DESIGNATED FUND GIFT INSTRUMENT

Page 1

DESIGNATED FUND GIFT INSTRUMENT Section One – Donor(s) DONOR 1

DONOR 2

Full Name: _____________________________________

Full Name: _____________________________________

DOB or Age: ________________________Gender: ____

DOB or Age: ________________________Gender: ____

Address: ______________________________________

Address: ______________________________________

City: ____________________ State: ____ Zip: ________

City: ____________________ State: ____ Zip: ________

Contact Number(s):

Contact Number(s):

(H) _____________ (C) ____________ (W) ___________

(H) _____________ (C) ____________ (W) ___________

Email: _________________________________________

Email: _________________________________________

Section Two – Fund Name & Anonymity The name of the Fund shall be: ________________________________________ Every grant made from a fund at the Foundation is coupled with a letter identifying the name of the fund unless you request anonymity. Fund names are often listed in our written and electronic publications as well. I/We would like to remain anonymous. I/We would like grants from the above fund to remain anonymous. I/We would like the above fund listed as anonymous in the Foundation’s publications. Section Three – Fund Purpose You may establish a designated fund that provides distributions from the fund be made to one or more Section 501(c)(3) public charities. Please indicate the qualifying charitable recipient(s) that you would like to receive distributions from the fund. You may designate the Hawaii Community Foundation as a charitable recipient if you desire. The Fund shall be (choose one): ____ Initial(s) ○ Endowed, meaning I would like my fund to be permanent and limit the amount available for grantmaking to the Foundation’s spending policy ____ Initial(s)

○ Non-Endowed, meaning I would like my fund to be able to make grants from the entire balance

I/We have provided a charitable “guide” for our successor advisor(s) in the attached “Statement to Successor Advisors”. Name and Address of Organization Percentage Allocation ______________________________________________________________________

__________%

______________________________________________________________________

__________%

______________________________________________________________________

__________% 100%

If you wish to specify a purpose or impose restrictions, please describe in the Exhibit “A” attached. Note that distributions from the Fund are subject to the Foundation’s “Terms and Conditions Applicable to Designated Fund Gift Instruments”. (03-2018)


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