Fohloza Foundation Support Form - Fohloza Foundation

1. Basic Information

Name *

Full Names *

Phone *

Email Address *

ID Number *

Attach Copy of ID *

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Provide proof of residence (Lease Agreement, Electricity Bill, or Bank Statement) *

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Street Address *

Apartment, suite, etc *

City *

State/Province *

ZIP / Postal Code *

Country *

Age *

Disability *YesNo

Alternative contact person

Name *

Full Names *

Phone *

Email Address *

Employment Details

Company Name *

Company Phone *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Country *

2. Questionnaire

2.1. Information of Minister of the Gospel

Name of Deceased Minister of the Gospel *

Date of Death *

Day

Month

Year

Date of Birth *

Day

Month

Year

Name of Church or Ministry where they ministered *

Years of ministry *

How are you related to the minister? *

Address of Church *

Please attach an affidavit as a supporting document *

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2.2. Information about Family

Please attach birth certificates or ID Copies of the children *

Ages *

Address of Residence *

Occupation of Children *

Name of Church or Ministry where they ministered *

Provide details of employment for children over 18 *

2.3 Family Wellness

Do you have a chronic illness, or do you stay with someone who has a chronic illness? *YesNo

Do you suffer from any addiction, or do you stay with someone who suffers from addiction? *YesNo

If yes, please elaborate.

Explain your financial situation, where do you think you need assistance most? *

Do you have children that need assistance with their school needs. i.e., Uniform or stationery? If yes, please specify the needs and provide details of the school. *

3. Reference

Name of Current Minister who knew the deceased Minister *

Contact details of current minister *

Provide any other proof

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