Defy Consortium — Expression of Interest Form

Defy Consortium — Expression of Interest Form

Submit this form to express your organisation’s interest in joining the Defy Consortium.
Organisation Information
Company Name*
HQ Country*
Operating Markets

AfricaEuropeCentral AsiaEast AsiaSouth AsiaSoutheast AsiaLatamMENANorth America
Company Website*
Type of Organisation*
Industry / Sector*
Other (Please specify)
Primary Contact
Name*

First NameLast Name
Email*
Phone Number
Please enter a valid phone number.
Job Title / Designation*
Preferred Mode of Contact*

EmailPhoneWhatsApp / Messaging
Membership Type
Membership Type (Expression of Interest)*

Steward MemberAmplifier MemberNot sure yet, please contact me to discuss both options
Areas of Interest & Motivation
Areas your organisation wants to support

Digital Identity, VerificationKYC / AML / CFTFinancial Literacy, Capability BuildingInclusive Credit Alternative ScoringCommunity-based Finance / Cooperative ModelsDigital Payments, Micro-TransactionsMSME Enablement / EntrepreneurshipWomen’s Economic EmpowermentGreen FinancingImpact Measurement; SDG AlignmentPolicy, Standards, GovernanceTechnology (AI, Blockchain, Open Data, etc.)Pilot Projects, TestbedsFunding / SponsorshipOther (Please Specy)
Other (Please Specify)
Which underserved groups do you aim to support?

WomenMSMEsYouthMigrant workersRural communitiesRefugees / Stateless personsOther (Please Specify)
Other (Please Specify)
Why is your organisation interested in joining the Defy Consortium?
What resources or capabilities can your organisation contribute? (e.g., technology, data, field networks, funding, talent, user communities)
Consent & Declaration*

I agree to the terms stated below.
- I confirm the information provided is accurate.
- I acknowledge that submitting this form does not guarantee membership.
- I agree that Defy Consortium may contact me for follow-up discussions.
- I agree to the processing of my data according to the Privacy & Data Protection.
Date of Submission*

MonthDayYear
Signature*

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