Anglo American Social Investment and Donations Program
Application Form
Part 1 – Organisation’s Details
Formal legal status of organisation Type (please tick):  Community Group
 Corporation
 Partnership
 Not-for profit
 Government entity  other
Formal name of the organisation:
Organisation postal address:
Name and title of organisation’s
leaders (Chairperson/CEO):
Does your organisation have an
ABN (or equivalent business
number)?
Name and title of day to day
contact:
Email address of day to day contact:
Telephone number:
Mobile number:
Website:
Profile of Organisation:
Short statement of your
organisation’s history, mission,
vision and strategic purpose:
Please attach annual reports including
financial statements with your
application
How many members do you have?
What is the average number of
people accessing or using your
organisation’s facilities/services
annually?
Yes No
If yes list ABN number:
What are the principal age groups
of persons involved?
Are you registered for GST?
 Yes  No
Is your organisation an
Incorporated Association, a
Company or a Registered charity?
Does your organisation have a
social investment policy?
 Yes  No  other - list
 Yes  No
If yes please attach.
If no please briefly describe what procedures you
have in place to ensure sponsorship funds are spent
according to the purpose for which they are provided:
Attach the following documents (as
appropriate) in support of your
organisation’s capacity to undertake
the project:
What groups/individuals in the
community benefit from your
organisation’s activities?
Latest annual report
Copy of constitution
Trust document (if applicable)
 Latest set of signed audited financial statements
Organisational budget for current financial year
Reports from other projects successfully completed
Part 2 – Disclosure
Will any Government Official
personally benefit if Anglo
American provides support for this
community project?
 Yes  No
If yes please explain:
 Yes  No
If yes please explain:
Is any officer, director, beneficiary
or employee of the organisation
known to be a Government
Official in a position to make or
influence decisions for or against
Anglo American?
 Yes  No
If yes please explain relationship:
Is any officer, director, beneficiary
or employee of the organsation
known to be an immediate family
member of such a Government
Official?
Part 3 – Project Details
Name of project:
What is the total monetary
value of support being sought?
$
Provide the total project budget request excluding GST. Attach
additional documents and budgets to support your application.
Brief description of the
projects:
Provide relevant imagery, designs,
graphics to tell the story.
What are the projects’ aims
and objectives?
What are the expected
outcomes of the project?
What is the timeline for your
project? When will it
commence, when will it finish?
Does the project have key
milestones? Provide a
milestone plan if appropriate.
What is the primary target
group that will benefit from this
project and how many people
will benefit?
Provide names and relevant
qualifications/experience of key
people who will be involved in
the project:
Why should Anglo American
support this project?
What evidence is there that this
project has community
support?
What is the community or
geographic area will benefit
from this project?
Explain how this project aligns
with one or more of the Anglo
American priority social
investment areas?
(Anglo American’s five priority
investment areas are outlined in
the Social Investment and
Donations Fact Sheet)
Provide evidence that you have
undertaken a risk assessment
of the project and that
appropriate treatments are in
place to address risks
identified.
Does your organisation have
the appropriate level of public
liability insurance for this
project?
 Yes  No
If no outline how risks will be covered:
Part 4 – Project Performance
Identifying and measuring key performance indicators (KPIs) is an important part of
understanding and demonstrating how beneficial your project has been to the community or
the groups within the community your project is targeting. KPIs should be:



understandable;
meaningful; and
measurable.
KPIs will be the basis of the applicants monitoring and evaluation report due up to 3 months
after funding is received.
List key performance
indicators you will
use to measure and
report on the
success of your
project:
1
2
3
4
Part 5 – Other sources of funding
Anglo American is keen to support a culture of self reliance and sustainability.
Is this activity/event/project
eligible for funding or a grant
from other sources (including
government grant programs
and community benefit funds)?
What other sources of funding
are you seeking? How much?
 Yes  No
What was the outcome (status)
of these applications to other
funding sources?
What proportion of total
funding does this represent?
If your application to other
sources is unsuccessful is this
project still achievable? What
is the plan?
 Yes  No
If yes provide some details about how your project might
change:
Part 6 – Anglo American’s Social Investment Support
Has your organisation
received support from Anglo
American previously?
What Anglo American site
provided support:
 Yes  No
If yes provide details below:
Value of Support:
$
In kind:
When was support provided:
Name of project (if applicable or
brief description of support):
If this project will be
implemented over more than
one year or if this is a project
that is likely to be presented
for funding next year please
provide a plan for how the
project outcomes will be
sustained beyond two years of
Anglo American funding? e.g.
the event will generate funds
from ticket sales after two years,
train-the-trainer program will be
implemented.
Will your project result in a
facility that may require ongoing funding to maintain or
service? If so, how do you
plan this to happen? e.g.
Council has agreed to provide
on-going maintenance costs
(evidence provided)
Part 7 – Anglo American Support for Partnerships/Co-funding
List any other multi-national
companies or Commonwealth
or State Government
programs that are known to
support this project e.g. other
mining companies operating in
the region:
Part 8 – Promotion of Anglo American Support
How do you propose to
promote Anglo American’s
support of your organisation
on this project?
If this project has more than
one source of funding how
will you ensure Anglo
American’s support is
differentiated?
What Anglo American
branding support materials
will you require?
 flyers, brochure, event programs
 local print media
 attendance at the event
 radio/TV
 merchandise
 signage
 acknowledgment in speeches
other (please
specify)_______________________________
Part 9 – Declaration
Please note: only your organisations accountable officer (Chairperson, President, CEO or
another officer formally delegated such authority should sign this declaration.
If this request is approved, your organisation agrees to the following terms and conditions:

Funding will be used for the purpose for which it was given and will be spent in
accordance with letter of offer and Anglo American’s social investment and donations
policy or as outlined in the Project Details section of this application form.

Any special conditions attached to the letter of offer and funding will be met and
documented including acknowledgement of Anglo American as a sponsor.

Anglo American may promote this funding agreement, including beneficiary, purpose
and amount of funding.

Evaluation reports and a final project report (including an evaluation against project
KPIs) will be submitted to your local mine.

It is the responsibility of the organisation to ensure adequate insurance cover for
activities.

There is no commitment of continuing funding for the organisation by Anglo American
and all future applications will be assessed individually, on a case-by-case basis, in
accordance with the Anglo American’s Social Investment and Donations Policy.
I have read and agree to these Terms and Conditions. I certify all information provided is
current and correct and I give permission for Anglo American to contact any relevant
persons or organisations in the processing of this application.
Name:
Position/Title:
Signature:
Date:
Part 10 - Organisation Statement
This is required to completed and submitted with the application form if your organisation
has an ABN but it is not registered for GST
ORGANISATION DETAILS
Name of Organisation:
Address of Organisation:
ABN:
I hereby certify that the information and ABN quoted above is correct and that the above
named organisation is not registered for GST. Therefore, GST is not required to be paid for a
donation/contribution by Anglo American Metallurgical Coal Pty Ltd.
CERTIFICATION
Name of Authorised Person:
Position in Organisation:
Signature of Authorised
Person:
Date:
Part 11 – Submission Information
Applications should be submitted to you local mine. Electronic submissions are preferred.