Application worksheet
A printable version of Clutha District Council - Reimbursement of ANZAC Day Costs's application questions, extracted from their official form. Use it to plan your answers - then submit through the funder's real form.
View the original PDF →Application worksheet
ANZAC Day Reimbursement Application Form
Clutha District Council - Reimbursement of ANZAC Day Costs
This worksheet mirrors the questions on the funder's official application form. It is NOT the official form. Submit your final answers through https://www.cluthadc.govt.nz/community/grants-and-funding/reimbursement-of-anzac-day-costs.
1. ORGANISATION DETAILS
Name of Organisation*
Postal Address*
Contact Person*
Contact Phone Number*
Contact Email*
2. THE PROJECT
Details (venue and time) of the Anzac Day service for which funds are sought*
3. FINANCIAL
Please state the item/s (ie, wreath, hall hire and/or printing) you would like assistance with (receipts must be supplied).*
Description*
Amount Paid*
Receipt #*
Your GST No. (if registered)
4. ADDITIONAL INFORMATION
If there is any additional information you wish to submit, please continue on a separate sheet.
Documents to attach
- bank deposit slip
- receipts
Declarations
- I hereby declare that the above information is correct and is lodged with the full knowledge and consent of the organisation.
- I ______________________________________________________________ (name) consent to the Clutha District Council collecting the personal contact details provided above, retaining and using these details for mailing and contact lists and disclosing them to any agencies for the purpose of reviewing the council’s funding schemes. I undertake that I have obtained the consent of the other contact person to provide these details. I acknowledge my right to have access to this information. This consent is given in accordance with the Privacy Act 1993.
Signature
Date
Worksheet generated by All Too Human (alltoohuman.nz/grants). Source: official PDF. This is not an official submission form.