remitter

Institution	Stiftung Mercator GmbH

Street address	Huyssenallee 40

ZIP code, City	45128 Essen

Country	Germany

remittee

Institution

Street address

ZIP code, city

Country

Contact person

transfer and purpose

Amount in figures	EUR

Amount in letters	EUR

Date of incoming payment

Project Title

Project Number

It is hereby confirmed that the remittee has received the above-mentioned amount from Stiftung Mercator GmbH. The funds will be used in accordance with the agreements made, the by-laws, and exclusively for not-for-profit purposes as defined by the German General Tax Code (Abgabenordnung).

Date

Signature