Application on behalf of an organization

Details organization

Name organization*

Statutory name organization*

Address (number, addition, street)*

Postal code*

City*

Country*

Does the organization have a different postal address?*

Yes
No

Postal address (number, addition, street or PO box)*

Postal code*

City*

Country*

Email address organization*

Website*

Details main user account

We can only issue an account to a person who is an authorized signatory. In an online application form, you can however state a contact specifically for an application.

First name*

Initials*

Surname*

Title*

Ms
Mr

Date of birth*

Email address contact*

This email address must be person-related and can only be used once in our application system. All correspondence concerning your applications will be sent to this email address. Your email address will be your login name. If you already have an account as an individual, or on behalf of another organization you can choose to also use this account for your applications, or a second account can be issued using a different email address.

Telephone number contact*

Upload document(s)

In this section we ask you to upload a recent extract of the registration of your organization with the Chamber of Commerce, or a similar register in your country. This extract must be recent and up-to-date (no older than one year). If this is not possible, we would need an alternative official document stating your legal status. We also need proof of your authority to sign, or power of attorney. If the above mentioned extract, or official document does not state you as an authorized signatory, we ask you to upload (an) additional document(s) to verify your signing authority. The required document(s) can be uploaded as .pdf, .doc, or .jpg with a total maximum of 5MB.

Please upload the required documents*

Drop files here or

Have you ever submitted an online application on behalf of this organization to the Mondriaan Fund before?*

Yes
No

Note

Signature*

I hereby declare that I am authorised to sign

* Mandatory fields

We aim to process your request within 24 hours. However, before deadlines we cannot always guarantee this.