Contact Person's Name (required)

Contact details (phone & email)

Location of project

Organisation name

Registration Number

PBO number

Beneficiary Demographics: Race
Percentage African
Percentage White
Percentage Indian
Percentage Coloured

Beneficiary Demographics: Gender-Females
Percentage African Female
Percentage White Female
Percentage Indian Female
Percentage Coloured Female

Please provide an overview of the organisation for which you are requesting a donation/sponsorship.

Please give details of your sponsorship request (you may attach a copy of your proposal if you have one)

Donation value

How will you recognise Fuchs' contribution if you are successful in obtaining a donation/sponsorship?

Please tell us about your corporate/organisational governance

Other information not included above you consider important to support favourable consideration of your request

Your Email (required)