PROFORMA FOR HUMANITARIAN ASSISTANCE TO DPs NORTH WAZIRISTAN AGENCY

1. Full legal/ Registered Name of Organization & address

2. Focal Person, Contact & email:

3. Place of Registration
a. Social Welfare
Department
b. Economic Affairs
Division, Islamabad
c. Security and Exchange
Commission of Pakistan
4. Donor or source of Funding

5. Sector Interested
1. Agriculture 2. Livestock
3. Child Protection (Sub-cluster) 4. Community Restoration
5. Education 6. Food Security
7. Gender 8. Health
9. Nutrition 10. Protection
11. Assessment 12.Skill Development/Livelihood
13.Shelter & Non-Food Items 14.Wash
If any other specify:
6. Proposed Activities (If required use extra page)


7. Area of Intervention/District

8. Detail of HR for proposed activity (If required use extra page)
Name Designation Total Period of deployment CNIC# Contact

9. Logistic details For Organizational use only Can be made available to
Government directly
i. Funds
ii. Equipments etc
iii. Office
10. Others



Name: _______________
Designation: _______________