APPLICATION FORM for FINANCIAL SUPPORT Dutch Albert Schweitzer Foundation NASF
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APPLICATION FORM FOR FINANCIAL SUPPORT Dutch Albert Schweitzer Foundation NASF
In order to apply for funds, we request the following:
1. Completed Application Form
2. Completed Bank Account Form
3. Detailed project budget
Requests for funds will only be considered if the 3 above listed required documents are completed and included in the application. It is also strongly advised to include photo’s in your application. Any other additional information or documents to support your application. Please include such documents as attachments (email) or appendices (post) to your application, and clearly list them at the bottom of this form.
Applications should be sent to the email address: [email protected] . Applications sent to any other NASF email address will unfortunately not be accepted as applications. You might also fill in this form and print it and send it as a hard copy by regular post to this address:
Dutch Albert Schweitzer Foundation (NASF) PO Box 8568 3503 RN Utrecht The Netherlands
For more information please visit our website : http://www.nasf.nl/project-application
Contact information applying organisation
Name of organisation
Address
Country
Email address
Telephone Indicate at least two telephone numbers Website
Contact person Function
Email address
BANK ACCOUNT INFORMATION SHEET
Beneficiary Name of beneficiary
Address
City
Country
Bank account Bank account number
IBAN BICC/Swift
Bank Information Name of Bank
Address
City
Country
Notes: An IBAN (International Bank Account Number) is used to identify a customer’s bank account. The IBAN consists of an alphabetical country code, followed by two digits, and then up to thirty five characters for the bank account number. A SWIFT code (or BICC, as it’s sometimes known) is a code that helps overseas banks identify which bank to send money to. You will usually find this information on your bank statements. Organisation
Type of organisation
(NGO, volunteers, school, church organization etc.) Objectives of the organisation: .. .. .. Short description of your organization : (maximum100 words) (number of staff, volunteers, history, organisational set up, composition of Board, etc.)
Has your organisation implemented other projects ? If yes, when, which projects and in collaboration with which organisations ?
Have you previously submitted an application to NASF ? If yes, when (date) ?
Project Name of the project
Total amount requested (in local currency and in euros)
Duration of the project (start date – end date) Location of the project
(country, region, city)
Main focus of the project? (for example: health, education, income generation, etc.)
Target group (s) of the project .. (main target group and how many .. people involved)
Objectives of the project: .. ..
Project activities: .. .. .. .. Description of the project (maximum 150 words):
Are there any other donors or project partners involved? If so which ones?
Date Place
Name (project responsible) Name (contact person) Signature Signature
Required Appendices: Detailed Project Budget Completed Bank Account Sheet
If available: Recent annual report of your organisation including financial report Copy of NGO registration certificate References, if any Any other………………………………………………………….