Application worksheet
A printable version of South Taranaki District Council - Community Surveillance System Fund'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
Community Surveillance System Maintenance Fund Application Form
South Taranaki District Council - Community Surveillance System Fund
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.southtaranaki.com/our-community/funding/community-surveillance-system-fund.
1. Conflict of Interest
Is anyone involved with your project have a conflict of interest?*
If yes, please provide details:
2. Applicant Details
Name of group/organisation:*
Email:*
(Note: all correspondence relating to your application will be sent to this email address in the first instance)
Postal Address (incl. Post code)*
Phone (day):*
Amount requested (maximum $1000.00 per annum):*
What is the legal status of your group?*
Are you GST registered?*
How many members does your group currently have?*
Contact details (please provide two contacts for your group)*
What is the purpose of your group?*
How is your group normally funded?*
3. Funding Request
Total number of months the surveillance system has been operating between 1 July and 30 June:*
Total cost of maintenance between 1 July and 30 June (please attach invoices/quotes):*
Details of maintenance required:*
4. Surveillance System
Total number of cameras:*
Total number of fixed cameras:*
Total number of mobile cameras:*
Recording system:*
Name of qualified installer :*
Name of qualified maintenance company or person:*
Other features or details:*
5. Additional Information
Benefits of the System (tell us how the system has made your community safer in the past year):*
Issues (tell us about any issues or challenges you have experienced with the operation of your system in the past year):*
Documents to attach
- A full set of accounts/financial statements and a copy of your most recent bank statement
- Quotes or invoices for maintenance from qualified company or person(s)
Declarations
- I/we declare that we are a not-for-profit group (A not-for-profit does not earn profits for its members. All of the money raised or donated is used in pursuing the group’s objectives)
- I/we declare that the information supplied in this application is true and correct.
- I/we undertake that that I/we have obtained the consent of all people involved to provide these details.
- I/we understand that my/our organisation name and brief details about the project may be released to the media or appear in publicity material.
- I/we understand that the South Taranaki District Council is bound by the Local Government Official Information and Meetings Act 1987.
Signature
Date
Worksheet generated by All Too Human (alltoohuman.nz/grants). Source: official PDF. This is not an official submission form.