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Revised Nov.7, 2007
APPLICATION FOR ACCREDITATION
FOR DONEE INSTITUTION
Pursuant to the provisions of Sections 34(H) and 101(A) of the National Internal Revenue Code of 1997, as implemented by Revenue Regulations No. 13-98 effective January 1, 1999, we hereby apply for accreditation as Donee Institution, and certify to the following:
1. Name of Institution: ___________________________________________________________________________
Address: ___________________________________________________________________
Telephone No. ____________________________ Fax No.:___________________________
2. SEC Registration No. _______________________ Dated: ____________________________
3. Status of Organization: (please check)
( ) Newly Established Years of Existence _____________
( ) Existing Donee Institution previously registered and allowed limited / full deductibility
donations for donors under:
_________________________________________________________________
(Please state PD & RA No. or Special Law granting deductibility to donors)
4. Purposes for which organized;
[ ] Religious [ ] Athletics / Character Building, Youth
[ ] Charitable and Sports Development
[ ] Scientific Research [ ] Cultural
[ ] Rehabilitation of Veterans [ ] Social Welfare and Development
[ ] Educational [ ] Health
[ ] Microfinance
5. Actual Activities (Brief Description) ______________________________________________
___________________________________________________________________________
___________________________________________________________________________
6. Proposed Projects: ____________________________________________________________
___________________________________________________________________________
7. Sources of Income:
___________________________________________________________________________
___________________________________________________________________________
8. Disposition of Income: _____________________________________________________
___________________________________________________________________________
(Please attach duly signed extra sheets, if needed)
9. Disposition of assets, in the event of dissolution:
___________________________________________________________________________
___________________________________________________________________________
10. Other facts relating to its operations relevant to its qualification as donee institution:
___________________________________________________________________________
___________________________________________________________________________
We declare under the penalties of perjury that the foregoing statements are true and correct, and that the institution undertakes to faithfully comply with the provisions of Sections 4, 5, and 8(b) of Revenue Regulations No. 13-98 relating to utilization requirements, issuance of certificates of donation and substantiation requirements and all other rules and regulations governing its operation as a Donee Institution.
We further declare that no part of our net income inures to the benefit of any private individual, and that the level of administrative expenses of our organization does not exceed thirty percent (30%) of total expenses for taxable year.
______________________________________
Applicant
(Signature over Printed Name)
__________________________________
Position / Title