NGO-Fomu/UHK/2017

JAMHURI YA MUUNGANO WA TANZANIA

MAOMBI YA UHAKIKI WA SHIRIKA LISILO LA KISERIKALI

Jina La Shirika ……………………….……………………………………………………………………..

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Tarehe ya Usajili………………………………... Na. Usajili……………………………………………….
Ngazi ya Usajili………………………………………………………………………………………………
S.L.B. …………………...……………………………..Simu……………………………….......................
Barua pepe………………………………………………Simu ya Kiganjani……………………………….
Mahali yalipo Makao Makuu ya Shirika Tanzania ………………………………………………………….
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Majina ya Viongozi wa Shirika na Vyeo vyao:
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Idadi ya Matawi na mahali yalipo:
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Orodha/Majina ya Washirika wa Shirika (Partners):
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Viambatanisho halisi:-
a) Cheti cha Usajili
b) Mikataba au Hati ya Makubaliano ya Washirika wa Shirika
c) Katiba ya Shirika iliyoidhinishwa na Msajili wa NGOs
d) Barua ya Utambulisho toka kwa Msajili Msaidizi (Afisa Maendeleo ya Jamii)
e) Stakabadhi za malipo ya ada ya mwaka

Mimi/Sisi tunawasilisha
Jina: ……………………………………….. Saini………………….………………..
Jina:…………………………………………… Saini: ……..……………………………