Donation Matching Gifts Form

DONATION MATCHING GIFTS FORM

RECITALS (WHEREAS)

WHEREAS, the Employer named below maintains a charitable contribution matching program for eligible employees and agrees to consider matching qualified charitable donations made by employees; and

WHEREAS, Employee: has made a voluntary donation to the charitable organization identified below and seeks Employer matching in accordance with Employer policy; and

WHEREAS, Employer: agrees to evaluate and, if eligible, disburse matching funds as set forth in this Agreement and the Employer's matching policy.

DONATION DETAILS (TO BE COMPLETED BY EMPLOYEE)

Donation Date:    Donation Amount: $

Donation Type: Cash Securities In-kind

SCOPE OF MATCHING OBLIGATIONS

Employer will evaluate the request for matching funds for the donation described above and, if eligible under Employer policy and this Agreement, will remit a match in the manner and amount set forth below. The obligation to match is conditioned upon Employee's compliance with Employer procedures, submission of required documentation, and charity verification.

PAYMENT TERMS

Matching Amount Requested: $

Employer shall make reasonable efforts to disburse eligible matching funds within the schedule stated above following receipt of charity verification and any required internal approvals. Employer may withhold payment if documentation is incomplete or if the donation does not meet eligibility criteria.

TERM AND TERMINATION

Program Start Date:    Program End Date:

Either party may terminate the Employer's obligation to match with written notice delivered at least days prior to the effective termination date. Termination does not affect Employer's obligation to process matches for donations already submitted and verified prior to the effective date of termination, except where otherwise prohibited by law or policy.

CONFIDENTIALITY

The parties agree that any personally identifiable donor information, tax identification numbers, and financial details provided in connection with this form will be used solely to evaluate and process the matching gift and will be maintained in accordance with Employer's confidentiality practices. Neither party will disclose such information except as required by law or as necessary to administer the matching process.

GOVERNING LAW

This Agreement and any dispute arising out of or relating to the matching of the donation shall be governed by the laws of the state of without regard to conflict of law principles.

ENTIRE AGREEMENT

This document, together with any employer matching policy expressly incorporated herein, constitutes the entire agreement between Employee and Employer with respect to the subject matter hereof and supersedes all prior understandings and agreements, whether written or oral. Any amendment must be in writing and signed by an authorized representative of Employer and Employee.

CHARITY VERIFICATION (TO BE COMPLETED BY THE CHARITABLE ORGANIZATION)

I certify that the donation described above was received by the charitable organization named below in the stated amount and on the date indicated.

Date of Charity Verification:    Contact Phone:

EMPLOYEE CERTIFICATION

By checking the box below and signing, I certify under penalty of perjury that the information provided is true and that I personally donated the amount claimed. I acknowledge that knowingly providing false information may result in disciplinary action and repayment of any improperly issued matching funds.

I certify that the donation described above was made by me and is eligible for matching under Employer policy.

Receipt or written confirmation from charity is attached.

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