A request by a distributing agent filed with the Board for approval of a distribution of charity days' net proceeds to one or more beneficiaries shall include therein the total amount of charity days' net proceeds held by the distributing agent, the name of each beneficiary selected for a distribution, a brief statement as to the purpose of each beneficiary, the amount to be distributed to each beneficiary, a representation by the distributing agent as to the eligibility of all beneficiaries, the total amount of the net proceeds to be approved by the Board for the requested distributions, and the amount of net proceeds to be held by the distributing agent after the approved distributions are made.