FORMS WILL NOT BE ACCEPTED This information is treated in strictest confidence DOCUMENTS TO BE ATT ACHED Memorandum and Articles of agreement / Constitution Audited accounts or most recent financials Two column project budget itemisi ng projected expenditure Anticipated income (including sponsorship or donations)

2 IDENTIFY YOURSELF 1. YOUR ARTS ORGANISATION/COMPANY a. What is the name of your organisation/company? b. Postal Address: Physical Address: Telephone: Cell: Fax: c. What is the name of the head of your organisation/company? (ie Director, CEO) What is his/her title or position? Q1d We may discuss all relevant aspects of your application with this person who should be able to discuss all aspects of the sponsorship. d. Who is your nominated representative? What is his/her position? e. Status of your organisation Q1e For different types of eligible arts organisations see Rules 4-5 on the sheet enclosed. Do you have a constitution Yes No Are your accounts audited? Yes No If YES, please give the name, address and telephone number of your auditors.

3 If NO, please explain why and outline how you keep your accounting records. Are you registered? Yes No If YES, please supply registration number. Please supply income tax number, if applicable. Are you registered as a not-for-profit? Yes No Q1f This section must be completed in full. f. Do you have a bank account? Yes No If YES, please give account details which any supporting grant should be paid into Account name: Bank: Branch: Account Number: Type of Account: g. Do you receive any funding from any public bodies such as NAC, DAC, Lotteries, etc Yes No If YES, please list below Name of public body: Purpose of funding: h. Are you an amateur organisation to whom question e. does not apply? Yes No

4 i. Please provide at least three references from previous funders or community leaders, and give details of where BASA may contact these referees.

5 2. YOU, THE INDIVIDUAL APPLICANT a. Full name and surname: b. Date of birth: c. Identity number: Q2d The Commissioner for the South African Revenue Service requires BASA to disclose all supporting grants made, and to issue IT3(a) certificates to all recipients of grants. d. Please supply income tax number, if applicable: e. Nationality: f. Postal Address: Physical Address: Telephone: Fax: g. Profession/occupation: Please give account name, bank, branch and account number into which any supporting grant should be paid. NO GRANT MAY BE PAID TO A PERSONAL ACCOUNT, UNLESS FUNDS ARE RING-FENCED. h. References (Please attach at least three references); please give names and contact telephone/fax numbers/ .

6 ORGANISATIONS AND INDIVIDUALS TO FILL OUT ALL THE FOLLOWING SECTIONS 3. THE PROJECT a. Name your project: b. Date project starts: c. Duration of project: d. Place where the project will be carried out: e. Description of the project: Please give all details and if necessary attach additional documents.

7 4. MOTIVATION FOR A SUPPORTING GRANT a. Who, from the business or private sector, has agreed to sponsor this project? Please list all business and private sector sponsors for this project and the amount given. b. Has the money already been paid to you? c. Who is the contact person at the sponsoring business? What is his/her title or position? Address: Telephone: Fax: d. How did you secure this sponsorship?

8 Q4e This section must be completed in full. e. How are you planning to acknowledge the support of your sponsor? Please detail the benefits they will receive, including details of any publicity material you plan to generate. f. Is the director or principal of the sponsoring business also directly involved with your arts organisation? Yes No If YES, please give details below

9 5. THE SUPPORTING GRANT FUNDING Q5 The Supporting Grant Funds must be used to provide additional benefits to your sponsor/s. This could include better quality print material, more press advertising, workshops or hospitality opportunities etc. A breakdown of costings should be included e.g. 10 additional complimentary tickets to event at R25 each = R250. See rules on sheet enclosed. If your application is successful, what additional benefits will you be able to provide to your sponsor which otherwise could not have been offered. This should not repeat items listed in 4.e above. PLEASE ITEMISE THESE BENEFITS IN FULL DETAIL BELOW, INCLUDING A BREAKDOWN OF COSTS. WHAT IS THE TOTAL GRANT YOU ARE REQUESTING FROM BASA (Please attach a project budget)? R Q5b If you receive supporting grant funding, you must acknowledge this in all relevant publicity. Please detail your intentions as specifically as possible e.g. printing Supporting Grant from BASA on 1,000 programmes and 2,000 posters, etc. a. How do you plan to credit the Supporting Grant Scheme if your application is successful? b. Please give any relevant media deadlines for material bearing Supporting Grant credits.

10 Q6 This information is a useful guide for the Annual Business Day/BASA Awards for businesses and the arts. 6. IS YOUR PROJECT INTENDED TO DO ANY OF THE FOLLOWING? (Please tick where applicable) Increase access to the arts, i.e. Bring new audiences to art forms or new art forms to audiences; offer specific access to disabled people; develop a new education programme; interaction between arts groups and/or schools with the local community. a. Offer strategic opportunities to the sponsoring business, in terms of marketing or promotions. b. Encourage long-term/ongoing sponsorship of the project in order for it to develop. c. Develop an interest in the arts among the youth. d. Educate through the arts. 7. BASA AWARDS The BASA Awards recognise and encourage excellence and innovation in the field of business support for the arts. I herewith give BASA permission to automatically enter our sponsors support of this arts project into the next BASA Awards. Yes No 8. ARTS ORGANISATIONS DECLARATION (to be signed by an authorised signatory of the organisation and not an agent) I hereby certify that all the information given on this application form is accurate and complies with the rules of the scheme, which I agree to be bound by. If a supporting grant is received I undertake: a. to maintain accurate accounting records b. to provide an audited statement (if required) showing how the grant has been used c. to provide a full and detailed report-back to BASA in line with the template provided. d. to implement any conditions attached to the grant by BASA e. to credit the BASA Supporting Grant Scheme in the manner prescribed

11 f. BASA reserves the right to conduct an independent audit of the project, using an audit firm appointed at its sole discretion Signature Print name Position Date On a grant being made, this application form together with the rules will form a legally binding contract between you and BASA.

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