Research Agreement

Date *

This is the Research Agreement between the Health Research Foundation - Hawke's Bay Inc ('Foundation') and ('Recipient'): *

Address: *

Mobile phone: *

Email *

Amount approved in NZ$ (GST inclusive): ('Grant') *

Research Project: *

Research Purpose: *

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Commencement Date: *

Completion Date: *

Milestones & Amounts (if any): *

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Expected date of report(s) to be received by the foundation (see page 4 item 5.5.1(a)):

(Reports can now be completed on our website)

Date *

The foundation agrees to make the Grant and the Recipient agrees to receive the Grant on the terms and conditions of the Research Agreement.

Signed for and on behalf of the 'Foundation': (leave this blank for our committee to complete)

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Signature

Date

Signed by Recipient:

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Signature *

Date *

For Direct Credit details, please supply your bank account number as well as evidence of your bank details (such as a bank statement):

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Your creditcard number:

Upload your bank statement here:

Click or drag a file to this area to upload.

By signing this form, you agree to the Terms and Conditions for our Research Agreements. Make sure to familiarise yourself with its contents: