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Fathima Fowzia Foundation

This is a Government of India registered non-profit organisation. (DARPAN ID: TS/2025/0766747). Visit Our Website

Beneficiary Details | Consent & Agreement Form

(All the personal information we collect will be stored safe)

Personal Details

Full Name (முழுப் பெயர்)

Gender (பாலினம்)

Date of Birth (பிறந்த தேதி)

Address (முகவரி) (Please write in full)

Phone No (தொலைபேசி எண்)

Email ID (மின்னஞ்சல் ஐடி)

Relationship to the beneficiary

ID Submitted

(Submit a copy of anyone of the ID)

Purpose (நோக்கம்) (in brief)

PAN Card No. (பான் கார்டு எண்) (For Tax Purpose)

Amount Requested

Which Support Vertical Are You Applying Under

Add Supporting Documents Under Relevant Section

[Multi files upload allowed]

Education (கல்வி)

School or College ID; Fee Structure Details; Fee Due Details

Healthcare (சுகாதாரம்)

Hospital Admission Records; Medical Bills & Prescription; Hospital Estimate & Medical Reports

Livelihood (வாழ்வாதாரம்) or Ongoing Charity (தொடர் தொண்டு)

Project Costs, Bills, Invoices, or Quotations

Payment Details (கட்டண விவரங்கள்) (Direct to Service Provider)

To keep things transparent, the Foundation pays the hospital, school, or vendor directly — not into your personal account. Please share their official payment details below.

Service provider type

Service provider full registered name

Service provider person name (if known)

Service provider contact person (if known)

Bank account holder name (வங்கி கணக்கு வைத்திருப்பவரின் பெயர்)

Bank Name (வங்கி பெயர்)

Bank Branch (வங்கி கிளை)

Bank Account Number (வங்கி கணக்கு எண்)

IFSC Code (IFSC குறியீடு)

UPI ID (UPI ஐடி)

Terms I Understand and Agree To

By signing this form, I confirm that I have read, understood, and accepted the following:

Truthfulness. All information and documents I have shared with the Foundation are true, accurate, and complete to the best of my knowledge. If anything is found to be false or misleading, the Foundation may immediately cancel my application and any funds raised in my name.

No Money or Commission. I testify that neither the Foundation nor any of its founders, volunteers, or representatives has asked me for, and I have not paid or promised, any money, fee, commission, gift, or favour at any stage — whether for listing my case, sharing my story, raising funds for me, or receiving any help under the Foundation's programmes. The Foundation's help to me is purely charitable and entirely free of cost.

Consent to Share My Story Publicly. I give the Foundation full permission to share my name, photograph, story, situation, and supporting documents publicly to raise funds for me. This includes posting on WhatsApp, Instagram, Facebook, the Foundation's website, and any other platform the Foundation chooses. The Foundation may edit my story for clarity without changing its meaning.

Documents I Will Submit. I will provide clear copies of: (a) a valid government-issued ID; (b) documents proving my situation — such as medical reports and hospital estimates, school/college fee structure, livelihood project details, etc.; and (c) any other reasonable proof the Foundation may ask for.

Direct Payment to the Service Provider. I understand that, wherever possible, the Foundation will pay funds directly to the hospital, school, vendor, or service provider — and not transfer cash to me. I will share complete and correct payment details (hospital/institution name, account number, IFSC, GST/registration if any, and the official bill or estimate) for this purpose.

Use of Funds. Funds raised in my name will be used only for the specific purpose stated in my application. I will not divert these funds for any other use.

No Guarantee of Amount Raised. The Foundation does not promise or guarantee that the full amount I have requested will be raised. The Foundation will make sincere efforts; the final amount depends on donor response.

Excess or Unused Funds. If the funds raised are more than what is needed, or if my situation changes (for example, the patient recovers, the admission falls through, or the treatment is no longer required), I agree that the excess or unused amount will remain with the Foundation and be used for other deserving cases under similar programmes.

Updates and Cooperation. I will keep the Foundation informed about my situation and will share updates, photographs, or short videos when reasonably requested, so the Foundation can update its donors on the progress.

Privacy of Sensitive Information. While my story will be shared publicly, the Foundation will use reasonable judgement to protect highly sensitive details — such as full bank account numbers, complete ID numbers, and any specific details that could put me at risk — from public posts.

Withdrawal. I may withdraw my application at any time before funds are disbursed by writing to the Foundation. Once funds have been disbursed to the service provider, withdrawal is not possible.

No Employment or Legal Relationship. This agreement does not create any employment, partnership, or legal claim between me and the Foundation. The Foundation is helping me purely as a charitable initiative.

Liability. I will not hold the Foundation, its founders, volunteers, or donors responsible for any delay, shortfall, or any consequence arising out of the fundraising or disbursement process.

Acceptance. I have read all the points above (or had them clearly explained to me in a language I understand), and I accept them fully and willingly.
(If you submit, you agree with the Terms mentioned above)