Form B2: Donor Intent Form (Organization)
Please complete this form if your organization interested in becoming a donor for COVID-19 response. Personal information submitted will be used only for communication and monitoring purposes. Rest assured that it will be treated with utmost confidentiality.

In compliance with Administrative Order No. 27, s. 2020, we strongly encourage donors of medicines, medical equipment and supplies, and other health products to address COVID-19, whether given to the National Government as a whole or to the Department of Health (DOH) to inform the Office of Civil Defense (OCD) directly for inventory purposes and to help the Government ensure equitable allocation and distribution of assistance.

(Maaaring sagutan ang form na ito kung ang inyong organisasyon ay interesadong maging donor para sa COVID-19 response. Makakasiguro ka na iingatan at gagamitin lamang namin ang iyong personal na impormasyon para sa pakikipag-ugnayan at monitoring.

Bilang pagsunod sa Administrative Order No. 27, s. 2020, hinihikayat namin ang mga nagbigay ng donasyong gamot, kagamitang medikal, at iba pang produktong pangkalusugan para sa pagtugon sa COVID-19 sa national government o Department of Health na ipagbigay alam sa Office of Civil Defense (OCD) para maitala at masiguro ang tamang alokasyon at distribusyon.)
GENERAL INSTRUCTIONS
Please answer N/A if the question is not applicable. If you would like to provide additional information which cannot be captured by the questions, please include these under the " Additional Information" which can be found near the end of this form.

(Maaaring sumagot ng "N/A" kung hindi naaangkop ang tanong. Kung nais mong magbigay ng karagdagang impormasyon na hindi saklaw ng tanong sa bahaging ito, maari mong ilagay ang mga ito sa " Karagdagang Impormasyon" na matatagpuan malapit sa dulo ng form na ito.)
Profile of the Organization
Name of Organization *
Complete Address (House No., Street, Subdivision, Barangay, City/Municipality, Province)
Block and Lot No./ Floor and Building No. *
Street/Subdivision *
Barangay *
City/Municipality *
Province (If the organization is based in NCR, please answer N/A)
Region *
Classification (Klase ng Organisasyon) *
If others, please specify...
Government Agency where your organization is registered/accredited (Ahensya ng pamahalaan kung saan rehistrado ang inyong organisasyon)
If others, please specify... (Kung iba pa, tukuyin)
Year Established *
Head of Organization *
Focal Person/Coordinator *
E-mail address *
Mobile/Telephone No. *
Website
Facebook page URL , if any
Other social media accounts, please provide organization’s username
Type of Donation
I want to donate *
Required
If goods, please specify...
If money, please specify how much...
Source/s of Funds for the Donation
If others, please specify...(Kung iba pa, tukuyin...)
Direct Recipient of Donation (Organisayon/Grupo kung saan nagbigay ng donasyon o serbisyo) *
Required
Please specify the name of the individual/organization which is chosen as direct recipient. (Tukuyin ang pangalan ng indibidwal o organisasyon na piniling pagbigyan ng donasyon) *
In case your target recipient institution does not like to accept donations, is your organization willing to be referred to other institutions? (Kung ang institusyon na gustong pagbigyan ay hindi nais tumanggap ng donasyon, ang iyo bang organisasyon ay bukas na magbigay sa ibang imumungkahi na institusyon?) *
Additional Information regarding your donation (Karagdagang impormasyon tungkol sa donasyon)
Thank you for answering this form.
Later on, we will ask you to accomplish a report form where you can provide information on the donation you have given.
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