INDIVIDUAL RECIPIENT AGREEMENT

Date: 09/21/2020

Dear Sergey Chechko,

It is my pleasure to inform you that Film studio "Brama-film" / Филь-студия "Брама-фильм" has
designated you as the agent to receive the grant funds awarded by Urgent Action Fund for
Women’s Human Rights (UAF) on 09/21/2020.

As agreed in the grant contract, Film studio "Brama-film" / Филь-студия "Брама-фильм" is

awarded $5000 to complete the following work:

Grant purpose: The funds will cover arrest fees, relocation, and psycho-social support of Volha
Nikakaichyk. We require receipts for all expenses funded by this grant. Please be prepared to
submit receipts with the final report. Final approval will be determined after reviewing the
completed grant approval form.
Individual wire explanation: The organizations that receive funding from foreign donors are
subjected to constant and aggressive inspections. Therefore, we are requesting to send funds to
a private account of our group member Sergey Chechko.

As a fiscal agent, you will assume the responsibility of receiving and disbursing the funds to Film
studio "Brama-film" / Филь-студия "Брама-фильм". UAF requires W-9 form from all US-based
fiscal agents or W-8BEN form from all international agents. Please complete the appropriate form
sent to you by your UAF program officer.

Payment of this grant will be transferred to you when UAF receives signed Individual Recipient
Agreement with the completed Wire Transfer Payment Form and signed W-9 (US based) or W-
8BEN (International) form.

We appreciate your assistance in the administration of this grant.

Warmest regards,

Kate Kroeger
Executive Director
Urgent Action Fund for Women’s Human Rights

www.urgentactionfund.org
660 13th Street, Suite 200 | Oakland, CA 94612 USA | 415.523.0360
 WIRE TRANSFER PAYMENT FORM

Beneficiary Account Details

Account Name:
Sergey Chechko

Account Number, Mexican

CLABE # or International BY51AKBB30141000339220070000
Bank Account Number (IBAN)
where applicable:
Home/Office Address
associated with the account: Tashkentskaia 8-14
(used for bank purposes)
Street #, street name, city, Minsk
country [please make sure to
include – bank will not process Zavodskoi
payment without], postal code

220096

Belarus

Beneficiary Bank Details

Bank Name:
ASB Belarusbank №529/367

Routing/ABA or SWIFT Bank

Identifier Code (WSIFT BIC): AKBBBY2X
(within U.S.)
SWIFT Bank Identifier Code
(WSIFT BIC): AKBBBY2X
(if outside U.S.)
International Routing Code
(if applicable):
BY28AKBB38193821000170000000

www.urgentactionfund.org
660 13th Street, Suite 200 | Oakland, CA 94612 USA | 415.523.0360
Intermediary Bank Details

Routing/ABA or SWIFT Bank

Identifier Code (WSIFT BIC):

AKBBBY2X
Account Number, Mexican
CLABE # or the International BY28AKBB38193821000170000000
Bank Account Number
(IBAN) where applicable:

My signature here indicates agreement to all of the information on this form

Signature of Representative:

Name of individual wire recipient: Sergey Chechko

Date: 10/19/2020

www.urgentactionfund.org
660 13th Street, Suite 200 | Oakland, CA 94612 USA | 415.523.0360