The Board Meeting is on 25 August 2020.
(09) 263 4622
|info@akaranacommunitytrust.co.nz

Grant Application

Grant applications can be made by competing and printing the attached form or by downloading Akarana’s grant form in PDF format here.

Download Grant Application PDF Form

Grant applications should be received by the 15th of each month.  The grant applications are generally considered in the last week of each month, with payment of approved grants being made in the first week of the following month.

Date received (FOR OFFICE USE) :

Organisation Information

Organisation Name*

Type of Organisation*

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

Purpose of Organisation*

(e.g. Sports club)

Organisation Incorporation Number*

New Zealand Business Number*

(Your NZBN number may be found at www.nzbn.govt.nz)

Address*

(Street Address & PO Box Number)

Website*

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

Main Contact Person

Name*

Position*

Address*

Email*

Telephone Work*

Telephone Home

Mobile*

Application Info

Have you used a professional fundraiser to assist you with this application?*

YESNO

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?*

YESNO

GST Number



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

YESNO

If yes, give full details



Territorial Authority*

Please detail the territorial authority in which you are located:



Please detail the territorial authority where the benefit from the grant will be received:



Please detail any other territorial authority that will benefit from the grant:



Please detail the items that you are applying for and the cost of each item (continue on a separate sheet if necessary):

Item Supplier 1 – Preferred Quote Cost (ex GST) Supplier 2 – Competitive Quote Cost (ex GST)
Total Requested

Please complete the section below if you are applying for wages or salaries.

Person Title Annual Salary or Hourly Rate Total Hours Worked Per Week

CONDITIONS OF GRANT

As required by section 115A of the Gambling Act 2003, grant money must only be used for the specific purpose for which it was granted and in accordance with the conditions of the grant. Breach of section 115A is a criminal offence ($10,000.00 maximum fine).

Copies of invoices, receipts and bank statements must be provided to Akarana Community Trust within 6 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 6 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.

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.

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 ensure you have not applied for funds for the same purpose from any other source.Please attach a copy of your certificate of incorporation.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 and detail any association with an Akarana trustee or Akarana venue.Please ensure that this application is completed in full and signed by two senior members of your organisation.

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)

If you would prefer to complete a paper application, the pdf form can be downloaded here.

Please print and post your application with the supporting documentation to:
Akarana Community Trust, PO Box 217231, Botany Junction, 2164.

Print

APPLY FOR A GRANT

JOIN AKARANA

CONTACT US

PH: (09) 263 4622