Application worksheet

We (the undersigned) make a solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957.*

The information provided is true and correct to the best of our knowledge.*

We have the authority to make this application on behalf of the applicant (if the applicant is not a natural person).*

This application has not been completed by a person who has any management or ownership interest in Rano Community Trust venues that host gaming machines (“a gaming machine venue key person”).*

When any grant money is obtained the persons who decide how that money is spent will not be Rano Community Trust gaming machine venue key persons.*

When any grant money is obtained a check will be undertaken and no payment will be made from grant money to any Rano Community Trust gaming machine venue key person for any goods or service.*

All of the information presented in this application – relating to the organisation I represent and to the specific proposal/project for which grant funds are requested – is true.*

This application includes complete information relating to other sources of funding that my organisation has received, been pledged, applied for, or intends for future application, for this and other organisational projects.*

All prices and quotes included in this application represent the actual costs that will be incurred by my organisation.*

I have read and understand the Conditions for Allocation of Funds and Audit and Inspection requirements.*

My organisation hereby agrees to participate in an inspection, to provide further information if requested, and/or audit by the Department of Internal Affairs or Rano Community Trust if so requested.*

In the event of payment default, any legal or collection agent costs will be the responsibility of the applicant.*