APPLICATION FORM FOR CHARITY DONATION
A. CHARITY/ORGANISATIONAL NAME
Registered Address:
1. ABOUT YOU
Name of the main contact (for correspondence)
Title(Mr, Mrs, etc) / First Name / Surname
Address for correspondence:-
Post Code:-
Email address
Telephone
Mobile
Are you making this application on behalf of a group?
Position held in the Group
2. ABOUT YOUR GROUP
Are you a Branch of a National Organisation or Umbrella Body?
Please tell us which one.
Are you a registered charity?
Charity Registration Number
How long has your group been running?
Hae you applied for funding from Hoggin The Bridge in the past? (if so, when and whether you were successful)
What are the main activities of your group, or what services do you provide?
Please give us a basic understanding of your accounts by answering these questions
Balance of accounts
(brought forward from the previous year of operating)
Total (gross) income for the last year of operating
Total Expenditure for the last year of operating
3. ABOUT YOUR PROJECT
Please tell us about your project
How much are you applying for as a donation by Hoggin The Bridge
Please tell us the total cost of the project
How will any difference in funds be made up?
Are you applying elsewhere for any donations? (if so, please detail where and for what amount)
Tell us how your project will benefit your local community
If your application is successful how will you be prepared to report back to us on how the money has been spent?(You may tick as many as you would like)
REPORT
/ PHOTOS
/ PRESENTATION
Contract
I confirm that I am authorised to sign this agreement on behalf of the group name in section 1 of this application. To the best of my knowledge and belief, all of the information given in this application is true and accurate. If this application is successful, in full or in part, I/the group agree to the following terms and conditions. I understand that this is an agreement between the group and the Caldicot Town Team.
I/we understand and agree the following:-
  1. To use the grant awarded for exactly the purpose set out in this application.
  2. No goods are to be purchased or ordered prior to the receipt of any grant.
  3. To acknowledge the Caldicot Town Team's contribution in any publicity materials we (the recipient) produce about the product and, where applicable, in our annual report/Chair's/Secretary's report at our AGM.
  4. Caldicot Town Teamcan use our name for which the grant will be used in its own publicity materials.
  5. All cheques must be banked before 31st January 2018
  6. To be prepared to report on the progress of our project as required, to the Caldicot Town Team.
  7. Where equipment or services are being purchased we will provide copy receipts for Caldicot Town Team's information.
  8. Caldicot Town Team may hold back a grant or ask us to repay a grant, in whole or part, in the following circumstances.
  • If we fail to keep this contract in any way
  • If the application form was completed dishonestly or the supporting documents gave false or misleading information.
  • If Caldicot Town Team close down, become insolvent, go into administration, receivership or liquidation or make an arrangement with our creditors.
  1. The amount of sponsorship requested on this form is final and cannot be amended once submitted.
  2. We will not approve any application to fund posts for staff.

If your application is successful, who should the cheque be made payable to?
SIGNED / NAME / DATE
Completed forms can be posted to:-
Caldicot Town Team, c/o 38 Newport Road, Caldicot, NP26 4BQ
or E-mailed (once signed) to:-
for official use only
Successful / Amount / Date Informed / Report attached
Yes / No / £

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