Organization Details

Name of the Organization or Community Applying

- Name of Beneficiary (The community name as will appear on contract)

Country

Address

City

Zip Code

The person signing the contract is different than the person filling out the form

Contact Person's Details

First name

Last name

Phone Number

Email

Beneficiary Authorized Name

First Name

Last Name

Beneficiary Email

Details of the Institute for which the Assistance is required

Full Name of the Institute

Address

Phone Number

The Institute’s Purposes and Activities

Description of the Population Benefiting from the Institute’s Activities

Recent photo of the front of the facility

The facility is?

Ground Building

Multi Level Building

Ground Building

If the facility is a stand alone building, please specify: neighborhood name, neighbors, yard, entrances, if there are surrounding fences and elevators.

Multi level building

Please specify: Number of floors in the building, entrances, on which floor is the facility located and elevators.

Is the facility rented or owned by the Community/Organization?

OwnedRented

Please indicate the end date of the lease

DD/MM/YYYY

Pleas select all the measures you are requesting. If you have one quote for more then one of the requested measures, you can upload the same file again.

Requests

Category name:

Other Category name:

**Category Name

Amount requested for this measure

How Many?

Total cost of requested items

File Name

Upload PDF File

Internal cameras will not be approved

Length of the fence

Hight

Is there currently a fence in the facility?

We won't approve less than 300 microns

Wooden door will not be approved

Door type

On what floor/s are they requested for

How many square meters?

Cost per one square meter

:Note
The fund will not approve internal cameras, wooden doors, CPR Kit, weapons, human
resources and rental payments

Hidden Files

Quote - Bulletproof window

Up to 2MB

Picture of existing window

Up to 2MB

Picture of existing gate (if there is)

Up to 2MB

Quote - Bars

Up to 2MB

Sketch

Up to 2MB

Sketch for the requested fence

Up to 2MB

Quote - Doors

Photo of existing fence

Up to 2MB

Picture of existing door

Up to 2MB

Lock type

Camera and TV	Fence	Bars	Films
Doors	Bulletproof window	Pedestrian gate	Locks
Barriers	Planters	Intercom	UPS
Door closer	Alarm system	Other

Pleas select all the measures you are requesting. If you have one quote for more then one of the requested measures, you can upload the same file again.

Internal cameras will not be approved

We won't approve less than 300 microns

Wooden door will not be approved

:NoteThe fund will not approve internal cameras, wooden doors, CPR Kit, weapons, human resources and rental payments

:Note
The fund will not approve internal cameras, wooden doors, CPR Kit, weapons, human
resources and rental payments