INDIA COVID RELIEF INITIATIVE

JIV DAYA FOUNDATION

DONATION REQUEST FORM

Name of Organization:
Address:

TYPE OF ORGANIZATION:
Name & Designation of Main Contact Person:
Phone -
Email -
Name of Other Contact Person (if applicable):

A. Brief about your organization

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1) Approximately, how many individuals/families are served by your organization per year? _______________
2) Which geographic locations are being served by your organization?
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3) Number of Total staff in the organization

Designation Number
Project managers
Field workers
HR & Admin
Volunteers
Others

B. Administration

1) Does your organization have FCRA clearance? –

a. If Yes, please provide FCRA registration no. _________________________
2) Approximate annual budget of your organization in INR ______________________
3) Number of regional offices (if any) _______________________________________
 C. COVID Relief activities

Activities till May 2020 to help families/individuals affected in COVID

Items No. of Cost per Geographic areas where donation given
Distributed items/kits kit
1. Ration kits
2. Cooked meal
3.Other items

Details of any other activities undertaken by your organization for COVID relief.
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D. Requirements
a. Food/ration Support needed from JDF (Please justify requirement with expected outcome)-
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b. Any other support required to help individuals affected by COVID? Please give details.
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Additional Information you wish to share:

Form completed by:

Place:
Date: