Mediclinic Southern Africa Corporate Social Investment Contact Form

If you answered YES to the above complete the three questions below, othewise skip ahead to the next section under 'no'

If you answered NO to the above

In which area does the organisation focus its activities?

Please outline who will benefit from this initiative in actual numbers

Please note: This table needs to be completed in accordance with the Employment Equity Act and B-BBEE Act definitions of Africans (A), Coloureds(C) and Indians(I) who are citizens of the Republic of South Africa by birth or descent; or who became citizens of the Republic of South Africa by naturalization before 27 April 1994; or on or after 27 April 1994 who would have been entitled to acquire citizenship by naturalization prior to that date.

 

Males: provide numbers per demographic below

 

South African Citizens

Non-citizens

Females: provide numbers per demographic below

Non-citizens

 

Have you presented this proposal to other potential funders?

Does your organisation have a constitution?

Do you have a comprehensive budget for the initiative?

Do you have proof of registration as a Public Benefit Organisation or evidence of being in the process of being registered as one?

Does the organisation does have any political affiliations?

Do members of the organisation have any political affiliations?

Does your organisation have a valid TAX clearance?

Does your organisation have audited financial statements?

Do you have a comprehensive business plan if you do not have audited financial statements? {new organisations only}

Do you have a record of current and past donors and their levels of support?

Have you completed all the fields above. Check yes below to confirm.

This field is required.
Please add the two figures together (spam protection)