Holcim (New Zealand) Ltd
SPONSORSHIP APPLICATION FORM

Application Date

Name of Organisation


Type of Organisation(please double click on box to tick it)

Incorporated Society Registered Charitable Trust Club or Association
Other (please specify)

A brief description of your organisation and how it works

Full Description of the Project / Event
(including date and location if applicable, target audience and benefits)


Holcim is committed to supporting the communities in which it operates.(Please see company location information on our website )Please indicate which, if any, of these communities this opportunity/ event relates to.

Please Detail Amount of funding required

Other corporate sponsors approached / involved

Organisation / Applied (√) / Received (√) / Level of Support

Benefits you propose to return to Holcim (New Zealand) Ltd

(Include any proposed media coverage, signage opportunities)

Any other relevant information you wish to add to this application

Deadline for Our Response (if applicable)

(eg. to allow recognition of sponsorship to be included in production of any signage, programmes, invitations)

Contact Person / Role

Daytime Phone NumberCellphoneEmail

I hereby declare that the information supplied in this application is correct. If the application is successful, I agree to provide a report within one month of carrying out the project/ event stated in this application, outlining how well it achieved the objectives originally set for it.

Our group / organisation agrees to be part of any publicity that Holcim (New Zealand) Ltd decides is appropriate to promote the benefits that its supportfor this project/ event provides to the community.

We also consent to Holcim New Zealand collecting, retaining and using the contact details of the persons listed in this application. We confirm that we have obtained the consent of the persons listed in this application to provide these details and we have the authority to commit the organisation to this application. This consent is given in accordance with the Privacy Act 1993.

Name:

Signature:

Date:

Before sending us your application, please check that you have answered all the questions (if they are not applicable, write N/A) as an incomplete application may mean it is not considered.
Attach any information relevant to your application.

Send your application and any supporting material to:

Community Support Programme

Holcim (New Zealand) Ltd

P O Box 6040

Christchurch

Or email to:

Please retain a copy for your records.

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