form

1. Applicant Information

Organization name

Operational structure/Legal status

Tax ID

Address

City

Zip

State

Country selector

Mission of organization

Website

Email

Head of organization

Full name

Position within organization

External contact person submitting the request:

Email

Full name

Position within organization

Telephone number

Address

City

Zip

State

Country selector

Internal contact person (for product requests: EVP BA)

2. Request Details

Type of Request

Sponsorship

Donation/Charity

Project Area

Project Country(s)

Project Description

Amount of funding requested from Getinge (in EUR)

Amount of external funding requested in total (in EUR)

Percentage of overall budget sought from Getinge

Payment Method

Personnel responsible for financial controls

Bank account details

(This must be an account in the name of the body making the application and not an individual)

Bank account details

(This must be an account in the name of the body making the application and not an individual)

Bank name

Bank country

Account holder

IBAN number

BIC or SWIFT Code

3. Project General Details

Title

Start date

End date

Location & venue

City

State

Country

Name

Address

Website

Objective of the Project:

Targeted beneficiaries

Local

National

International

Application procedure

Is the applicant a Government Official or Government and Politically-Affiliated Entity? If “Yes”, please provide full details.

Yes

No

Will any Government Official or Government and Politically-Affiliated Entity benefit from the sponsorship/donation, directly or indirectly? If “Yes”, please provide full details.

Yes

No

Will any Healthcare Professional and/or Organization benefit from the sponsorship/donation, directly or indirectly? If “Yes”, please provide full details.

Yes

No

Does the applicant or the applicant’s employee have any business or business-related decision pending (e.g., a contract, application, tender, approval, license, permit, etc.) with Getinge? If “Yes”, please provide full details.

Yes

No

Are you aware of any Getinge competitor or supplier sponsoring/donating to the project? If “Yes”, please provide full details.

Yes

No

4. Previous Donation Support

Has your organization already applied for or received funding from Getinge before?

Yes

No

5. Remarks

Please provide any additional information related to the application process and/or the Project.

6. Supporting Documents

Please attach the following supporting documents to this form:

A copy of most up-to-date draft program / project description, agenda / plan or communication material related to the Project
A copy or proof that the organization is eligible / qualified to receive donations.
A draft budget laying out how the funds will be spent

Please attach the following supporting documents to this form:

A copy of most up-to-date draft program / project description, agenda / plan or communication material related to the Project
A copy or proof that the organization is eligible / qualified to receive donations.
A draft budget laying out how the funds will be spent

Supporting documentation

I have read and agree to the terms and conditions of the Privacy Policy.*

I agree to receive further information about Getinge and its solutions.

Charitable Donations

Please read before completing the form

Charitable Donation Request Form

1. Applicant Information

1. Applicant Information

2. Request Details

2. Request Details

3. Project General Details

3. Project General Details

4. Previous Donation Support

4. Previous Donation Support

5. Remarks

5. Remarks

6. Supporting Documents

6. Supporting Documents