Request Humanitarian Aid

Organization Information

Organization Name:

Organization
Address:

Organization Contact Information

Contact :

Organization Registration Information

Location of registeration:

Date of registeration:

(day/month/year)

Government agency registered by:

Registration Number:

Taxes and Custom Duties

Entitled to receive humanitarian cargo taxes and customs duties free:

Yes

Organization Activities

List main types of activities:

Geographic and Demographic Information

Short description of the city (area, region, Republic), where your organization is working:

Approximate number of people living in this area:

Categories of people in need and approx. number in each category for this area:

Types of Humanitarian Assistance

List the t ypes of humanitarian assistance your organization is requesting:

Distribution

How will your organization distribute cargoes you are going to receive?

Categories of People in Need

Main categories of people in need, who are going to benefit from these cargoes
(i.e., orphans, elderly, invalids, refugees, etc.):

Send request information, you will be contacted by email once your request has been received.

Date:

(day/month/year)

Signature
(Seal/Stamp)

Our on-line form is not yet available - please download the pdf request for humanitarian aid form and mail to the address below.

Mail form to:
Rotary Help Network, #315-475 Hoew Street, Vancouver, BC, V6C 2B3
We will contact you once your request has been received.