Beneficiary Form – Project Ark

07063711409

All for one, One for all.

Request relief items from Project Ark.

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Name

First

Last

Email address*

Telephone Number*

I am registering as

Let's get to know you

What are the items you need?*

Family's Name*

Address*

Environs*

Nearest bus-stop/landmark*

Receiver's name*

Let's get to know you

What are the items you need?*

Are you citizen of Nigeria?*

Nearest bus-stop/landmark*

Average income per month*

Where can we find you?*

Environs*

Let's get to know you

Family size*

I am the bread winner*

where do you work?*

Average income per month*

What are the items you need?*

Address*

Environs*

Nearest bus-stop/landmark*

Can items be delivered to this address?*

Delivery Address*

Receiver's name*

Let's get to know you

Ward*

What are the items you need?

Would you like us to serve cooked food?*

What are the safety measures you have?*

Schedule a day*

Address*

Nearest bus-stop/landmark*

Let's get to know you

Environs*

What are the items you need?*

Would you like us to serve cooked food?*

What are the safety measures you have?*

Schedule a day*

Address*

Nearest bus-stop/landmark*

This field should be left blank

Join 325 people donating for COVID-19 Response Campaign

Going beyond giving handouts to encouraging a united effort towards solving the challenges we face as a people.

In partnership with Lagos State Government

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