MAZDA FOUNDATION LIMITED
                                                         (ABN 12 465 501 576)


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Mazda Foundation Form

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Mazda Foundation Form

  1. 1. MAZDA FOUNDATION LIMITED (ABN 12 465 501 576) PROJECT NOTIFICATION PRIORITY AREA OF FOCUS COMMUNITY BASED PROGRAMS FOCUSSED ON YOUTH HEALTH, WELFARE AND EDUCATION Please note that during the period 1 October 2008 to 31 March 2010, the Mazda Foundation is only accepting project notifications in relation to the priority area notified on the Mazda Foundation website and summarized above. ORGANISATION NAME:       ORGANISATION ADDRESS & PCODE:       STATE: Select ABN REGISTRATION NUMBER:       CONTACT PERSON & POSITION:       CONTACT DETAILS: TEL NO:       FAX NO:       EMAIL:       IS CONFIRMATION OF TAX IS APPLICANT PLEASE SELECT PLEASE SELECT ELIGIBILITY AVAILABLE: REGISTERED FOR GST ENDORSEMENT AS A DEDUCTIBLE       DATE OF ISSUE OF: GIFT RECIPIENT (Insert Date): (This area must be completed) ENDORSEMENT AS AN INCOME TAX       EXEMPT CHARITY(Insert Date): OUTLINE OF GRANT REQUEST, INDICATING HOW THE REQUEST RELATES TO THE PRIORITY AREA:       GST EXCL AMOUNT GST AMOUNT GST INCL AMOUNT AMOUNT OF FUNDING REQUIRED:                   DATE PROJECT FUNDS ARE REQUIRED BY:       Notes: 1. Mazda Foundation will acknowledge receipt of your notification but this should not be seen as in any way indicating the notification will progress for further detailed consideration. 2. The Foundation does not fund overseas projects/trips in accordance with Australian Taxation Office requirements applying to the Mazda Foundation. 3. No attachments should be forwarded with this Project Notification. On completion of the Project Notification follow the instructions as below: Select FILE; SEND TO; MAIL RECIPIENT (As attachment); TO: info@mazdafoundation.org.au; SUBJECT: Project Notification; SEND If you have any difficulties returning this form via email please fax to (03) 8540 1920

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