Lula Sandla Business Partners & Clients Nomination Form

Lula Sandla Business Partners &
Clients Nomination Form

Lula Sandla Business Partners & Clients Nomination Form

DETAILS OF INDIVIDUAL / ENTITY MAKING THE NOMINATION

Please insert the details of the relevant person acting on behalf of the entity.

Name(Required)

First Last

Telephone (w)

Telephone (c)(Required)

Email(Required)

Please insert the details of the relevant person acting on behalf of the entity.(Required)

Are you a Halls customer? If yes, which company are you a customer of?(Required)

WHERE THE NOMINATING PARTY IS A BUSINESS

Name(Required)

Registration number of entity(Required)

DETAILS OF THE NOMINATED PROJECT

Name of organisation and / or project (where applicable):(Required)

Non Profit Organisation (NPO/ NGO/ PBO) Registration Number:(Required)

Description of the project and it’s location:(Required)

Your/the entity’s role / responsibility within the project:(Required)

Any challenges that the project has faced and how these challenges have been overcome:(Required)

Does this project currently have access to funds? Yes/No and If yes, How frequently are these funds made available?(Required)

Average number of hours that you/the entity (through its employees) work on the project per month:(Required)

Average number of hours that you work on the project per month:(Required)

Total years / months / weeks that you/the entity have been involved with the project:(Required)

RECIPIENTS/ BENEFICIARIES AND IMPACT OF NOMINATED PROJECT

Description of the recipients / beneficiaries (i.e. the people the project helps):(Required)

Number of direct recipients / beneficiaries:(Required)

What positive impact has this project had on the recipients / beneficiaries?(Required)

Why do you believe that this project deserves a Lula Sandla Award? What makes this project excellent?(Required)

If this project is selected for the Lula Sandla Award, what would the money be used for specifically? Please provide as much detail as possible.(Required)

REFERENCES

Please provide two references that we can contact for additional information regarding the project:

Reference 1

Name(Required)

First Last

Contact Number(Required)

Email(Required)

Relationship to individual / project:

Reference 2

Name(Required)

First Last

Contact Number(Required)

Email(Required)

Relationship to individual / project:(Required)

BANKING DETAILS PERTAINING TO NOMINATED PROJECT

Bank Name(Required)

Account Name(Required)

Bank Account Number(Required)

Branch Code(Required)

Name of Signatory(Required)

Please upload your NPO/NGO/PBO Certificate (JPG or PDF accepted)(Required)

Accepted file types: jpg, png, pdf, Max. file size: 10 MB.

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