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Contribution Acknowledgement Form

I can confirm that the contribution will not be used to provide a personal benefit to any Government Official, nor to carry out any other activity that would be contrary to Code of Conduct and Anti-Corruption standards.

I confirm the receipt of a contribution from Discovery Porcupine on

in the form of:

an in-kind/non-monetary donation

a monetary donation

The funds/materials received will be used to:

Organization:

Name of Recipient

Role/Position in Organization

Date: