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Foundation Grant Request Form

Required fields

Charity Name/Event	Date or time period of charity name/event

Is your Charity registered?	If yes, please provide us with your Canadian Charitable Registration Number

Description and location of charity/event

Amount requested

Will UMC Charity receive corporate recognition?
Yes No
What is the percentage of funds that the charity earmarks for administrative costs?

Explain your role with this organization. For example, do you regularly contribute either by time, energy or money?

Applicants may be contacted for further information.

Office use only:

© 2012 uniPHARM Wholesale Drugs Ltd. - Charitable Registration 856477856RR0001

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