Winter COVID Grant Acceptance

This is an agreement between UNITED in Hammersmith & Fulham and

Key Contact Name and Address for your Organisation

For the grant amount of

For the Winter Covid Response Grant activity of

I understand this grant may only be used for the activity any changes must be discussed and agreed in writing with the United in Hammersmith & Fulham Grant Officer.

I understand that if UNITED in Hammersmith & Fulham discovers that false information has been supplied, it reserves the right to reclaim or cancel the grant.

I understand that UNITED in Hammersmith & Fulham will contact me to ask about the impact of this grant.

I understand that my organisation must acknowledge UNITED in Hammersmith & Fulham funding such as tagging on social media, and, where appropriate, use the logo (available on request) on any print or website public communications. This includes sharing any positive media with UNITED in Hammersmith & Fulham.

I understand that by accepting this grant, our organisation must not do anything which might bring UNITED in Hammersmith & Fulham into disrepute, and that UNITED in Hammersmith & Fulham reserves the right to reclaim or cancel a grant in such circumstamces.

Name and Address of Bank

Account Name

Account Number

Sort Code

Signed( Full Name)

Contact Telephone (in case of queries only)

I confirm I am authorised person at the organisation to sign and submit