Professional Documents
Culture Documents
Education
Infrastructure Development
Cultural Event
Environmental Issues
Date received:
Received by:
Unit:
Reference no.
Name of organisation:
2.
3.
Postal address:
Postal code:
4.
Physical address:
Postal code:
5.
Telephone number:
Cellular number:
Website (if applicable)
6.
Fax number:
Email address:
Bank:
Type of
account:
Account
number:
Account
holder:
Branch:
Branch
code:
7.
Name of auditor
Postal address:
Postal code:
Fax number.
Telephone number.
8.
Registration details
How is your organisation registered: (e.g.: Trust, NPO, CBO, FBO)
If NPO, what is the NPO number:
PBO Number:
9.
Yes
No
Yes
No
Yes
No
If yes, please attach a certified copy of the necessary authority from the Tax Exemption Units of SARS
And your NPO Certificate
10. If you are an income generating project, has your organisation registered for:
Please indicate registration number
Section 21 (not for profit)
Yes
No
Yes
Cooperative
No
Yes
Sole Proprietorship
No
Yes
Closed Corporation
No
Yes
Partnership
No
Voluntary association
NPO
11.
Governance
Name of Trustees / Members of the
Board or Advisory Management
Committee
Designation
ID Number
HDI / PDI
Status
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Brief history of organisation: (Complete on a separate sheet of paper if more space is required)
Date established:
Mission statement:
Service to community:
Major achievements:
Constitution
Organisational Profile
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Previous funding
Give fetails and totals of all donations/grants received during last two complete financial years
Year
Amount
Donor
Do you receive financial or other support from government (provincial or your municipality?
14. Give details of any previous funding or material support from ARM
Year
Type of support
UNDERTAKING
I certify to the correctness of all the information, figures, data and documentation contained in and attached to
this funding application.
I also undertake to supply additional information if required by ARM. I also indicate my willingness to abide by
the rules, regulations and instructions issued by ARM in respect of any funding awarded and agree to subject
my organisation to any audit or monitoring and evaluation initiative required by ARM.
I also understand that completion and submission of this document does not commit ARM to approving this
application and subsequent funding
________________________
Signature
_____________________
Position in the organisation
______________________
Date application submitted
B1.
Name of project:
B2.
B3.
Province
(Specify)
Location
Indicate
name of town /
village / informal
settlement
B4.
B5.
Immediately
3 12 months from now
B6.
B7.
Project personnel
What staff resources will be allocated to this project?
Yes
No
B8.
Funding Needs
What is the total cost of the entire project for the year?
Indicate how much money you would like ARM to consider donating to you?
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B9.
Donations in kind
If you do not need money but
would prefer donations in kind,
please indicate
Infrastructure / buildings
Office equipment
Computers
Office or project furniture
Training
Mentorship
Prizes for functions
Transport
B105.Additional
funders
Have you received any feedback or promises of support from government, national agencies or other
funders?
If yes please indicate what type of support
B117.Sustainability
of project to be funded
In the event of ARM approving your application, how will the project continue after ARM terminates its
funding of the project?
11
yes
no
yes
no
B13. Authorised
Designation
Phone:
Fax:
011-779 1000
011-779 1248
Physical Address
African Rainbow Minerals Limited
24 Impala Road
Chislehurston, Sandton
Johannesburg
Postal Address
African Rainbow Minerals Limited
Corporate Social Investment Department
PO Box 786136
Sandton, 2146
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