Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697800306813.pdf (Dominica)
GOVERNMENT OF THE COMMONWEALTH OF DOMINICA APPLICATION FOR INCLUSION IN THE LIST OF APPROVED CHARITABLE ORGANIZATIONS Submit Application to: Permanent Secretary Ministry of Governance 3rd Floor, Government Headquarters Kennedy Avenue, Roseau, Dominica Email: pssecgovernance@dominica.gov.dm This information is being collected to determine the suitability of charities and associated persons for inclusion as an Approved Charitable Organization.
Submit the completed application form along with all required documents to the address or email provided above.

Please note that incomplete applications will not be processed.

For further information or inquiries please call (767) 266-4193.
Name of Organization: Physical Address of Organization: Mailing Address of Organization (If different than physical address): Phone Number: Email Address: URL (Website) of the Organization: Non-profit Registration Number: Tax Registration Number: Name of Person Submitting the Application: Phone Number: Email Address: Which of the following categories of charitable purposes best describe those of your organization?

Tick all that apply.
o Disaster Risk Management and Post Disaster Support o The advancement of education, indigenous people, religion, health, community development, arts, culture, science, sports, human rights, animal welfare, environmental protection o Provision of housing and other social welfare services o The support of those in need because of youth, advanced age, ill-health, disability, financial hardship, or another disadvantage o The support of the Dominica National Resilience Development Strategy 2030 (NRDS), the Dominica Digital Transformation Strategy, the Climate Resilience and Recovery Plan (CRRP), and the United Nations Sustainable Development Goals (SDGs) o The advancement of any other purpose that may reasonably qualify as determined by Cabinet Application Form – ACO 1 Please identify the primary objectives of your organization, and its main beneficiaries.
Please identify the nature of any fundraising activities, projects, and programs that the organization intends to engage in.

Please explain how the organization’s objectives and aims are of benefit to the public.

State reason for seeking charitable status.
Application Form – ACO 2 LIST ALL BOARD OF DIRECTORS OF THE ORGANIZATION Official Title: Name: Address: Contact Information: Phone: Email: Official Title: Name: Address: Contact Information: Phone: Email: Official Title Name: Address: Contact Information: Phone: Email: Official Title: Name: Address: Contact Information: Phone: Email: Official Title: Name: Address: Contact Information: Phone: Email: LIST ALL MAJOR DONORS AND COUNTRY OF ORIGIN Name of Donor: Country of Origin: Name of Donor: Country of Origin: Name of Donor: Country of Origin: Name of Donor: Country of Origin: Application Form – ACO 3 We, being two trustees of the applicant charity, hereby certify that the particulars contained in this application for registration are true and correct to the best of our knowledge and belief.
_____________________________________________________ Signature _________________________ Date _____________________________________________________ Print Name _____________________________________________________ Title in Organization _____________________________________________________ Signature _________________________ Date _____________________________________________________ Print Name _____________________________________________________ Title in Organization Application Form – ACO 4 SUBMIT THE FOLLOWING REQUIRED DOCUMENTS (Please select the documents submitted) o Certificate of Registration / Certificate of Incorporation o Articles of Association that that specifies the regulations for the organization’s operations and defines the organization’s purpose to include tasks that are to be accomplished within the organization and the handling of financial records o Prior year’s Financial Statement or current financials to include all donations received and related expenditure o A list of imported items for which tax exemption will be needed o A letter of endorsement or recommendation from an affiliated institution or organization that can attest to the information provided, where applicable.
o Resolution of the Board approving the request for inclusion in the list of Charitable Organisations o Declaration of source of funding o Recent Police Record of Directors FOR OFFICIAL USE Date Application was received by the Ministry of Governance ______/______/______ Date last Charitable Status was approved (FOR RENEWAL) ______/______/______ Processed By: _____________________________________________ Form Completed: Yes Approval Granted: Yes If no, reason: No No Documents submitted: Yes No ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Application Form – ACO 5