Request for support of a Cross Operator SMS donation for beneficiary organizations recognized by the government

Please fill out all fields. The request form has to be signed by the beneficiary and send to the technical facilitators involved and/or ALL operators.

Info & contact details organization
Beneficiary: (only charity organizations recognized by the government are eligible for the support of an SMS donation campaign by operators)	Beneficiary organization: Click or tap here to enter text. E-mail address: Click or tap here to enter text. Tel: Click or tap here to enter text.
Name and first name of the official representative of the beneficiary as mentioned in the articles of association. Please add a copy of the articles of association:	Name: Click or tap here to enter text. First name: Click or tap here to enter text. E-mail address: Click or tap here to enter text. Tel: Click or tap here to enter text. Website: Click or tap here to enter text.
Bank account number of the beneficiary organization:	BE Click or tap here to enter text.
Applicant (other than the beneficiary): type of organization:	☐Media ☐Government ☐Charity ☐MNO
Details of the SMS processing technical facilitator:	Name: Click or tap here to enter text. E-mail address: Click or tap here to enter text. Tel:Click or tap here to enter text.
Administrative information about the charity
Only charity organizations recognized by the government are eligible for SMS donation by operators:	Specify the name mentioned in the list of officially recognized organizations published by the government Click or tap here to enter text.
Description of the action:	Click or tap here to enter text.
Companies or intermediaries involved in the action will not charge any cost. Details of other companies/intermediaries involved in the SMS action:	Will other companies be involved: (marketing agencies, technical facilitators): yes ☐no ☐ Will these companies be paid for their participation in this action: yes ☐no ☐
Operational information about the SMS action via short code 4xxx
Duration of the SMS action (max 1 month per ongoing calendar year):	Start date: Click or tap to enter a date. End date: Click or tap to enter a date.
SMS consumer tariff. Only messages sent by mobile phones to the application can be paying.	1€
Proposed short number for the SMS:	Existing short codes with: CM.com: 4666 ☐ RingRing 4050 ☐ Other than the numbers mentioned hereabove (limited to the 4xxx series) Click or tap here to enter text. In case of the request to configure a non-existing number, the action can only be started at the earliest 8 weeks following its approbation.	Sending free return SMS messages will be billed according to the commercially applicable rate.
Amount expected to be raised via SMS:	Click or tap here to enter text.
Will the action be supported by media (radio, Internet, social media and/or TV):	Yes ☐no ☐ National action: yes ☐ no ☐ in case “no”; Regional action: Flanders ☐ Wallonia ☐ Concerned media: Click or tap here to enter text.
Describe how the operators will be mentioned by the media:	Click or tap here to enter text.

This request needs to be signed by the official representative of the beneficiary charity organization:

Date: Click or tap to enter a date.

Name: Click or tap here to enter text.

Role within the charity organization: Click or tap here to enter text.

Signature (preceded by “Read and approved”)

This application can be submitted to:

Mobile Vkings : smsdonation@mobilevikings.be

Orange: smsdonation@orange.be

Proximus: smsdonation@proximus.com

Telenet Mobile / BASE : smsdonation@telenetgroup.be

VOO : smsdonation@voo.eu

https://financien.belgium.be/sites/default/files/downloads/116-lijst-instellingen-20191216.pdf