DETAILS OF ORGANISATION / INSTITUTION
This Application Form is NOT meant for the Self-Employed Assistance Scheme or the Government Wage Assistance Scheme
Organisation / Institution *   Registration Number *
 
Main business activity  
Sector *  
Type of activity *  
Detail of activity *  
 
Postal Address  
Building Number   Street *
Locality   Mauritius Postal Region *
Village / Town *   Postal Code
Country *  
 
Contact Details  
Telephone Number *   Mobile Number *
Email Address   Fax Number
 
DETAILS OF ORGANISATION / INSTITUTION'S REPRESENTATIVE
Name *   Designation *
Telephone Number *   Mobile Number *
Email Address   Fax Number
 
BANK DETAILS
Bank Name *   Account Holder Full Name *
Bank Account Number *   Branch Name *
  Please make sure that the bank account number is correct
 
DETAILS OF BENEFICIARIES
Number of Beneficiaries *   Type of Beneficiaries *
 
OTHER DETAILS
Please give a brief statement on the activities of the Organisation/Institution *
 
Please give a brief statement on the programme, project or scheme and its relation to COVID-19 (use annex, if any) *
 
What are the expected outcomes of the programme, project or scheme, based on the proposed activities/output *
 
Please confirm that the programme, project or scheme is a non-profit initiative *
 
What type of assistance, including the financial package, which is expected from the COVID-19 Solidarity Fund *
 
ATTACHMENT(S)
 
DECLARATION
Declarant Name *   Capacity in which acting *
 
 
NOTES TO APPLICANT
(a) Kindly note that one can apply for the Covid-19 Solidarity Fund ONLY ONCE and cannot do any modification after submission of same.
(b) The Fund may request for additional information in relation to the application; and
(c) False information / incomplete application form may lead to rejection of the request.
 
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