PleasereadtheGuideToApplication–Environmental.docVIP

Please read the “Guide To Application – Environmental Education and Community Action Projects” before completing this form. You may complete this Application Form in Chinese or English. 填表前請參閱《環保教育和社區參與項目 - 申請指引》。請以中或英文填寫本表格。 Completed application form (in both hard and soft copies) should be returned to (Please state “Minor Works Projects” on the envelope): 填妥的表格(正本及軟複本)請送交 (信封面請註明「小型工程項目」): Secretariat, Environmental Campaign Committee Environmental Education and Community Action Projects Vetting Sub-committee 5/F Southorn Centre, 130 Hennessy Road, Wan Chai, Hong Kong 香港灣仔軒尼詩道130號修頓中心5樓 環境運動委員會 環保教育和社區參與項目審批小組秘書處 Tel 電話 : 2835 1180 Fax傳真 : 2827 8138 Email電郵 : eeca@.hk Section A – Data Sheet 甲 部 – 資料頁 Applicant Organisation 申請機構 For applicant, please complete the “Supplementary Sheet for NGO Applicants” 非政府組織申請機構請額外填寫《供非政府組織申請機構填寫的補充資料頁》 Name of Organisation 機構名稱 (English英文) (Chinese中文) Mailing Address 通訊地址 Person-in-charge * 負責人* Position Held 職位 Tel. No. 電話號碼 Fax No. 傳真號碼 Mobile Phone no. 流動電話 Email Address 電郵地址 * The person-in-charge should be the Head or Deputy Head of the applicant organisation. 負責人必須是申請機構的主管或副主管。 Proposed Project 申請項目 Project Title 項目名稱 (English英文) (Chinese中文) Brief Description of the Purpose of the Project 項目簡介 Amount of Grant Requested 申請資助總額 HK$ Cheque Payable to 支票抬頭人 Declaration 聲明 I certify that 本人謹此聲明 - the organisation is non-profit-making in nature and it * Receives / Does NOT Receive Government subvention at present; 本機構屬非牟利性質，現 * 有 / 沒有 接受政府補助； all activities seeking grant of fund are non-profit-making and will not be used for political, religious or commercial purposes for any individual or organisation;所有申請資助的活動均屬非牟利性質，且非為個人或團體作政治、宗教或商業宣傳之用； rom other sources has / has not* been or is / is not* being obtained by us for the same project or activities under application. If subsidy from other sources has been or is being obtained, please specify: