mayors fund 2013 application form interactive
TRANSCRIPT
Mayor’sFund
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th pt, le pe the evimet i sth dbli Ct.
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Applications close at 12.00 noon on Friday 1st November 2013
Mayor’sFund
APPLICATION FORMPlease write or type in BLOCK CAPITALS and attach further documentation that will clarify or enhance your application.If the question is not applicable, please write NIL or N/A.
Name of Group
Is Group Constituted or a Company
No. on Committee No. of Members
Location of Activities
Is the premises your own YES NO
Website address of Group
Contact Name & Address
Telephone Mobile number
Contact email
1. Which category in the Mayor’s Fund are you applying for? (please tick as appropriate)
Youth & Sport Older Persons The Environment in South Dublin County
2. Please attach a detailed description what you intend to use this Grant for.
3. Please submit a copy of your Audited Accounts or Bank Statements for previous 12 months.
4. It is a requirement within our Finance Department that groups/organisations must present a Tax Clearance Certificate number or Vat
Registration number. For further information contact Sharon Tobin, Community Services Ph: 4149270
FINANCIAL DETAILS OF YOR PROjECTEstimated Cost of the Proect? €
Expenditure INCOME: (Please give a breakdown of how you will meet the above costs)
Item Cost Source Cost
€ €
€ €
Total Grant requested from The Mayor’s Fund? €
Details of your Bank/Building Society:
Name of Account:
Name and Address of Bank:
Account Number: Sort Code: – –
DECLARATION
I declare that the information supplied in this proposal is accurate and complete. I understand that all information provided in respect of the
Grant Application will be held electronically and may be made available to other South Dublin County Council Departments as appropriate.
It should be noted that the Freedom of Information Act applies to all records held by South Dublin County Council.
Signed: Chairperson/Secretary/Treasurer (Please delete as appropriate)
Name (please print): Date: D D M M 2 0 Y Y
Please return completed form by 12.00 noon on Friday 1st November 2013 to:
South Dublin County Council, Community Services, County Hall, Tallaght, Dublin 24.
Phone: 01-4149270 Fax: 01-4149306 Email: [email protected]
To complete this form electronically, please save to your PC/Laptop then complete and email to [email protected]