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Home » Compliance & Ethics » Third-Party Grants and Donations Request – Asia Pacific » Charitable Donation – Asia Pacific

Charitable Donation – Asia Pacific

If you are located in Australia or New Zealand, please click here to access the correct forms.

Please fill out the form below for your request to be considered. 

"*" indicates required fields

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Organisation Requesting Grant

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Address

 

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Primary Contact Name
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Organisation Receiving Grant

 

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Primary Contact Name
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Grant Recipient Information

Type of Entity*
Address
Please indicate local currency.
Please indicate the name & quantities of the Merit products requested.
To the best of your knowledge, do you know anyone who is a member of the Board of Directors, or an Executive Committee of the grant recipient entity a Merit medical customer?

 

PLEASE NOTE:
* In general, only grant requests completed in full and received by the Merit Grant Committee at least four (4) weeks prior to the start of the program will be considered.

* For Charitable Donations, a Letter of Request must be submitted with this Grant Request.

Charitable Donation Details

Will there be other supporters of this program?*

 

Required Documents

The grant request will be declined unless you provide the following documentation with this form:
Max. file size: 50 MB.
Describe program objectives, purposes of the requested support, including format, scope, number of programs covered. If Merit products are requested, need to include the details, quantities of the Merit products required and the shipping details such as the recipient organisation name and address including specific dates of arrival if applicable.

 

Max. file size: 50 MB.
Please upload a document verifying the charitable nature of the organization or the event / activity.

 

Acknowledgement

By submitting this grant request you certify that to the best of your knowledge, all information set forth in this form is correct and complete, and is in compliance with Merit’s Compliance Program (attached below). You also certify that the grant is not for the purpose of inducing someone to purchase, prescribe, endorse or recommend a product, or otherwise for the purpose of obtaining or retaining business or gaining an improper business advantage.

Submission of this Grant Request and the foregoing documentation does not guarantee approval of the request. In addition, past funding does not guarantee future approval. Merit will only pay grants upon approval by the Merit Grant Committee and after the Grant Agreement has been signed by Merit and the Grant Recipient. The Merit Grant Committee reserves the right to award less than the amount requested.
Primary Contact Name
Date of Submission*
Privacy Acknowledgement*

Grants

  • Third-Party Grants and Donations Request – Asia Pacific
    • Grants and Donations FAQs – Asia Pacific
  • Third-Party Grants and Donations Request – Europe (EMEA)
    • Grants and Donations FAQs – Europe (EMEA)
  • Third-Party Grants and Donations Request – U.S. and Other Countries
    • Grants and Donations FAQs – U.S. and Other Countries
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