Grant-In-Aid Application Form - Knysna (Page 2 of 5) in pdf

DECLARATION

I ______________________________________________ (ID number)_____________________________________________

hereby declare under oath, on behalf of ______________________________________________________

(name of organisation) as ________________________________________________________(position in organisation) that I

am authorised to sign this declaration, and that to the best of my knowledge all answers to questions on and attachments to this

application form are accurate. In the event that the application is successful, this organisation will use the grant only for the

purposes specified in this application, and will comply with all the terms and conditions as set out in the Grant-in-Aid Policy. I

confirm that the organisation has the power to accept the grant subject to conditions and to repay the grant if the conditions are

not met. I also confirm that any funds not utilised for the purpose it was granted, must be reimbursed to the Knysna Municipality

as well as any unspent funds.

Date:________________________________ Signature:________________________

SECTION A: DETAILS OF ORGANISATION

Postal address: ____________________________________________________________________

Postal code:

_____________

Street address:____________________________________________________________________

Telephone Number: __________________ Fax Number:________________

E-mail address:

_____________________________________________

When was the organisation formed (date)?_____________________________

Is the organisation registered?_______________________________________

If yes, what type of registration? (E.g. NPO, Section 21 Company, Trust etc.)

________________________________________________________________________________

Date of registration?________________________________

Registration number:______________________________________________

(please attach copy of registration certificate)

A10

Details of main contact person at organisation:

Name:__________________________________ Position:_________________________________

South African ID number:__________________________________________

Office number:_____________________ Cell number: __________________

A11

Details of second contact person at organisation:

Name:__________________________________ Position:_________________________________

South African ID number:__________________________________________

Office number:_____________________ Cell number: __________________

Grant-In-Aid Application Form - Knysna Page 2