๺᱌ጊධࡠ࡯࠲࡝㧙ࠢ࡜ࡉ㧞㧜㧝㧜㧙㧞㧜㧝㧝ᐕᐲႎ๔ᦠ
੹࿁࿾඙ߩ WCS ࡈࠔࡦ࠼ߩᡰេࠍ㗂߈࿾඙㧡㧟㧠㧜㧜㧜౞‫ޔ‬๺᱌ጊධࡠ࡯࠲࡝࡯㧡㧟㧠㧜㧜㧜౞ࠍ಴ߒ߹ߒߡᆌᆂࠢ࡜ࡉߢ޽ࠆ㖧࿖㧟㧟㧢㧜࿾඙ᣂᷣᎺ RC ߣ౒ߦᣂᷣᎺ RC ߩᆌᆂࠢ࡜ࡉߢ޽ࠆ࠲ࠗ㧟㧟㧡㧜࿾඙ࡃࡦ࡜࠶ࠢ RC ਥ௅ߩᡰេ੐ᬺߦදജߒߚ‫ޕ‬㧝ߟߪࡃࡦ࡜ࠗ∛㒮߳ߩ⿥㖸ᵄ⸻ᢿⵝ⟎㧔ࠛࠦ࡯㧕ߩነ⿅‫߁߽ޔ‬㧝ߟߪࡃࡦࡐ࠙∛㒮߳ߩ
⒖േᑼ⊕ౝ㓚ᚻⴚⵝ⟎ߩᡰេߢ޽ߞߚ‫ޕ‬㧝㧝᦬㧞㧟㧙㧞㧣ᣣߦ๺᱌ጊධ RC㧢ฬ‫ޔ‬ᣂᷣᎺ RC18 ฬ߇ෳടߒߡวᵹߒߡ⺞ශᑼߦ⥃ࠎߛ‫ޕ‬㧞㧡ᣣߦࡃࡦ࡜࠶ࠢ RC ߩ଀ળߦ಴Ꮸ‫ߩߘޔ‬ᓟゞߢ㧟㧚㧡ᤨ㑆⿛ࠅ‫ޔ‬ㅜਛ⼊ኤゞਔߩవዉߩ߽ߣࡃࡦ࡜ࠗ∛㒮ߦ೔⌕‫ޔ‬Ꮢ㐳‫ޔ‬㒮㐳‫ޔ‬㧟㧟㧡㧜࿾඙ࡃࡦ࡜ࠗ RC ߩ߅ㄫ߃ߩ߽ߣ⺞ශᑼౖࠍⴕߞߚ‫࠻ࡦ࡜ࠣࠣࡦ࠴࠶ࡑޕ‬੐ᬺߣߒߡ㧣㧜㧜㧜㧜㧜ࡃ࡯࠷ߩ⿥㖸ᵄ⸻ᢿⵝ⟎ߩነ⿅‫⺞ޔ‬ශᑼࠍⴕߞߚ‫ࠗ࡜ࡦࡃޕ‬࿾ၞߩᄢㇱಽߩੱ߇೑↪ߔࠆࡃࡦ࡜ࠗ∛㒮ߦߪ㧝บߩᯏ᪾ߒ߆ߥߊ‫ޔ‬࿖ߦ↳⺧ߒߡ߽㧝㧜ᐕએ਄߆߆ࠆߣߩ੐ߢࡃࡦ࡜ࠗ RC ߇⓹ญߦߥࠅࡃࡦ࡜࠶ࠢ
RC ߦᡰេࠍⷐ⺧ߒߚ‫ޕ‬㧝ࡩ᦬ߦ㧠㧜ฬ߇∛㒮ߢ಴↥ߔࠆߣߩ੐ߢ‫ޔ‬ᣂߒ޿ᯏ᪾ࠍᇚੱ⑼ߢ
૶↪ߒ಴↥ߔࠆᲣⷫߦᷓೞߥ໧㗴߇޽ࠆ႐ว‫ޔ‬ᣂ↢ఽߩ๮ࠍᢇ޿‫ޔ‬಴↥೨ߩ⢝ఽߩ⁁ᴫࠍ⷗ࠆߎߣ߇ߢ߈ࠆߣᄢᄌ༑ࠎߢ߹ߒߚ‫ޕ‬๺᱌ጊධ RC ߣߒߡ‫ޔ‬࿾඙ WCS ࡈࠔࡦ࠼ࠍᵴ↪ߒߡೋ߼ߡ࠲ࠗ࿖ߩ࿾ၞක≮ߦ⽸₂ߢ߈ࠆߎߣߦᗵ⻢ߒ߹ߔ‫ޕ‬ߎߩ੐ᬺߩౝኈߪ๺᱌ጊධ RC ߇ࠠࡖ࠶ࠪࡘ㧢㧜㧜㧜࠼࡞ߣ࿾඙ WCS ࡈࠔࡦ࠼㧢㧜㧜㧜࠼࡞ว⸘㧝㧞㧜㧜㧜࠼࡞‫ ࠢ࠶࡜ࡦࡃޔ‬RC ߇ࠠࡖ࠶ࠪࡘ㧟㧡㧜࠼࡞ߣ࿾඙ DDF㧝㧝㧜㧜࠼࡞‫ޔ‬࿾రߩࡃࡦ࡟ࠗ RC ߇ࠠࡖ࠶ࠪࡘ㧟㧡㧜࠼࡞‫ޔ‬ᣂᷣᎺ RC ߇ࠕ࠙࠻ࠨࠗ࠼ߣߒߡ㧝㧜㧜㧜࠼࡞‫ߡߒߣ࠻ࠢࠚࠫࡠࡊࠣࡦ࠴࠶ࡑޔ‬㧣㧞㧤㧠࠼࡞ ว⸘㧞㧝㧤㧟㧠࠼࡞㧔㧣㧜㧜㧜㧜㧜࠲ࠗࡃ࡯࠷㧕ߢⴕ߁߽ߩߢ޽ࠆ‫ޕ‬ࡑ࠶࠴ࡦࠣࠣ࡜ࡦ࠻ߩ↳⺧ߪࡃࡦ࡜࠶ࠢ RC ߩరળ㐳ߢ࿾඙ࡠ࡯࠲࡝࡯⽷࿅ᆔຬ㐳߇৻᜝↳⺧ࠍߒߚ‫ޕ‬෶㧞㧢ᣣߦᣂᷣᎺ RC ߇ਥ૕ߣߥࠆ੐ᬺߦ‫ޔ‬๺᱌ጊධ RC ߦࠕ࠙࠻ࠨࠗ࠼ነઃ㧝㧜㧜㧜࠼࡞ߩⷐ⺧߇޽ࠅᒁ߈ฃߌ⺞ශᑼߦ಴Ꮸߒߚ‫ࠄ߆ࠢࠦࡦࡃޕ‬㧝ᤨ㑆ゞߢ⿛ࠅ‫∛࠙ࡐࡦࡃޔ‬㒮ߦⴕߊ‫ߪߎߎޕ‬ᣂᷣᎺ RC,ࡃࡦࡐ࠙ RC ߣࡃࡦ࡜࠶ࠢ RC‫ޔ‬๺᱌ጊධ RC ߢ✚㗵㧝㧞㧡㧜㧜㧜㧜ࡃ࡯࠷ߩ⒖േᑼ⊕ౝ㓚ᚻⴚⵝ⟎ࠍነ⿅ߩ⺞ශࠍߒߚ‫∛ޕ‬㒮ߪㄭઍ⊛ߢ⌒⑼ኾ↪ߩᄢ߈ߥᣉ⸳߇޽ࠅ‫ޔ‬ᄙߊߩᖚ⠪߇⸻ኤࠍฃߌߡ޿ߚ‫⽺ޕ‬࿎ߢ∛㒮ߦ߽ⴕߌߥ޿ੱߦ⒖േක≮ᣉ⸳ߢ⊕ౝ㓚ߩᚻⴚࠍⴕ߁ߣߩ੐ߢ޽ࠆ‫ޕ‬๺᱌ጊධ RC50 ๟ᐕ‫ޔ‬ᣂᷣᎺ RC㧟㧜๟ᐕߩ⸥ᔨ੐ᬺߣߒߡ‫ߩ⪲⸒ޔ‬ოࠍਸ਼ࠅ⿧߃㧟࿖㑆ߢ࠲ࠗߢߪߓ߼ߡߩᡰេ‫࠻ࡦ࡜ࠣࠣࡦ࠴࠶ࡑޔ‬੐ᬺࠍⴕ߁ߎߣ߇಴᧪ߚ߇‫ޔ‬ᣂᷣᎺ RC ߇ਛߦ౉ࠅ‫ ࠢ࠶࡜ࡦࡃޔ‬RC ߩળ㐳‫ޔ‬࿖㓙ᄺ઀ᆔຬ㐳‫ޔ‬࿾඙ࡠ࡯࠲࡝࡯⽷࿅ᆔຬ㐳ߩరળ㐳߇߹ߣ߼ߡ޿ߚߛ޿ߚ੐ᬺߢ޽ߞߚ‫ޕ‬๺᱌ጊධࡠ࡯࠲࡝࡯ࠢ࡜ࡉ                        ࿖㓙ᄺ઀ᆔຬ㐳 ධᣇᐽᴦ೎ᷝ౮⌀㧝㧚ࡃࡦ࡜࠶ࠢ RC ଀ળ ળ㐳᜿ᜦ㧞㧚          ධᣇળ㐳᜿ᜦ㧟㧚ࡃ࠽࡯‫࠻ࡦ࠯࡟ࡊޔ‬੤឵㧠㧚ࡃࡦ࡜ࠗ∛㒮ߢߩ᱑ㄫ㧡.಴Ꮸࡔࡦࡃ࡯㧢㧚᱑ㄫ᐀㧣㧚⿥㖸ᵄⵝ⟎ߩ౮⌀              㧤㧚Ꮢ㐳ߩ᜿ᜦ㧥㧚ධᣇળ㐳᜿ᜦ                㧝㧜㧚ᣂᷣᎺ RC ળ㐳᜿ᜦ㧝㧝㧚ࡃࡦ࡜࠶ࠢ RC ળ㐳᜿ᜦ          㧝㧞㧚ࡃࡦ࡜ࠗ∛㒮㐳᜿ᜦ㧝㧟㧚⺞ශᑼߩᮨ᭽                㧝㧠㧚∛㒮㐳ࠃࠅߩࡊ࡟࠯ࡦ࠻㧝㧡㧚⺞ශᦠ                   㧝㧢㧚ࡃࡦࡐ࠙∛㒮ߢߩ⺞ශᑼ㧝㧣㧚ධᣇળ㐳ߩ᜿ᜦ              㧝㧤㧚ࡃࡦࡐ࠙ RC ળ㐳ߣࡃ࠽࡯੤឵㧝㧥㧚ᱜ㕙₵㑐                   㧞㧜㧚⌒⑼ࠦ࡯࠽࡯

