OLD MUTUAL FOUNDATION. Application Form

Transcription

1 OLD MUTUAL FOUNDATION Application Form INTRODUCTION Old Mutual has been involved in corporate social initiatives since The Old Mutual Foundation was established in In response to national imperatives and Old Mutual s strategic objectives, the focus areas of the Old Mutual Foundation are the following: Enterprise Development foster entrepreneurship and job creation Skills Capacity Building develop skills for products and services Education a focus on Maths and Science in secondary schools Vulnerable Members of Community support ad hoc causes (e.g. care, health, welfare and crisis relief) that improve the livelihoods of children, disabled persons, women and the elderly Our bias is towards rural and peri-urban communities where most of the poorest of the poor reside and who can derive maximum benefit through our interventions. In general The Old Mutual Foundation does not provide funding for the following: Funding the same organisation more than once during a period of 12 months Individuals or groups of individuals Funding of fundraisers Running costs of an organisation or project Building of Structures Gala or Charity events, seminars, conferences etc. Tours (School, sports, or other) Vehicles Bursaries Religious and Political Organisations Organisations, projects or beneficiaries outside the boundaries of South Africa It is imperative that organisations wishing to apply for financial support are approved as non-profit organisations and have applied for and received NPO/PBO status from SARS. Please note: Incomplete Application Forms will be declined APPLICATION PROCESS STEP 1: Complete Application Form Please ensure that the following documentation is attached to your completed application: 1. A certified copy of a VALID NPO/PBO/EMIS certificate. 2. Letter from the bank verifying your banking details. 3. Copy of your organisation s constitution. 4. Annual results/report/audited financial statements for the previous year. 5. Business plans (if available). 6. Marketing & Promotional Material (photographs, press clippings, brochures) STEP 2: Application Evaluation We will acknowledge receipt of your application within 5 working days. If the application does not meet our funding guidelines, or if it is not an area that we support we will let you know within 10 working days. If the application is aligned to our guidelines the application and supporting documents will follow the approval process. Depending upon the complexity of the application this process could take up to 3 months. In the event that the quarterly Trustee approval cycle is missed, this process could take up to 5 months. For less complex applications the process is shorter. STEP 3: Application Contracting and Funding Disbursement If your application has been successful we will contact you to negotiate and agree on some specific deliverables and milestones. This will be formally contracted with the organisation before disbursing any funds. This process should be done within 1 month after approval by the Trustees. STEP 4: Monitoring and Reporting on Project Progress Post the disbursement of the funds we require regular feedback on the approved project as agreed with the organisation (as contracted in Step 3 above). During this phase of the process we will visit the organisation to observe and discus progress. Please ensure that each page is initialled and that the application is signed by a duly authorised person. Please forward the Application and documents to: CSI Administrator Fax: omfoundation@oldmutual.com Old Mutual Foundation PO Box 66 Cape Town 8000 Should you have any queries on the above, please do not hesitate to contact us on:

2 FUNDING APPLICATION: GENERAL INFORMATION What is the name of your organisation? What is the name of your project? Category of funding application Education: Maths & Science Focus Teaching Resources Leadership & Management Skills development: Craft Focus Trades & Artisans Focus Sport Development Enterprise development: Agriculture Manufacturing Industries Environment How much funding are you requesting? What is the duration of the project? Type of organisation Non-Governmental Organisation Non-Profit Organisation Public Benefit Organisation Co-operative Registered School Have you previously applied for funding from the Old Mutual Foundation, and when? Have you previously received funding from the Old Mutual Foundation and when? Old Mutual Foundation Application Form August

3 SECTION 1: CONTACT DETAILS Registered name of Organisation NPO/PBO Registration number Postal address Physical address Website address (if available) Contact person at the Organisation Designation Telephone Fax Cellphone address SECTION 2: ORGANISATION INFORMATION When was the organisation established? Who established the organisation? What was the main reason why the organisation was established? Briefly describe the current purpose of the organisation Describe the different operations of your organisation. Old Mutual Foundation Application Form August

4 What are the organisations main achievements to date? What are the organisations goals for the coming year? How many staff members & volunteers are involved in the organisation? Staff members Permanent Temporary Volunteers Please list the organisation s current sponsors and the amount contributed. Sponsor Funding used for Amount Please list other organisations to which your organisation is affiliated. Organisation Nature of relationship Please provide details if the organisation received Old Mutual assistance in the past. Year How was funding used Amount Old Mutual Foundation Application Form August

5 SECTION 3: PROJECT INFORMATION What is the main reason for this project? What is the main aim of the project? How will you know when this project is successful? Who are the beneficiaries of this project? List how many people (gender, race, and disabled) will benefit directly from this project. Total number of beneficiaries Number of males Number of females Number of youth (age 15-35) How will the beneficiaries benefit from this project? Old Mutual Foundation Application Form August

6 Tick the provinces which the project will be focusing on. Eastern Cape Western Cape Free State Mpumalanga Gauteng North West Kwazulu-Natal Northern Cape Limpopo National Which rural community/communities will be benefitting from this project and indicate nearest town? Give details of the community support for this project. Give a brief overview how you plan to implement the project. Give a brief overview of how you are going to ensure that the planned benefits of the project are sustained into the future, after the project has been completed. Give a brief overview of how you plan to monitor and measure progress of the project. Please list the current sponsors that are co-funding the project and the amount contributed. Sponsor Funding used for Amount Old Mutual Foundation Application Form August

7 SECTION 4: FUNDING DETAILS What is the total cost of the project?: How much funding are you requesting?: R R Give a breakdown how this funding will be utilised. Itemise funding breakdown/funds utilised for Cost DECLARATION I hereby declare that the information provided in this document is true and correct and that I have not purposefully withheld any information, which may influence the decision taken by the Old Mutual Foundation. I further agree that the answers provided in this application are legally binding on the recipient. Signature of Duly Authorised Person Name Designation Date OFFICIAL STAMP OF ORGANISATION Please ensure that ALL supporting documentation required are returned along with your Application Form. Incomplete Application Forms will not be considered. Old Mutual Foundation Application Form August