CORPORATE TEAM REGISTRATION FORM

COMPANY NAMEBUSINESS SECTORADDRESS

OFFICE LANDLINE # WEBSITE

DETAILS FOR SCMM 2016CONTACT PERSON NAME DESIGNATION EMAIL ID MOBILE #

1.

2.

80 G RECEIPT IN THE NAME OFPAN # OF COMPANYSUPPORTED CHARITY / CHARITIESNUMBER OF TEAMS TEAM 40 TEAM 25 TEAM 15

WOULD YOUR EMPLOYEES BE FUNDRAISING UNDER CORPORATE CHALLENGE?

YES NO

MODE OF DONATION (Please refer Terms & Conditions)

SINGLE CHEQUE DONATION TO UWM SPLIT CHEQUEUWM CHEQUE #: DATED: AMOUNT:

* NGO CHEQUE #: DATED: AMOUNT:(If you are supporting more than one charity, add additional details below)

* NGO CHEQUE #: DATED: AMOUNT:

* NGO CHEQUE #: DATED: AMOUNT: (* Applicable only if split cheque option is selected)

Note: * If 51% or more of the Company Share Holdings are foreign held then the contribution is deemed as FCRA and comes under the Foreign Contributions Regulations Act. Beneficiary charities need to have an FCRA certification to receive such funds. Company has to provide copy of share holding pattern along with this registration.

As per above, does your Company falls under FCRA? Yes NoCSR FOCUS AREA

CSR HEAD DETAILS NAME

EMAIL PHONE

TERMS AND CONDITIONS: Your company registers by filling up this Corporate Team registration form and making a donation amount as

may be applicable.

1 United Way of Mumbai, 309, Nirman Kendra, Famous Studio Lane, Dr E. Moses Road, Mahalaxmi Estate, Mumbai 400011

Once the Corporate Team is registered, it cannot back out of the registration. The donation amount is neither refundable nor transferable to any other category.

A corporate can register a maximum 200 employees. You need to specify the charity(s) to which you intend to donate the proceeds of the registration amount. In

case your company has not decided the charity yet, please leave the section blank. The charity can be added later while registering the team online.

Donation contribution can be made in either of the following 2 ways –1. Single Cheque Donation: The company issues a single cheque/ bank transfer in favour of ‘United Way of

Mumbai’

Team sizesOPTION A (Single cheque)

In the name of UWM(Inclusive of applicable event fee, UWM donation retention* and donation to the beneficiary NGO)

Team 15 INR 3,00,000Team 25 INR 4,50,000Team 40 INR 7,00,000

United Way of Mumbai will issue an 80 G receipt to the company for the full donation amount.2. Split Cheque:

Team sizes

OPTION B (The company divides the registration amount into two cheques)

In the name of UWM(inclusive of applicable event entry fees and UWM donation retention*)

In the name of beneficiary NGO

Team 15 INR 44,000 INR 2,56,000Team 25 INR 67,000 INR 3,83,000Team 40 INR 1,05,000 INR 5,95,000

Note: Please submit both the cheques along with this form& we will hand over the cheque to the NGO.

Please note, this payment is a donation and therefore no TDS needs to be deducted. An 80 G receipt will be issued to the company on the registration donation amount.

Event entry fee: As per race category chosen by employees.

Race Category Event Fee Overseas ApplicantsDream Run INR 800 USD 30

Half Marathon INR 1,400 USD 40Full Marathon INR 1,500 USD 45Senior Citizen INR 350 USD 15

Champions With Disability INR 350 USD 15

The list of NGOs who register for the SCMM 2016 with United Way of Mumbai will be available on our website-www.unitedwaymumbai.org/marathon and also on the online registration page that will be created for your team.

Teams registering for ‘Corporate Team’ are eligible for the following benefits in SCMM 2016.o Employees will be hosted in a special CC Tent separate from general race in Azad Maidan on race day.o Bibs will have ‘CORPORATE TEAM’ mentioned irrespective of the race category. o Regular newsletters and pre-race day communication.o Participants will be lined-up ahead of general category on race day during the Dream Run.o Team acknowledgement on website and event docket. o Pledge raising workshop conducted by UWM along with beneficiary NGO, on request and prior

intimation, for the team members.

2 United Way of Mumbai, 309, Nirman Kendra, Famous Studio Lane, Dr E. Moses Road, Mahalaxmi Estate, Mumbai 400011

o Online giving page facility on the UWM website and tax exemption 80G receipts to every donor and corporate for donations made to United Way of Mumbai.

o Individual corporate fundraisers will be rewarded a certificate.o THE SCMM CORPORATE CHAMPION trophy will be awarded to the corporate with the highest

amounts in employee fundraising.o Highest Individual fundraisers in this category will be awarded the LEADING THE CHANGE trophy. o THE CORPORATE ICON trophy will be awarded to the corporate which has raised the highest

amounts (donation as a part of the registration + employee fundraisers). o Please note limited number of applications for Half Marathon race category will be accepted without

Timing Certificate per ‘Corporate Team’

Team 15: Maximum Five Half Marathon slots allowed without Timing CertificateTeam 25: Maximum Eight Half Marathon slots allowed without Timing CertificateTeam 40: Maximum Fifteen Half Marathon slots allowed without Timing Certificate If your company comes under FCRA regulations, please note that your designated supported charity partner

must have FCRA permission. Also while registering you will be required to submit your company shareholder pattern while registering without which our bank will not clear the payment.

Please refer to the corporate charity structure in the download section of www.unitedwaymumbai.org/scmm for details regarding UWM retention.

All terms & conditions for participation in the Standard Chartered Mumbai Marathon 2016 as indicated on www.scmm.procamrunning.in shall also apply to Corporate Team participation.

Participation in the event is subject to confirmation of application of each participant. The race organizer’s decision in this regard is final & binding.

Race application fees payable by each team will depend upon the race category each team member will opt for.

All contributions are eligible for 80G tax exemption receipt. Your application is not transferable.

AUTHORIZED SIGNATORY (NAME)DESIGNATION

DATE

SIGNATURE COMPANY SEAL

Philanthropy Partner309, Nirman Kendra, Famous Studio Lane, Dr. E Moses Rd, Mahalaxmi Estate, Mumbai 400011, India

Tel: 00 91 22 24937676/79-83/85/86 Helpline#: 09029080123E-mail: corporate@unitedwaymumbai.org Website:www.unitedwaymumbai.org

3 United Way of Mumbai, 309, Nirman Kendra, Famous Studio Lane, Dr E. Moses Road, Mahalaxmi Estate, Mumbai 400011