Grants Application Form

Shareholder Details

Applicants Name *

Contact Email *

Shareholder No *

Also Known As:

IRD No *

Date of Birth *

Day

Month

Year

Gender *

Male

Female

Phone *

Mobile

Address Details

Address *

Suburb *

City/Town *

Postcode *

Please tell us what you require a Grant for *

(Please use a separate paper if needed and attach it to this form – be clear)

Have you applied for funds from any other source? *

Yes

If yes, please provide details

Trust Details

Applicants Name *

Shareholder No *

Whanau Trust Name *

IRD No *

Date of Birth *

Day

Month

Year

Gender *

Male

Female

Phone *

Mobile

Please list the Trustees of the Whānau Trust and mark who has approved your application

Name *

Please list the names here

Signatures

Please scan and upload the document with signatures of Trustees who have approved your application.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt html pdf doc docx.

Leave this field blank