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    Beneficiary Identification Form

    Uploaded by

    eugene
    The document is a beneficiary identification form for a community support program. It collects information such as the name, address, contact details, founders, activities, beneficiaries, accreditations, funding sources, and challenges of an institute applying for funding support. The form also includes spaces for comments from the employee filling out the form and their relationship manager.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Beneficiary Identification Form

    Uploaded by

    eugene
    131 views2 pages
    The document is a beneficiary identification form for a community support program. It collects information such as the name, address, contact details, founders, activities, beneficiaries, accreditations, funding sources, and challenges of an institute applying for funding support. The form also includes spaces for comments from the employee filling out the form and their relationship manager.

    Original Description:

    Zambian kwacha

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    © © All Rights Reserved

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    The document is a beneficiary identification form for a community support program. It collects information such as the name, address, contact details, founders, activities, beneficiaries, accreditations, funding sources, and challenges of an institute applying for funding support. The form also includes spaces for comments from the employee filling out the form and their relationship manager.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    131 views2 pages

    Beneficiary Identification Form

    Uploaded by

    eugene
    The document is a beneficiary identification form for a community support program. It collects information such as the name, address, contact details, founders, activities, beneficiaries, accreditations, funding sources, and challenges of an institute applying for funding support. The form also includes spaces for comments from the employee filling out the form and their relationship manager.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    COMMUNITY SUPPORT PROGRAM

    BENEFICIARY / PROGRAM IDENTIFICATION FORM

    Employee Name: ___________________________ Designation: ___________________________


    Branch Name: _____________________________ Team Name: ___________________________

    Name of the Beneficiary / Institute: __________________________________________________

    Address: ________________________________________________________________________

    Contact Person: __________________________ Designation: _____________________________

    Contact Number 1: ________________________ Contact Number 2: _______________________

    Email: __________________________________________________________________________

    Give details of all the locations if the institute is operating from multiple locations: ____________
    _______________________________________________________________________________
    _______________________________________________________________________________

    Date of inception of the institue: _____________________________________________________

    Names & background of founders / beneficial owners of the institute: _______________________


    _______________________________________________________________________________
    _______________________________________________________________________________
    _______________________________________________________________________________

    How do you know the Institute?: ____________________________________________________


    _______________________________________________________________________________
    _______________________________________________________________________________

    Describe the nature of activities carried out by the Institute: ______________________________


    _______________________________________________________________________________
    _______________________________________________________________________________
    _______________________________________________________________________________
    _______________________________________________________________________________

    Number of people currently benefitted by activities carried out by the Institute: ______________

    Give details of the the acrreditions / affiliations held by the Institute: _______________________
    _______________________________________________________________________________
    _______________________________________________________________________________

    Community Support Program – Beneficiary Identification Form Version1.0 Page 1


    Sources of funds of the Institute: ____________________________________________________
    _______________________________________________________________________________

    Challenges faced by the Institute: ____________________________________________________


    _______________________________________________________________________________
    _______________________________________________________________________________
    _______________________________________________________________________________

    Future Plans of the Institute: ________________________________________________________


    _______________________________________________________________________________
    _______________________________________________________________________________
    _______________________________________________________________________________

    Employee Comments: _____________________________________________________________


    _______________________________________________________________________________
    _______________________________________________________________________________
    _______________________________________________________________________________
    _______________________________________________________________________________

    Date: ________________ Place: ___________________ Employee Signature: ________________

    RM’s Comments: _________________________________________________________________


    _______________________________________________________________________________
    _______________________________________________________________________________
    _______________________________________________________________________________
    _______________________________________________________________________________

    Date: __________________ Place: _________________ RM’s Signature: ____________________

    Community Support Program – Beneficiary Identification Form Version1.0 Page 2

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