THE SIGRID RAUSING TRUST

Trustees: Sigrid Rausing, Andrew Puddephatt, Chris Stone, Geoff Budlender,

Jeffrey Jowell, Joshua Mailman, Hosh Ibrahim, Ruth Rogers, Mabel van Oranje

GRANT APPLICATION SUMMARY SHEET

Organisation information:
Please tell us your organisation and contact details.

Organisation

Organisation name

Acronym and other

organisation names (if
these are used)
Postal address

Country
Website address
What year was
organisation founded
Country or Countries
organisation works in
Contacts

Primary contact name

Primary contact email

Primary contact phone
Primary contact role
Director name

Director email
Contract signatory
name
(if different to
Director)
Contract signatory
email
Contract signatory
role

12 Penzance Place, London, W11 4PA

Tel: +44 (0)7500 829 372
E-mail: info@srtrust.org
Web: sigrid-rausing-trust.org
Charity No: 1194828
 THE SIGRID RAUSING TRUST
Trustees: Sigrid Rausing, Andrew Puddephatt, Chris Stone, Geoff Budlender,
Jeffrey Jowell, Joshua Mailman, Hosh Ibrahim, Ruth Rogers, Mabel van Oranje

Grant request:

Please tell us about the grant you are applying for. Only fill out the table applicable to your
request, with amounts in the UK currency £ (GPB)

Unrestricted grant request

Year Amount per year £ Percentage of the organisation’s total
budget for year
Year 1
Year 2
Year 3
Total

Project grant request

Year Amount per year £ Percentage of project’s total budget
for year
Year 1
Year 2
Year 3
Total

Organisation income and expenditure:

Please tell us the start and end dates of your organisation’s financial year.
Financial year start date (month and year): _______________________________________
Financial year end date (month and year): _______________________________________

Please tell us about your past, current and projected income and expenditure, with amounts in the
UK currency £ (GPB)

Income and expenditure

Financial year Financial year Income £ Expenditure £
start date end date (GBP) (GBP)
(Month and (Month and
year) year)
2 years ago

1 year ago

Current
financial year
Next year

Year after next

12 Penzance Place, London, W11 4PA

Tel: +44 (0)7500 829 372
E-mail: info@srtrust.org
Web: sigrid-rausing-trust.org
Charity No: 1194828
 THE SIGRID RAUSING TRUST
Trustees: Sigrid Rausing, Andrew Puddephatt, Chris Stone, Geoff Budlender,
Jeffrey Jowell, Joshua Mailman, Hosh Ibrahim, Ruth Rogers, Mabel van Oranje

Please tell us the highest annual salary in the organisation, including benefits (pension,
healthcare, housing etc.) with amounts in the UK currency £ (GPB)

Highest Salary information

Job title Salary £ (GBP) Benefits £ (GBP)

Please tell us about your five largest sources of income for the current year, with amounts in the
UK currency £ (GPB)

Income sources
Funder name What are funds for? Restricted or Amount
unrestricted? £ (GBP)
1

Assessment of application
By signing this application form we agree to our application being assessed and to permit The
Sigrid Rausing Trust or its authorised agent(s) to come to our offices on reasonable notice to
obtain information or documents that are reasonably required to assess our application. We
understand that in the absence of assessment our application cannot be progressed or a grant made.

Supporting documentation
We enclose all documents listed on the attached checklist in support of our application prepared
(where appropriate) in accordance with the Trust’s guidance.

I am authorised by______________________________________[name of organisation] to sign

this application on its behalf and declare that the information in this application form and its
supporting documentation is true to the best of my knowledge, information and belief.

Name: Job Title:

Date:

Signature:

12 Penzance Place, London, W11 4PA

Tel: +44 (0)7500 829 372
E-mail: info@srtrust.org
Web: sigrid-rausing-trust.org
Charity No: 1194828