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Mercy Mission DAF Due Diligence form
"
*
" indicates required fields
Your organisation or cause may be eligible for a grant. Let’s do the due diligence check first.
Form Filled in by
Individual
Charity
Company
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Beginning of Individual start
Personal Information
Full Name
*
Insurance/Social Security Number
*
Ex: UK National Insurance (NI) number, US Social Security Number (SSN), Australia Tax File Number (TFN), Canada, Social Insurance Number (SIN), Türkiye T.C. Kimlik Numarası (Turkish Identity Number)
Grant/Prize Information
Description of the Grant/Prize
Estimated Value of the Grant/Prize
Proof of Identification
Proof of ID
Type
*
Number
*
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Consent
I agree that I upload the Proof of ID
Upload Proof of ID
*
Max. file size: 10 MB.
Proof of Address
Address
*
Start of Residence Date
MM slash DD slash YYYY
This field is hidden when viewing the form
Consent
*
I agree that I upload the Proof of Address
Upload Proof of Address
*
Max. file size: 10 MB.
Tax Information (if applicable)
Is this prize/grant subject to reporting for tax purposes?
Yes
No
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End of Individual section
Organisation Summary
Organisation Name:
*
Company Name:
*
Operational Name (if different):
Charity Registration Number:
*
Charity Registration Date:
MM slash DD slash YYYY
Company Registration Number:
*
Company Registration Date:
*
MM slash DD slash YYYY
Registered Address:
*
Do you have a website?
*
Yes
No
Website:
*
Contact Information
Key contact for grant application (Name):
*
Position:
*
Telephone Number:
*
Email Address:
*
Enter Email
Confirm Email
Governance details
Trustee/Board Member Names:
*
Name
Date of birth
Add
Remove
Minimum of 2 Directors, up to 12.
Directors Names:
*
Name
Date of birth
Add
Remove
Minimum of 2 Directors, up to 12.
Investigation history
Has your organisation ever been subject to an investigation by any authority, regulatory body, or any other investigatory body in the last 5 years?
Yes
No
Have you ever been subject to an investigation by any authority, regulatory body, or any other investigatory body in the last 5 years?
Yes
No
Description
*
Bank Details
Bank name:
*
Branch name (optional):
Account Name:
*
Account currency:
*
Upload bank statement
*
Max. file size: 15 MB.
Is your bank account based in the UK?
Yes
No
Account Number:
*
Sort Code:
*
SWIFT/BIC:
*
IBAN:
*
Routing number:
*
Upload Files
Upload the following documents (in pdf format)
Proof of ID for Trustee/Board Member #1
*
Yes
No
Proof of ID for Director #1
*
Yes
No
Upload Proof of ID
*
Accepted file types: pdf, Max. file size: 10 MB.
Proof of ID for Trustee/Board Member #2
*
Yes
No
Proof of ID for Director #2
*
Yes
No
Upload Proof of ID
*
Accepted file types: pdf, Max. file size: 10 MB.
Director #1 proof of address
*
Yes
No
Upload Proof of Address
*
Accepted file types: pdf, Max. file size: 10 MB.
Director #2 proof of address
*
Yes
No
Upload Proof of Address
*
Accepted file types: pdf, Max. file size: 10 MB.
Registration Certificate / Certificate of incorporation
*
Yes
No
Upload Registration Certificate / Certificate of incorporation
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 10 MB, Max. files: 4.
Latest Annual Accounts
*
Yes
No
Please explain why:
*
Upload Latest Annual Accounts
Accepted file types: pdf, Max. file size: 10 MB.
Latest Bank Statement
*
Yes
No
Upload Latest Bank Statement
Accepted file types: pdf, Max. file size: 10 MB.
You are not yet eligible for a grant.
Policies and Procedures
Speaker and Events Policy
*
Yes
No
N/A
Upload Speaker and Events Policy
Accepted file types: pdf, Max. file size: 10 MB.
Data protection policy
*
Yes
No
N/A
Upload Data protection policy (optional):
Accepted file types: pdf, Max. file size: 10 MB.
Anti-Money Laundering / Anti-Bribery Policy
*
Yes
No
N/A
Upload Anti-Money Laundering / Anti-Bribery Policy (optional):
Accepted file types: pdf, Max. file size: 10 MB.
EDI Policy
*
Yes
No
N/A
Upload EDI Policy (optional):
Accepted file types: pdf, Max. file size: 10 MB.
Financial management policy
*
Yes
No
N/A
Upload Financial management policy (optional):
Accepted file types: pdf, Max. file size: 10 MB.
Safeguarding policy
*
Yes
No
N/A
Upload Safeguarding policy (optional):
Accepted file types: pdf, Max. file size: 10 MB.
You are not yet eligible for a grant. Because you failed to to have either Speaker and events policy or Safeguarding policy
Based on your responses to the due diligence checks, your organisation may be eligible for a grant
And also based on your responses to the due diligence checks, your organisation may be eligible for a grant including one over £20,000
Signature and Consent
Accuracy declaration:
*
I confirm the information submitted is accurate to the best of my knowledge.
Authority declaration:
*
I confirm I have the authority to submit this information on behalf of the organisation.
Consent
*
I agree to the Terms and Conditions
Consent
*
I consent that my data may be shared with Mercy Mission UK DAF clients
Form Filled in by (name):
*
Position:
*
E-mail:
*
Enter Email
Confirm Email
Form completion date:
*
MM slash DD slash YYYY
Disclaimer
*
I consent that Mercy Mission UK may request additional documents if I am granted medium to large grants.
Disclaimer
*
I consent as a representative of the organisation, that Mercy Mission UK may request additional documents if we are granted medium to large grants.