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The document is a project funding application form from the National Department of Health's Chief Directorate for Non-Communicable Diseases. It requires detailed information about the organization, including its core program, focus areas, funding sources, tax compliance, audit history, personnel profiles, and a breakdown of requested funds. The proposal must not exceed five pages and includes sections for applicant details and signatures.

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8 views4 pages

Form

The document is a project funding application form from the National Department of Health's Chief Directorate for Non-Communicable Diseases. It requires detailed information about the organization, including its core program, focus areas, funding sources, tax compliance, audit history, personnel profiles, and a breakdown of requested funds. The proposal must not exceed five pages and includes sections for applicant details and signatures.

Uploaded by

neelsbriekwa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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NATIONAL DEPARTMENT OF HEALTH

CHIEF DIRECTORATE: NON-COMMUNICABLE DISEASES

PROJECT FUNDING APPLICATION FORM

1. DETAILS OF THE ORGANISATION

Name of the Organisation:


Contact Person’s Full name:
Physical Address:

Postal Address:

Telephone/Cellphone:
E-mail address:
NPO Registration No (attach
registration certificate):
Names of Board members Initials and Surname Designation ID number
(minimum of 3) i.e. Chairperson, 1.
Secretary and Treasurer

(Attach signed constitution) 2.

3.
2. ORGANISATION CORE PROGRAMME

STATE THE ORGANISATION’S CORE PROGRAMME

2.2. PLEASE STATE YOUR ORGANISATION’S FOCUS AREAS AND INDICATE OPERATION AT
DIFFERENT LEVELS

No FOCUS AREA Global/African Provinces Districts Sub-District/


Region Municipality
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.
,etc
3. SOURCES OF FUNDING

Indicate your sources Government: Source Amount Programme Operational


of funding in the past funded areas areas
2 years 1.

2., etc.

Other: 1.

2.

3., etc.

4. TAX AND AUDIT INFORMATION:


TICK

Is your organisation tax compliant YES NO If yes, attach the recent copy of the Tax
Clearence Certificate

Has your organisation been audited YES NO If yes, attach the latest audit report.
before?

6. YOUR PROPOSAL NOT TO EXCEED FIVE (5) PAGES

See specifications attached

7. PERSONNEL PROFILES (attach CVs, qualifications and current proof of registration and
license to practice where applicable)

Initials and Surname ID number Highest qualification Designation


1.

2.

3.

4.

5., etc

8. FUNDS REQUESTED (breakdown of costs and the total amount requested per year)
ACTIVITY Year 1 Year 2 Year 3

Amount in ZAR Amount in ZAR Amount in ZAR

TOTAL

INITIALS AND SURNAME OF THE APPLICANT:

SIGNATURE OF APPLICANT:

DESIGNATION:

DATE:

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