Defibs For Moray Funding Application Form

Dear Applicant

Please find attached the form to be used to making your application to Defibs For Moray for funding. The form should be submitted by email, and supporting information, including cost quotations, should be in email attachment form.

All files submitted as part of the Application must be in one of the following formats: PDF (the preferred format), or readable by Microsoft Word 2013, or readable by Microsoft Excel 2013, or JPG, or JPEG. No one file is to be larger than 2MB.

To comply with the terms of its Constitution and obligations, the Group stipulates Terms and Conditions for applications. Please take the time to study them and complete the checklist on the application form.

General conditions

  • Only applications from organisations and individuals in thecurrent council boundaryof Moray are eligible for consideration.
  • Assisted projects must have a clearly identifiable need for a PAD or training.
  • Assistance can be offered to small local businesses, community groups, Council offices/properties/grounds or individuals.
  • Purchasing will be carried out by Defibs For Moray following receipt of any contribution by the applicant.
  • Applications must be submitted and approved before commencement of a project. No retrospective applications will be considered.
  • Applications that are seen as campaigning on specific political or religious positions will not be considered.
  • Applications that contain match funding will be welcomed.
  • If considered necessary, the Fund reserves the right to request additional information or plans. This may include requesting the applicant to meet with the Fund to answer questions on the application.

Publicity

It is important that the work of this not for profit group is acknowledged in any published materials that relate to the project. If an application is successful, organisations or individuals are required to (a) acknowledge the contribution of Defibs for Moray in any publicity they might produce and (b) allow and participate in any reasonable publicity that Defibs For Moray might organise.

To return a completed application, please email

Defibs For Moray Funding Application Form

Name of organisation/resident/business making the application
For clubs, societies, groups and businesses, please give a contact name
Contact email
Are you registered for VAT?
Do you have a bank account registered in the name of your organisation? / Yes/No
Address for correspondence
Postcode
Daytime telephone number(s)
Contact website, if applicable
Brief statement on the purpose of the request?
Where is your nearest PAD?
(Full address)
How much are you able to contribute today?
How much do you feel you could raise specifically for this project over the next 3 months?

Defibs For Moray Funding Application Form

Have you identified a site for placement of the PAD?
If so, please provide details.
  1. Ownership of property
  2. Planning permission required
  3. Electrical supply availability
  4. Public Indemnity Insurance

In the past three years, have you applied toany other funding bodies (e.g. lottery, EU, HIE, wind farm funds) for this project, and either been granted or refused monies? Yes/No
If Yes, please provide details of the awarding body and monies requested and received.

I certify that the details provided are true and accurate to the best of my knowledge. I understand that Defibs For Moray will seek reimbursement if it is discovered that the above information was incorrect or if the defibrillator is not being used for the purpose stated and/or if the organisation is receiving funding for training. If the application is approved, I and the organisation I represent agree to any publicity Defibs For Moray might arrange, and to participate in this if requested.

Name (must be the name of the person whose email address, or whose organisation’s email address, is used to submit this application) / Date

Please return this form, and the section below, to

PLEASE ENSURE YOU HAVE ALSO INCLUDED ALL THE DOCUMENTATION REQUIRED

Defibs For Moray Funding Application Form

Project Description

Defibs For Moray Funding Application Form

APPLICATION CHECKLIST

Please ensure that all boxes are marked with an X before your application is submitted. If they are not, we will be unable to consider your application

This application is from an organisation or resident from the currentcouncil boundary of Moray.
I accept that Defibs For Moray will conduct purchasing of equipment only after our contribution has be received.
This application is not for retrospective funding.
This application does not campaign for specific religious or political beliefs.
We do not have available funds to meet the cost of the equipment and/or services/training we have requested.
Where applicable: Applications may be requested to a copy of most recent independently-examined Annual Accounts. These must include the Income and Expenditure details together with the Balance Sheet.
Are you a member of a wider organisation? YES/NO (please delete as appropriate). If YES, a copy of the parent organisation Accounts would also be requested.
Where applicable: Applications must be accompanied by a copy of the organisation’s Constitution.
If successful in this application, we will fully acknowledge Defibs For Moray in our publicity. We agree to - and will, if asked, participate in - any publicity organised.
Name (Must be the name of the person whose email address, or whose organisation’s email address, is used to submit this application) / Date