You must have Javascript enabled to use this form. Application form for financial assistance Completion of an application form does not guarantee that the organization will receive the requested assistance. This will be subject to a decision of the Board of the BritCham Charity Fund. PLEASE FILL IN THE FOLLOWING REQUIRED INFORMATION Organization details Name and legal form of entity or Name, Surname: Registration Number/ Identity Number: Address/Declared and current place of residence: Name, Surname for the contactperson: (if different from (1) above) Telephone No: E-mail address: The target group of the applicant, which applicant provides assistance for? Target group size (number of people and number of families): Region where the organization provides assistance: Information about the assistance requested What kind of assistance is needed? What is the purpose of the necessary assistance (what will be the result)? Total costs (EUR) How much of the total amount is requested as assistance from the BritCham Charity Fund? (EUR) In-kind donation Information about requested in-kind donation If you wold like to request an in-kind donation, please attach a detailed description of the requested assistance and estimated costs.Files must be less than 2 MB.Allowed file types: jpg jpeg png pdf doc docx. Documents that should to be attached (mandatory for legal entities): 1. A certificate from a competent authority (Register of Enterprises of the Republic of Latvia or an equivalent authority of another state) confirming the applicant as the authorized signatory of the organization; Files must be less than 2 MB.Allowed file types: jpg jpeg png pdf doc docx. 2. Statutes of the organization, and the decision of its administrative body for applying for the donation. Files must be less than 2 MB.Allowed file types: jpg jpeg png pdf doc docx. Confirmation I confirm that the information provided in this application form is true and up to date. Submitter's name and surname: Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20162017201820192020
