Page No 1 - World Federation of the Deaf

1.0 Contact Details
1.1 Country: ______________________________________________________________________________
1.2 National Association of the Deaf: _________________________________________________________
_________________________________________________________
1.3 Street Address:
Street Address: ______________________________________________________________________________
Street Address: ______________________________________________________________________________
City:
_____________________________________________________________________________________
Post code / Zip Code: _______________________________________________________________________
Country:
______________________________________________________________________________
1.4 Postal Address:
Postal Number: ______________________________________________________________________________
City:
_____________________________________________________________________________________
Post code / Zip Code: _______________________________________________________________________
Country:
______________________________________________________________________________
Website Address:
_______________________________________________________________________
Email Address: ______________________________________________________________________________
1.5 Telephone Numbers:
Landline Number:
Mobile Number:
Facsimile Number:
_________________________________________________________
_________________________________________________________
_________________________________________________________
Project Data Use Only
Country Reference No: ..............................................................................
Received Date: ......................................................................................
Data Entered: ........................................................................................
Country Classifications:
□ Low Income
□ Upper Middle Income
□ Lower Middle Income
□ High Income
The Project is under the auspices of the Swedish National Association of the Deaf (SDR) and the World Federation of the Deaf (WFD) Page No 74
and funded by the Swedish Agency for International Development Cooperation (Sida) and Swedish Organisations of Disabled Persons
International Aid Association (Shia).