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ULSTER GARDEN VILLAGES LIMITED GRANT APPLICATION
		FOR OFFICIAL USE ONLY
TO: ULSTER GARDEN VILLAGES LTD “FORESTVIEW ” PURDYS LANE NEWTOWNBREDA BELFAST BT8 7AR		APPL. NO PROJECT VALUE REQUEST PREVIOUS GRANTS OWN RESOURCES

DETAILS OF YOUR ORGANISATION
NAME		CHARITY REG. NO.
POSTAL ADDRESS		DATE OF FORMATION
		TELEPHONE NO.
POST CODE		FAX NO.
NAME OF MAIN CONTACT		EMAIL
TELEPHONE OF MAIN CONTACT		WEBSITE

AIMS AND PURPOSES OF YOUR ORGANISATION

HOW IS YOUR ORGANISATION CONSTITUTED?
COMPANY OR TRUST, ETC

HOW IS YOUR ORGANISATION FUNDED?

HOW IS YOUR ORGANISATION STAFFED
NO. OF FULL TIME STAFF		NO. OF PART -TIME STAFF
NO. OF VOLUNTEERS		NO. OF COMMITTEE OR BOARD MEMBERS
‘Forestview’, Purdy’s Lane, Newtownbreda, Belfast BT8 7AR Telephone: 028 90 491111 Facsimile: 028 90 491007 E-mail: admin@ulstergardenvillages.co.uk


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FINANCING THE PROJECT
TOTAL COST		AMOUNT REQUESTED
(Please attach detailed breakdown)
IS YOUR ORGANISATION VAT REGISTERED			YES / NO
HOW WILL YOU FINANCE THE BALANCE OF COST:
	SECURED			PENDING

OWN RESOURCES
TRUSTS (PLEASE SPECIFY)
STATUTORY AUTHORITIES (PLEASE SPECIFY)
OTHER SOURCES (PLEASE SPECIFY)

All applications for assistance must be disclosed; failure to do so may result in UGV withdrawing offer of support.


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WHAT ARE OBJECTIVES FOR THE PROJECT ?


HOW WILL YOU EVALUATE THE SUCCESS OF THE PROJECT ?


WHO WILL BENEFIT FROM THE PROJECT ?


ANY OTHER RELEVANT INFORMATION


SUSTAINABILITY
WILL THE PROJECT REQUIRE REVENUE FUNDING FOLLOWING COMPLETION? IF SO, QUANTIFY ANNUAL AMOUNT AND PROVIDE A BREAKDOWN AND SPECIFY HOW THAT AMOUNT WILL BE FINANCED.


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FINANCIAL HISTORY
IN ADDITION TO PROVIDING A CERTIFIED COPY OF YOUR LATEST AUDITED ACCOUNTS, PLEASE COMPLETE THE FOLLOWING.
	YEAR END	YEAR END	YEAR END


TOTAL REVENUE INCOME
TOTAL REVENUE EXPENDITURE
TOTAL INCOME SPECIFICALLY FOR CAPITAL PURPOSES
TOTAL CAPITAL EXPENDITURE
NET ASSETS AT YEAR END
CASH AND BANK BALANCES AT YEAR END
INVESTMENTS AT YEAR END

FOR LARGER PROJECTS A CASH FLOW STATEMENT SHOULD BE SUBMITTED.

DECLARATION OF MAIN CONTACT

NAME		POSITION
ADDRESS		CONTACT TELEPHONE NO
I DECLARE THAT THE FOREGOING INFORMATION IS ACCURATE
SIGNED		DATE

DECLARATION OF CHAIR OF ORGANISATION

NAME		POSITION
ADDRESS		CONTACT TELEPHONE NO
I DECLARE THAT THE FOREGOING INFORMATION IS ACCURATE
SIGNED		DATE


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