Apply for a borehole construction FILL IN THE FORM BELOW TO SUCCESSFULLY GET A BOREHOLE BUILT IN YOUR AREA DETAILS ABOUT THE AREA REQUESTING THE BOREHOLE Water source will be under which ownership? —Please choose an option—PrivateCommunalInstitutional Is there electricity near the proposed site for water source? —Please choose an option—YesNo Select the source of water people use currently —Please choose an option—BoreholeDug WellSpringSurface WaterLake/RiverSwampTap WaterOthers State the Proposed use of water —Please choose an option—Domestic UseLivestockIrrigationOthers Are there existing boreholes within one (1) kilometer to proposed the site? —Please choose an option—YesNo If yes. How many? DECLARATION I certify that the information provided in this form is correct to the best of my knowledge. I also agree that no decision will be made pursuant to this application until I receive a notification from the Management of Hands on Foundation Uganda. IMPORTANT NOTE All applications will be evaluated and Hands On Foundation Uganda shall communicate to only successful applicants.