NGO registration form

Please complete the following questions by selecting the answer(s) of your choice or writing in the space provided.

Name of Organisation*
Year of Establishment*
Year of Establishment*
Year of Establishment
Please enter a number greater than or equal to 1900.
Is it an Umbrella Organisation?*
(Tick the appropriate option) *If yes, kindly furnish your record electronically to FMOH
- Yes
- No
Year of Registration with CAC*
Registration Number*
Kindly Attach a Photocopy of your Certificate*
Is your Organisation for Profit or Non-Profit?*
- Profit
- Non-Profit
Full Postal Address of Organisation*
Email*
Telephone*
Fax*
Name of Contact Person*
First Name Last Name
Full Address of Contact Person*
Email of Contact Person*
Position of Contact Person*
Telephone/Fax of Contact Person*

Focus of the Organisation's Programmes in Health*

Banks and their full Addresses*

Other Assets (e.g. Building, landed property, shares etc.)*

Local Affiliation*

International Affiliation*

Past Projects in the last FIVE years
Drop files here or
Is your Organisation Networking with Others?*
(Tick the appropriate option)
- Yes
- No

If Yes, list the Organisation(s)*

Past Publications/Reports of your Organisation
(Kindly attach TWO samples)
Drop files here or
Regular Resource Persons to your Organisation
(Persons whose skills are utilised regularly by your organisation. Please forward their abridged CV duly signed not more than THREE pages containing the following: names, full address, qualifications, experience, and not more than TEN recent publications/reports)
Curriculum Vitae
Drop files here or

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Health Partners & Data Inventory