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SUPPORT FORM

Your Details

Salutation

Surname

First Name

National Identification Number

Required for automatic tax benefit in Belgium

Group / Company / Organisation

Country

Street Name and Number

Province / Municipality

Postal Code

City

Phone Number

Mobile Phone

Email address

Donation Details

Choose how you want to support Born in Africa

Sponsor a child and become a godparent

Sponsor a Dream In Africa and give a child more confidence by making their dream come true

Born in Africa Study Bursary (direct support to high school and tertiary students)

Support our Homework Centres

Support Born in Africa in a fun way by organizing your own fundraiser

Support us with your business in line with your CSR policy

Make an independent donation

Number of children (please select an option)

Gender (please select an option)

I wish to pay the 300 EUR in the following manner:

Yearly

Quarterly. Every 3 months I deposit 75 EUR

Monthly. I give my financial institution an order to deposit €25 on a monthly basis

For 100% tax benefit for citizens of The Netherlands through ANBI; Monthly deposit of €25 through my financial institution and I hereby agree to a commitment to BIA for at least 5 years.

UK citizens: donations to be paid into UK account (Account name: UK Supporters of Born in Africa, Plettenberg Bay, Account number: 83043541 Sort code: 20-29-90, Bank name: Barclays Bank)

Commitment Form (NL / BE only)

Sponsor a Dream in Africa Remarks

I will make a donation in the amount of

I will make a donation in the amount of

Study Bursary Remarks

Donation Amount (in Euro) for Homework Centres

Homework Centres Remarks

I will make a donation in the amount of

Independent Donation Remarks

I would like to organise the following

I would like to get involved with my company

Additional information

I was introduced to Born in Africa by

Additional Remarks

I'm a UK citizen and am aware my donation(s) should be paid into BIA's UK account: Account name: UK Supporters of Born in Africa, Plettenberg Bay Account number: 83043541 Sort code: 20-29-90, Bank name: Barclays Bank

Bank name: ING Bank Account nr.: BE38 3632 2998 0572 BIC code: BBRUBEBB

NL: ANBI-RSNI fiscaal nummer: 8255 04 648

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UK Bank Details

Account number: 83043541

Sort code: 20-29-90

Bank name: Barclays Bank

Account name: UK Supporters of Born in Africa, Plettenberg Bay

BIA is a registered UK Charity number 1169743

South African Bank Details

BIA RSA 2003/004484/08

Born in Africa
2 Virginia Street, Plettenberg Bay 6600

Account nr. 62049291298
Bank code: 210514
SWIFT code: FIRNZAJJ
Bank name: First National Bank
Bank address: PO Box 132, Plettenberg Bay
Mainstreet, Plettenberg Bay
South Africa

Bankgegevens in België

Belgian Bank Details

BIA VZW KBO 0479.842.073
RPR Brussel

Born in Africa
Robert Dalechamplaan 4
1200 Brussels, Belgium

Bank name: ING Bank
Account nr.: BE38 3632 2998 0572
BIC code: BBRUBEBB
ANBI-RSNI fiscaal nummer: 8255 04 648

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