Fundraising Support Application Form
Name of organisation:
Main address:
Postcode:
Switchboard:
Central fax:
Central email:
Website:
Mobile number:
Type of organisation (please tick all that apply):
Company Ltd by
Guarantee
Company Ltd by Shares
CIC Ltd by Guarantee
Charity
Other (please specify)
CIC Ltd by Shares
Industrial & Provident
Society
Ltd Liability Partnership
Charity Registration No:
Companies House No:
Size of Organisation
New
charity
Small
charity
Medium
charity
Organisations principal contacts:
Name of contact (Chief Executive or equivalent):
Position:
Direct telephone:
Direct email:
Direct fax:
Name of office manager:
Position:
Direct telephone:
Direct email:
Direct fax:
Annual turnover in financial year 2009-2010: £
Please give figures from your most recent accounts.
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Start-up
social
enterprise
Please briefly outline the activities that your charity undertakes,
including area of work and target communities:
Number of employees:
Full Time:
Part Time:
Volunteers:
About your Project
Main Activities List the activities planned to deliver the project
Who are the beneficiaries of your Project?
Background
Include the context, need and how this project fits in with existing activity.
Does the project have local or host government support and engagement?
Briefly describe.
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Please specify the amount you require to raise for your project
I declare that the information provided above is true and accurate.
Signed / Printed on behalf of the organisation:
Print name:
Date:
Data Protection. Personal data is gathered in accordance with the Data Protection Act 1998. Your data will be held on our
database and may be used to keep you informed of our products and services. Your details may also be made available to likeminded third party organisations. Tick here if you do not wish to receive information from other companies. 
What to do next?
For office use only
Category:
Band:
Application no.:
approval status:
Please send your completed form, along with a copy of your
most recent Annual Report, where applicable to:
Zakat House
C/O Humanitarian Forum,
Suite 27 Vicarage house,
58-60 Kensington Church Street,
London W8 4DB
or email to info@zakat-house.com
If you have any queries, do not hesitate to contact us on email info@zakat-house.com or telephone
020 7368 1645.
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Equalities Monitoring Form
Zakat House’s policy is to ensure that no applicant to the programme receives
less favourable treatment on any of the following grounds: age, race, gender, religion, disability,
sexual orientation or any other unjustifiable grounds. To help us measure the impact of this policy and
continue to develop relevant policies, could you please tick the appropriate boxes. The information will
be used for statistical purposes and to help us monitor the effectiveness of our practices. The
following information forms no part of the selection process.
Gender
Male
Female
Ethnicity
White: English
Asian/Asian British: Indian
White: Irish
Asian/Asian British: Pakistani
White: Other
Asian/Asian British: Bangladeshi
Mixed: White and Black Caribbean
Black/Black British: Caribbean
Mixed: White and Black African
Black/Black British: African
Mixed: White and Asian
Black/Black British: Other
Mixed: Other
Latin American
Chinese
Eastern European
Other ethnic group
Other: self-identification
Religion
Agnostic
Atheist
Bahai
Muslim
Pagan
Christian
Jewish
other
No Religion
Buddhist
Sikh
Humanist
Hindu
Prefer not to say
(please specify) _________________
Disability
Do you consider yourself to have a disability
Age group
16-25
Over 65
26-35
Yes
36-50
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No
51-65
Refugee background
Do you have a refugee background?
Yes
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No