APPLICATION FOR FUNDING

Name of the organisation applying for financial assistance

Name of the project for which assistance is being sought

Official use: (not to be completed by the applicant)

Areas
Health

Education

Community Capacity Building

Income Generation and Job Creation

Infrastructure Development

Community Sport Development

Cultural Event

Environmental Issues

Date received:
Received by:
Unit:
Reference no.

A. Tell us about your organisation:

1.

Name of organisation:

2.

Name and surname of project

co-ordinator or project
manager:
Title: Mr/Mrs/Ms/Dr/Prof/Rev/
Other (specify):

3.

Postal address:
Postal code:

4.

Physical address:
Postal code:

5.

Telephone number:
Cellular number:
Website (if applicable)

6.

Bank account details:

Fax number:
Email address:

Bank:

Type of
account:
Account
number:

Account
holder:
Branch:

Branch
code:

7.

Name of auditor
Postal address:
Postal code:
Fax number.

Telephone number.

8.

Registration details
How is your organisation registered: (e.g.: Trust, NPO, CBO, FBO)
If NPO, what is the NPO number:
PBO Number:

9.

Is your organisation registered for:

Section 21 (not for profit)

Yes

No

Tax exemption in terms of Section 10(1)(f) of the Income Tax Act

Yes

No

Tax exemption in terms of Section 18A of the Income Tax Act

Yes

No

If yes, please attach a certified copy of the necessary authority from the Tax Exemption Units of SARS
And your NPO Certificate

10. If you are an income generating project, has your organisation registered for:
Please indicate registration number
Section 21 (not for profit)
Yes
No
Yes
Cooperative
No
Yes
Sole Proprietorship
No
Yes
Closed Corporation
No
Yes
Partnership
No
Voluntary association
NPO

11.

Governance
Name of Trustees / Members of the
Board or Advisory Management
Committee

Designation

Name of manager responsible for

daily operations and any other key
managers in the organisation

ID Number

HDI / PDI
Status

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Brief history of organisation: (Complete on a separate sheet of paper if more space is required)
Date established:
Mission statement:
Service to community:

Major achievements:

Please attach copy of

your:

Verified: (office use only)

Constitution
Organisational Profile

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Previous funding
Give fetails and totals of all donations/grants received during last two complete financial years
Year

Amount

Donor

Do you receive financial or other support from government (provincial or your municipality?

Please add any comment you may feel necessary

14. Give details of any previous funding or material support from ARM
Year

Type of support

Amount of financial support

UNDERTAKING
I certify to the correctness of all the information, figures, data and documentation contained in and attached to
this funding application.
I also undertake to supply additional information if required by ARM. I also indicate my willingness to abide by
the rules, regulations and instructions issued by ARM in respect of any funding awarded and agree to subject
my organisation to any audit or monitoring and evaluation initiative required by ARM.
I also understand that completion and submission of this document does not commit ARM to approving this
application and subsequent funding

________________________
Signature

_____________________
Position in the organisation

______________________
Date application submitted

B. Tell us about your project

This part of the application form focuses on the project for which you are seeking funding or support

B1.

Name of project:

B2.

Focus area (select from categories below)

NB: A project may fit into several categories
Will the project create job opportunities
if yes, please explain
Health
Education
Community Capacity Building
Income Generation and Job
Creation
Infrastructure Development
Community Sport
Development
Cultural Event
Environmental Issues
Other (Specify in line below)

B3.

Where will the project be rolled out?

National

if yes, indicate if in all 9 provinces or indicate the selected provinces

Province
(Specify)

Location
Indicate
name of town /
village / informal
settlement

B4.

Need and rationale of project to be funded:

What community support do you have for this project?

How will the community be involved in the project?

B5.

Who are the primary beneficiaries of the project?

How many women?

How many youth?
How many senior citizens?
How many disabled person?
How many men?
Will the project ultimately benefit a wider number
than the primary beneficiaries?
If yes indicate how many?
Will any new jobs be created by this project?

Immediately
3 12 months from now

B6.

Summary description of project to be funded:

Purpose Statement:

Objectives of the Project

What will be the deliverables

What will be the indicators of success

How do you intend to monitor and evaluate your project

B7.

Project personnel
What staff resources will be allocated to this project?

Will the project make use of

volunteers?

Yes

If yes how many

No

Please attach the CVs of the key personnel

Do you require any training support for your staff?
If yes what kind of training would be useful for you?

B8.

Funding Needs
What is the total cost of the entire project for the year?

Indicate how much money you would like ARM to consider donating to you?

How will you use this money?

Please indicate on which items or activities you will spend the donation that
you would like

Please attach a detailed project budget to this application

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Cost of item or activity

B9.

Donations in kind
If you do not need money but
would prefer donations in kind,
please indicate
Infrastructure / buildings
Office equipment
Computers
Office or project furniture
Training
Mentorship
Prizes for functions
Transport

B105.Additional

Please explain how these items or support activities will assist

your organisation to achieve its project objectives

funders

Have you approached any funders to support this project?

Have you received any feedback or promises of support from government, national agencies or other
funders?
If yes please indicate what type of support

B117.Sustainability

of project to be funded

In the event of ARM approving your application, how will the project continue after ARM terminates its
funding of the project?

B12 If training is involved, are you an accredited training

Provider?
If yes please give your accreditation number
Is this particular programme you intend to deliver as part of
this project, accredited?

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yes

no

yes

no

B13. Authorised

signatories of organisation and designations:

Name of authorised signature

Designation

15. Please submit your completed application form to:

Contact Person:

Ms. Noluthando Vavi

Leader: Corporate Social Investment

Phone:
Fax:

011-779 1000
011-779 1248

Physical Address
African Rainbow Minerals Limited
24 Impala Road
Chislehurston, Sandton
Johannesburg
Postal Address
African Rainbow Minerals Limited
Corporate Social Investment Department
PO Box 786136
Sandton, 2146

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