<p> Philanthropy Award 2017</p><p>Nomination Form</p><p>A. Information about the entity or individual being nominated </p><p>Name of the business entity and its representative Name, Surname (if an individual) Address: City/Commune: Telephone: E-mail: </p><p>B. Information about the entity or individual that nominates </p><p>Name of entity (business company, institution, NPO etc.) Name, Surname (if an individual) Address: City/Commune: Telephone: E-mail: </p><p>C. Information about the entity or individual being nominated and their philanthropic activity during the last 12 months </p><p> In which of the following categories is this entity or individual being nominated for:</p><p>Award for Business Entities Contributing at the National Level Award for Business Entities Contributing at the Local Level Award for Individual Contribution </p><p> Please describe the reasons for this nomination: </p><p> Please shortly describe how it has contributed during the last 12 months, to the community and its development. </p><p> Please provide information on the period, location this activity took place, type of contribution given (money, products, services) and amount of the contribution. </p><p> Please provide information about the beneficiary groups and what they have benefited.</p><p> Please list three benefitiaries who can support your nomination. Provide their contact information as below:</p><p>Name: </p><p>Surname: </p><p>Telephone: </p><p>Email: </p><p>Name: </p><p>Surname: </p><p>Telephone: </p><p>Email: </p><p>Name </p><p>Surname </p><p>Telephone </p><p>Email </p>