Phone: Email Address Web Address Street Address PO Box Address Post Code - State Country ABN Number
include area code
Contact Person: (for enquiries relating to your request)
Title Given Name Surname Position Held Phone (Bus Hrs) E-Mail
Organisational Details
Do you have a Deductible Gift Recipient Endorsement (DGR)
YES NO
Date of DGR
Do you have a Income Tax Exempt Charity Endorsement (ITEC)
YES NO
Date of ITEC
Are you an Incorporated Body
YES NO
Method of Incorporation
Date of Incorporation
Incorporation Number
Brief History of your Organisation:
Numerical Membership:
Mission:
Brief Description of the Services you provide:
Description of Project(s) for which you are Fundraising. (Include timelines and amounts to be raised)
N.B. If you are fundraising for more than one project, submit separate descriptors:
Details of Fundraising undertaken in the past 3 years:
GRANT DETAILS Name of Grant Contact details of grant making body. Closing date N.B. Submit separate details for each grant that you have identified as matching your needs.