㧞㧝㧚⸻ኤቶ                    㧞㧞.⒖േ⸻ኤゞ㧞㧟.⺞ශᦠPROJECT BUDGET
Explanation: For detailed information on what TRF funds, please see The Guide to Matching Grants (144-EN). Official RI
exchange rates can be found at www.rotary.org. Please use the most recent rate. Please provide pro-forma invoices for budget
items over US$10,000 or when all budget items will be purchased from the same supplier.

Budget itemName of supplier

MINDRAY Digital Ultrasound Diagnostic Imaging

Supreme Products Co.,Ltd.

AmountSystem Model DP-9900Plus

Bht. 656,000.00

Subtotal
Exchange rate used
Total in U.S. dollars

Bht. 656,000.00

US$1=30.00
21,867.00

PROJECT FINANCING
Explanation: Clearly list all financing in U.S. dollars (please use whole dollars as TRF does not match cents) noting whichfunds will be contributed in cash and which will be contributed from District Designated Funds (DDF). Use of DDF must beauthorized by the district Rotary Foundation committee chair and the district governor. TRF matches US$0.50 for every $1 cash
contribution and $1 for every $1 contribution from DDF. The primary host club or district must provide at least $100 in either
DDF or cash.
NOTE: No funds should be sent to TRF prior to official Trustee approval. Upon approval, a letter will be sent to the sponsors
notifying them of approval and providing detailed instructions on how and where to submit their contributions.
Host Rotary clubs or
district inside theproject country(The primary host clubor district must provideat least US$100.)
RC Bangrak, D-3350District
Governor(Print Name)District
Governor
Authorization    

SuchadaIthijarukul                                                                                

International Rotary
clubs or district
outside the project
country

Cash (US$)

DDF(US$)DRFC Chair (PrintName)

DRFC Chair
Authorization

District
Governor(Print Name)District
Governor
Authorization

RC Wakayama South,12,000.00

                    

D-2640                                                                                                            

Subtotals, Cash andDDF

12,450.00

1,100.00

TOTAL cosponsor
contributions

13,550.00

Total funds requested
from TRF (must be atleast US$5,000)

7,325.00

Cash (US$)

DDF(US$)DRFC Chair (PrintName)

DRFC Chair
Authorization    

1,100.00

PrawitRojkajonnapalai

RC Banrai, D-3350

450.00                            Additional outsidefunding(not matched by, orforwarded to, TRF)
Please specify thesource of this funding.

(RC Shin Jeju,D-3660)

Total project
financing(must equal budget onpage 4)

21,875.00

1,000.00

HELPFUL HINTOne way to speed up the payment process for your Matching Grant is by financing your project solely with DDF. Submitting
cash contributions to the Foundation for a Matching Grant can significantly slow down the payment process and thecontributions will only receive a 50% match as opposed to a 100% match for DDF. Speak with your district leaders to see if
there is a way to utilize DDF as opposed to cash contributions for your application.