Reference Number: ni9ao2b0f3

Name of Lions Club/Organisation/Individual requesting for LCSF Grant

Submitted By (Your Name)

Designation

Contact Number

Email Address

Mailing Address

Project Name

Project Objectives

Why is there a need for this programme/activity/events?

How will these objectives be achieved ?

Who will be the Beneficiaries?

How many Beneficiaries will be supported?

Date of this programme/activity/event to be held

Project Duration

Date of Completion of this programme/activity/event

Total Project Costs

Funds Raised by Lions Club /Clubs/ Individual/Organisation for this Project (Indicate Name and Amount)

Funds to be raised by Lions Club/Clubs/Individual/ Organisation for this Project (Indicate Date funds will sent to LCSF, Name and Amount)

Grant Amount requested from LCSF

How will the activity achieve positive impact for LCSF / Lions Clubs/ Clubs/ Organisation?

Name of Payee for Grant Cheque

Contact number if different from above

Mailing Address of Payee if different from above

Applications must be received by LCSF within 2-3 months before the commencement of the project. Applicants are encouraged to submit their applications as early as possible.

By providing the information set out in this form, I/we agree and consent to Lions Community Service Foundation (Singapore), as well as its representatives and agents (collectively, “LCSF”) collecting, using, disclosing and sharing amongst themselves my/our personal data provided above as well as in the records of LCSF from time to time, and disclosing such personal data to LCSF’s authorised service providers, and relevant third parties for purposes reasonably required by LCSF for donation-related and communication purposes. Such purposes are set out in a Data Protection Policy, which is accessible at https://lcsf.org.sg/privacy-policy-2/ or available on request and which I/we confirm I/we have read and understood.

Upon Project completion, please refer to list of documents to be submitted to LCSF for disbursement of the LCSF grant.

List of documents to be submitted to LCSF for disbursement of LCSF grant: