Are you applying for yourself * YesNo
Your Name *
Date of Birth *
Gender * MaleFemale
Address Line 1 *
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Country * Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo The Democratic Republic Of TheCook IslandsCosta RicaCote D'Ivoire (Ivory Coast)Croatia (Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFiji IslandsFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambia TheGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernsey and AlderneyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong Kong S.A.R.HungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau S.A.R.MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMan (Isle of)Marshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands AntillesNetherlands TheNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory OccupiedPanamaPapua new GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent And The GrenadinesSaint-BarthelemySaint-Martin (French part)SamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth SudanSpainSri LankaSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaVietnamVirgin Islands (British)Virgin Islands (US)Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwe
State/Province/Region * Select State
City * Select City
Postal / Zip Code *
Phone Number with dialing code *
Email *
Marital Status *
Number of Dependants * ----please select anyone----123456789
Educational Qualification *
Training, if any
Skills *
Occupation
If unemployed, provide reason for unemployment
Employment history with dates and description of employment From Date To Date
Name
Email
Phone Number
Upload Educational Certificates
Upload training certificates
Upload skills certificates
Number of family members* —Please choose an option—----please select anyone-----123456789 Please specify -
Document Upload (Upload ration card or other proof of family)*
Document Upload (Upload educational certificates of family members)
Monthly income of person in need*
Assets of person in need* Source of income*
Upload bank statement of past 3 months
Upload pay slips for last 3 months
Upload proof of other income
Upload proof of assets (If you don't own any assets, attach self-attested affidavit)*
Monthly Income of family*
Name of the income earner and relation with person in need*
Assets of family*
Choose one of the options below to describe the help needed Legal Representation for Civil and Human Rights Advocacy Education Employment Medical Help Other financial help, specify
Explain how and why the person in need of help is destitute and desperate *
Has a request for help been made to any other person or organization? * YesNo
If funds are requested, provide full details of amount needed and how funds will be spent
Documents Upload: Upload any documents to show the funds needed and how they will be spent If you are requesting a loan, amount of loan needed
Please specify how and when loan will be repaid
Please provide details of persons/referee who could support your claim below, if any *
Name Address Mobile Number
How will you serve the community when you are able to? *
Passport size photo *
Signature *
I agree I hereby waive UNITED SIKHS, its staff and volunteers and its agents, partners or associates from any liability of injury, loss or damage in all circumstances that may arise from the support I have requested above. I acknowledge that I understand the waiver described in this document. This waiver is made to the maximum extent permissible under applicable law. I acknowledge that I have signed this document under my own free will. I affirm that the information I provide is true and accurate to the best of my knowledge.
Note: UNITED SIKHS is a non-profit organization and relies on public donations to fund our projects. While we make every effort to respond to all requests for help, it is not always possible to meet all expectations.
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