Application Form

Akarana Community Trust Ltd Grant Application Form

Download the pdf form here.

Organisation Information

Organisation Name*

Type of Organisation*

(e.g. Incorporated Society, Charitable Trust, School)

Purpose of Organisation*

(e.g. Sports club)

Organisation Incorporation Number*

Address*


(Street Address & PO Box Number)

Location

Please detail the area that will benefit from the grant

Website*

(URL must contain http:// or https://)

Main Contact Person

Name*

Position*

Address*

Email*

Telephone Work*

Telephone Home

Mobile*

Fax

Application Info

Specific reason for grant application*

Please ensure the application is for items which have not already been purchased.

Total Amount Requested*

$

 GST Incl. GST Excl.

GST Registered?*

 YES NO

GST Number

Has the application organisation applied for funds for the same purpose from any other source*

 YES NO

If yes, give full details

Grant Application Requirements

Please complete the checklist below

 Please attach two quotes or other evidence that the amount sought is reasonable. Please attach evidence of affiliation to a national body. Please attach a printed bank deposit slip. The account name must be the same as the recipient organisation. Please ensure the application is for items which have not already been purchased. Please attach a copy of your certificate of incorporation. Please attach a copy of your Charities Commission registration certificate (if you are registered with the Charities Commission). Please attach a copy of your signed full meeting minutes that record your organisation’s resolution to apply for funding to Akarana Community Trust. For grant applications greater than $15,000 please attach a copy of your latest audited annual accounts. Please attach a list detailing the names of all your committee members or the members of your board of trustees. Please ensure that this application is completed in full and signed by two senior members of your organisation.

Terms and Condition

GRANTS CAN BE MADE FOR

The Akarana Community Trust shall give priority to funding applications which support the local Indian Community. In particular the Trust wishes to strongly support applications that benefit local community centres, amateur sport in general and the young members of the Indian Community.

Akarana Community Trust may make grants for authorised purposes as follows:

  • any charitable purpose;
  • any non-commercial purpose that is beneficial to the whole or a section of the community; and
  • promoting, controlling, and conducting race meetings under the Racing Act 2003, including the payment of stakes.

The above authorised purpose includes, but is not limited to:

  • non-profit community cultural or arts festivals;
  • non-profit radio stations;
  • non-profit museums and art galleries;
  • advertising charitable appeals and non-profit cultural events;
  • providing public amenities and recreational facilities, e.g. community centres, soccer/rugby grandstands, sports centres, national parks, public halls, libraries, statues, temples, fountains, playing fields, gymnasiums, swimming pools, parks, churches, and botanical gardens;
  • amateur sport in connection with community centres, particular schools, technical colleges or universities;
  • amateur sport which involves the pursuit of physical fitness;
  • providing education through community centres, early childhood centres, schools and universities;
  • providing student scholarships (up to secondary level) and prizes for academic or sporting achievement;
  • developing the character of young people, e.g. youth groups or mentor programmes;
  • public health services including education, counselling and rehabilitation services;
  • providing public works and services, e.g. building roads, car parks and bridges;
  • protecting the environment, e.g. re-vegetation, afforestation, and conservation;
  • supporting non-commercial emergency rescue services; and
  • supporting animal shelters or sanctuaries; and
  • the support of immigrants and their integration into the local community; and
  • the purchase of land and the development and maintenance of community centres, sporting centres, or other facilities that benefit the community or a section of the community.

GRANTS CANNOT BE MADE FOR

  • personal or commercial gain;
  • professional sport; or
  • groups or individuals standing for an election to public office.

CONDITIONS OF GRANT

The grant must be used only for the specific purpose for which the application was made and spent within 3 months of the grant being made. Copies of invoices, receipts and bank statements must be provided to Akarana Community Trust within 3 months of the grant being made to verify that the grant has been used in accordance with the purpose approved. Any grant money which is not spent on the purpose approved must be returned to Akarana Community Trust within 3 months of the grant being made. We agree to reimburse Akarana Community Trust for all costs incurred (including legal costs on a solicitor/client basis) in recovering any outstanding grant money.

CONSENT TO AUDIT

We agree to comply with any request from an officer of the Department of Internal Affairs and/or a representative from Akarana Community Trust for additional information in relation to how the monies received from Akarana Community Trust have been spent. We also agree that an officer of the Department of Internal Affairs may direct an audit or inspection of the books, accounts, or data systems in which the proceeds of the grant have been deposited, by a Chartered Accountant and/or an officer of the Department of Internal Affairs. We agree that the audit or inspection will be carried out in such a manner approved by the Department, within the time frame specified by the Department.

I agree to the terms and condition.

DECLARATION

We declare that:

  • The information provided in this application form is true and correct to the best of our knowledge.
  • We have the authority to make this application on behalf of the applicant.
  • This application has not been completed by a person who has any management or ownership interest in a Akarana Community Trust venue that hosts 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 Akarana 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 Akarana Community Trust gaming machine venue key person for any goods or service.

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

I certify that the facts stated above are true and correct to the best of my knowledge and belief.

For Akarana Trust Community Use Only

Approved/Declined
Amount approved
Grant number (Net Proceeds Member)

Date approved
Date funds deposited (Net Proceeds Member)

Cheque number/Direct debit details
(Net Proceeds Member)

Please ensure that you print and post your application to the following address in order to complete your application. Make sure to include the relavent documents required:
Akarana Community Trust, PO BOX 217231, Botany Junction, 2164

Print

Welcome ACT

  • Akarana Community Trust is one of a number of community funders who derive income from the operation of gaming machines. For details of other funders who distribute grants in your area, please go to www.dia.govt.nz

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