Application form

Category 3: Request for a grant for victims of a conflict situation

  • This application form and all accompanying documents are to be completed in English.

  • Please indicate all amounts in Euros (€). Use rounded amounts and do NOT use dots and commas. Example: 8000 (eight thousand).

  • At the end of this form (under step 7 - Enclosures) you will need to submit a Word file with the budget and income table.
    You can download this Word file now or wait until step 7.

1. Applicant
Name of the organization
Address (street) number
Postal code; city or town
P.O. Box (optional)
Postal code of P.O. Box; city or town of P.O. Box  (optional)
Country
Phone number (incl. country and area code)
Fax number (incl. country and area code)  (optional)
Email
Website  (optional)
Managing Director or Chief Professional Officer
Accountant or bookkeeper of the organization  (optional)
Associated with any governmental agency or public authority?
 
 

2. Contact person
First name
Family name
Gender
Direct phone number (incl. country and area code)
Direct fax number (incl. country and area code)  (optional)
Email address (for confirmation email)
 

3. Mission and activities

Please describe briefly your organization and its mission (maximum 100 words):



Please describe your organization's activities and/or projects over the past three years (maximum 150 words):

4. Description of the project

Name of the project
Date of commencement
Date of completion
Place where the project will be carried out

Please give a short, to the point description of the project (maximum 250 words):



Please give a description of the target group, what their humanitarian needs are,
and what the size of the group is (maximum 50 words):
Explain the urgency of your project? (maximum 50 words):
What is the objective of your project? (maximum 100 words):
How do you evaluate your project’s objective? (maximum 100 words):
Please describe the Jewish involvement of your project (maximum 50 words):

5. Total budget, requested amount from the JHF, co-funding, own contribution

Only in very rare instances will JHF fund an organization where JHF is the sole funding source.

  Amount in Euro (€)
Total costs for the project
 
Co-funding details: Amount in Euro (€)
Amount requested from the JHF
Contribution from your own organization

Third party/parties funding

Name(s) of the organization(s):


Amount in Euro (€)
1.
2.
3.
4.
5.

6. Bank account details

Please fill in all requested items. Note that we can only transfer money to a Euro (€) bank account.

BIC beneficiary bank (SWIFT)
IBAN or account number of beneficiary
Exact name of beneficiary as known by the bank
Postal code and city of beneficiary
Country of beneficiary
Name of bank of beneficiary

7. Enclosures

Exhibit A:

If you have not already done so, please download the Word file with the budget and income table,.

Save this file to your computer's hard disk, and fill in the budget and income table. Then select the completed file here:
Exhibit B:

Please send the following documents by regular mail:

1. Annual financial reports for the past three years (2009, 2010 and 2011).
  • The annual financial reports must include a balance sheet, a profit & loss account per year, and explanatory notes.
  • These reports do not need to be translated into English. The original language is allowed.
  • Even if you have already sent the annual financial reports to our office in the past, please send them again.
2. A charter or articles of association of your organization;
3. A listing of your organization in the official public register;
4. If available: a published annual report, or its equivalent;
5. If available: an auditor's report.

Please note that:
  • The documents must be in our office by July 10th 2012.
  • If you have applied before and no legal changes have taken place, it is not necessary to send items 2 and 3 again.
  • When sending the documents, do not forget to note the name of your organization (the same name you use in the application form).
Our mailing address is:

Dutch Jewish Humanitarian Fund
P.O. Box 11646
2502 AP The Hague, The Netherlands

8. Print

Please review the data.

Before you submit your application, print the filled-out form for your own archive.

9. Sign & submit

The undersigned affirms that the form has been completed truthfully.

The undersigned is aware of the stipulations in the Disbursement Regulations for the Dutch Jewish Humanitarian Fund.

The undersigned agrees that the Dutch Jewish Humanitarian Fund may request information from any co-financing parties of the project and/or third parties, as required for proper evaluation of the application.



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