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									                                                       Virgin Active Donations Request
Club name if applicable:
Contact Person:
Organisations Name:
NGO (Company) Registration Number:
Date of Request:

Delivery / Site Address:

Postal Address:

Contact Number/s or e-mail address:
                                                                           Specify detailed list of requirements:

**For gym equipment donation, please specify size of area that will be utilised
                                                                      Motivation / Reason for request of Donation:

* Please note that should your request meet the criteria and be considered you may be placed on a waiting list.
* Donations are made at the sole discretion of Virgin Active SA.
* Donations are dependent on availability at the time.
* Equipment donations is dependent on a site inspection, prior to approval.
* Only registered organisations will be considered for donations.
* Should donations be approved a legally binding contract must be completed prior to delivery/collection.
* Arrangements for delivery must be coordinated by the organisation requesting the donation.
* Virgin Active reserves the right to conduct site inspections or request a feedback report post making donations to review sustainability of investment.
Full name of person receiving

Signature of person receiving

                                                                                   FOR OFFICE USE ONLY
VASA Criteria met:
Site inspection completed by:
Date of site inspection:
Date contract signed:
Equipment / donation delivered / collected by:
Date of equipment/donation delivery/collection:
Release Document signed:

Type of goods delivered or donation provided:

Rand value of donation provided:
* Please complete the Donations form in full and return via email to for CSI Managers attention.

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