Charitable Donation – EMEA

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

"*" indicates required fields

Organization Requesting Grant

Name

Address

Street Address Address Line 2 City Province / Region ZIP / Postal Code Country

Primary Contact Name

First Last

Phone

Organization Receiving Grant

Name

Type of Entity*

Profit

Non-Profit

Address

Same as above

Street Address Address Line 2 City Province / Region ZIP / Postal Code Country

Primary Contact Name

First Last

Contact Address (if different than above)

Same as above

Street Address Address Line 2 City Province / Region ZIP / Postal Code Country

Phone

Grant Recipient Information

Recipient VAT Number

Recipient Corporate Registration Number

Amount of Grant Request

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

Mission or Program Title

Humanitarian Trip or Program Date(s)

Entity Sponsoring Humanitarian Trip or Charitable Program, e.g., name of non-profit organization

Detailed Mission or Program Description

Humanitarian Trip or Charitable Program Destination

Proposed Use of Funds or Donated Product(s)

Required Documents

The grant request will be declined unless you provide the following documentation with this form:

Detailed Letter of Request

Max. file size: 50 MB.

Describing program objectives, purpose of the requested support, including format, scope, and number of programs covered

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.

Name

First Last

I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this request.

Privacy Acknowledgement*

I have read and accept the privacy policy and understand how you manage my Data under GDPR. Providing personal data is voluntary, but required to process your request. We cannot process your request if information is not provided.