1. Person Completing This Application

First Name
Last Name
Business phone
Home phone
Mobile phone
E-mail address
Your Address
(not a PO Box number)

2. Individual or Organisation Applying For Sponsorship

Name
Physical Address
(not a PO Box number)
Website Address (if applicable)
Briefly Describe the Purpose/s of the Organisation or Cause

3. How Can We Help You?

A. Please Describe What You Need From Us

B. Is There Anything You Could Offer Us In Return? (this section is optional)

4. Timeframe

When do you need the donation
(latest date)?

5. Miscellaneous

Have you already raised any money towards this application? Yes No

If yes, specify how much

Are you an organisation with IRD charitable status? Yes No

If yes, specify IRD number

Are you an incorporated society? Yes No

How many people will benefit from this application if approved?

6. Conditions of Funding

In submitting this application, the applicant acknowledges that if this application is approved, the following conditions will apply:

1. the donation must be applied for the purpose stated, and for no other purpose
2. the allocation is made as a donation, being an unconditional gift notwithstanding the provisions of clause 3B
3. the decision will be final and binding and the applicant will not request or demand reasons for the decision
4. submission of this application does not constitute approval; or if approved, that further payments to the same applicant or for the same purpose will be approved or made

7. Documentation

If we approve your application, we will require certain documents before we pay out anything.
Please indicate whether you can supply us with the following items:

A reference letter from an independent person (only applies to applications lodged for individuals) Yes No Not Applicable

Two written quotes on the suppliers letterhead, no more than one month old (only applies to requests for donations of money) Yes No Not Applicable

An authorised bank deposit slip in the name of the applicant (only applies to requests for donations of money) Yes No Not Applicable

A copy of your Certificate of Incorporation (only applies to incorporated societies) Yes No Not Applicable

NOTE: if you are unable or unwilling to provide these items,
your application will be automatically declined.

8. Declaration

By submitting this application, you as the applicant, declare that: