Requests for Support Form

Project Submission Form

This protocol concerns the submission of projects and use of donations.
- Organisation
- Name of the organisation / Company name
  Please fill in
- Tax status
- Department / Service
  Please fill in
- Address
  
  Address 1
  
  Address 2
  
  Town/CityState/Province/Canton
  
  Postal/Zip CodeCountry
- Web link
  Give the URL
- Bank
  Specify the bank name
- IBAN
  Enter the IBAN (2 letters followed by a maximum of 31 letters or numbers) - complete with xxxxxxxx if necessary
- Identity of the applicant / project manager
- First Name, Last Name
  
  First NameLast Name
- Title
  Please fill in
- Phone Number
  
  Country codeArea CodeNumber
- Email Address
  example@example.com
- Contact Person
- Same as the applicant?
  If "No", please fill in below
- First Name, Last Name
  
  First Name Last Name
- Title
  Please fill in
- Phone Number
  
  Country CodeArea CodeNumber
- Email Address
  example@example.com
- Sources that led to contact CARIGEST SA
  
  0/300
- Project Title
- Designation of the project's charitable area
- Current situation and specific needs
  
  0/350
- Project definition and objective
  
  0/1100
- Conditions for implementation and anticipated project duration
  
  0/350
- Anticipated project start date
  
  DayMonthYear
  Date
- Anticipated period of use (start)
  
  DayMonthYear
  Date
- Anticipated period of use (end)
  
  DayMonthYear
  Date
- Total project cost
  Figures only
- Currency
  Please Select
- List of budget Items
  
  0/350
- Sources of funding already obtained (amounts and names of partners)
  
  0/600
- Financing still to be obtained and applications in progress (amounts and names of partners)
  
  0/350
- Total amount requested from CARIGEST SA
  Figures Only
- Currency
  Please select
- Anticipated use of the amount requested
  
  0/300
- Comments
  
  0/500
- Previous success stories
  
  0/600
- Collaborations carried out
  
  0/600
- Recent publications
  
  0/600
- Your charters, certifications and/or ZEWO label or other attesting to best practices (information in a few lines, full documents to be attached)
  
  0/300
- Your conditions for accepting a donation if applicable (information in a few lines, full documents to be attached)
  
  0/300
- Information about the requesting organisation - please tick the information that appears in the attachments
- MEDICAL RESEARCH specific information - please tick the information that appears in the attachments
- Other information
  
  0/750
- Uploading attachments
  
  Please use the SwissTransfer platform and paste the sharing link in the field below.
- SwissTransfer link
  Paste your share link here
- When you click on "Send" you submit the completed form and give us access to the uploaded attachments.
  
  You will receive a copy of the form in PDF format by email to be printed, signed and returned to us, without the attachments, by post to:
  
  CARIGEST SA, Case Postale 321, Rue de l'Athénée 24, 1211 Geneva 12, Switzerland
- Privacy Policy
- Location
  Location
- Date
  
  DayMonthYear
  Date
- Signature (sign the paper version)
- Should be Empty:

Project Submission Form

Organisation

Identity of the applicant / project manager

Contact Person