PANGIR

AN

BUDISERVICESDNBHD1041626M

AMERIC

AN

BARASSOCIATIO

N

SCPANGIR

AN

BUDISERVIC

ESRL

EUROPE

SIR

DRIR

FEROZBIN

MUSA************************RUESS BASSES LONGEMALLE 1204 GENEVA,SWITZERLAND,EUROPEAN UNION

MILITARYQUARTERS,JOHORE CASTLE,81200,JOHORE BHARU,JOHORE,MALAYSIA

TEL ; +60177430448 FAX : +1 (844) 487-6306

Date: 11 JUNE 2016

Funding Application Checklist

Funding Request Application you will need the following information and documentation:

1. Registration Information

1. Contact name, telephone and email address

2. Organization name and zip code

3. Organization tax identification number

2. Contact Information

1. Contact name, occupation, address, telephone number and email address

2. Contact type:

1. Administrator, Board Member, Development Staff, Executive Director, Grant Writer, Trustee

2. Organization Information

1. Organization name, address, telephone number and website address

1. Organization Background

1. Organization's mission statement

2. Brief overview of the organization and evidence of its impact

3. Names of the organization's Board of Directors and key staff

4. Qualifications of organization's Board of Directors and key staff

5. Organization's other major donors and dollar amount of contribution(s)

6. Non-discrimination Policy (if available)

1. Funding Request Summary

1. Project title, start and end dates

2. Program summary

3. Description of alignment with Amgen Foundation funding priority areas: Community Life, Science

Education

4. Ethnicity, age and gender of population served

5. Target population served

6. Primary state served

PANGIR

AN

BUDISERVICESDNBHD1041626M

AMERIC

AN

BARASSOCIATIO

N

SCPANGIR

AN

BUDISERVIC

ESRL

EUROPE

SIR

DRIR

FEROZBIN

MUSA************************RUESS BASSES LONGEMALLE 1204 GENEVA,SWITZERLAND,EUROPEAN UNION

MILITARYQUARTERS,JOHORE CASTLE,81200,JOHORE BHARU,JOHORE,MALAYSIA

TEL ; +60177430448 FAX : +1 (844) 487-6306

7. Program website (if applicable)

8. Number of beneficiaries

9. Request date

1. Project Details

1. Executive summary of grant application

2. Describe the problem or community need that the project addresses

3. Describe what other organizations are doing to address this problem and what makes your approach

unique

4. Provide a brief history of the project

5. Describe the current project objectives and how they will be met

6. Provide an analysis of the project's risks and limitations, including how these factors will be

addressed or minimized

7. Provide the project timeline

8. Explain how this project can be adapted and expanded to meet increased need. If so, explain how.

9. Explain how this project can serve as a model for other nonprofits working in this field. If so,

explain how.

10. What method(s) of communication will be used to support this project?

11. Please describe your communications plan

12. Volunteer opportunities

1. Project Budget

1. Requested amount

2. Total project budget

3. Fill out Brief Line Item Budget template

4. Type of support:

1.

1. Program Support, Operating Support, Planning/Evaluation, Research Support,

Capital Support, Endowment

5. List non-Amgen donors and supporters and amounts contributed to this specific project

6. Detailed project budget including a description of how the funds will be spent and how the request

amount was determined*

7. Total annual organizational operating budget

8. Organization's IRS 501(c)(3) tax designation letter*

9. Organization's 990 or 990-PF federal tax return*

PANGIR

AN

BUDISERVICESDNBHD1041626M

AMERIC

AN

BARASSOCIATIO

N

SCPANGIR

AN

BUDISERVIC

ESRL

EUROPE

SIR

DRIR

FEROZBIN

MUSA************************RUESS BASSES LONGEMALLE 1204 GENEVA,SWITZERLAND,EUROPEAN UNION

MILITARYQUARTERS,JOHORE CASTLE,81200,JOHORE BHARU,JOHORE,MALAYSIA

TEL ; +60177430448 FAX : +1 (844) 487-6306

10. Organization's current audited financial statement*

1. Grant Evaluation

1. If this project was previously funded by the Amgen Foundation, provide a brief report on the results

of the grant (i.e. amount of funding, what was accomplished, challenges encountered, and

corrective actions taken)

2. Explain how you define success for this project

3. Describe the project deliverables and expected outcomes for this project

4. Explain the assessment strategies that will be used to measure the project's success

5. Please describe the involvement of the stakeholders (e.g. Board members, target population,

community members)

6. Please provide a sustainability plan. What steps will your organization take to ensure the future

success of the proposed project beyond the completion of Amgen Foundation funding (i.e. future

financial support, staff requirements, continued community interest)?

7. Please Note:

An electronic copy of items marked with a * must be submitted online.

Organizations that do not file a tax return or do not have audited financials will have the opportunity to state such

on the grant application.

You will not be able to submit your request unless all items above are provided.

Faithfully and In Command,

SIR DR IR FEROZ

CHAIRMAN

PANGIRAN BUDI SERVICE SDN BHD CR.1041626 M (MALAYSIA)

SC PANGIRAN BUDI SERVICE SRLCR. RO 26431686/J22/77/22.01.2010 (EUROPE)

AL SHAMOOKH UNITED CR.4030181661 (SAUDI ARABIA)