Grant Application

Contact

Your Organisation's Details

Name of Applicant Organisation *

This should be the same as the bank account name.

Organisation Address *

Street address and PO Box number

Phone *

Email

Contacts

Please supply two contacts from your organisation with addresses and both business and after hours phone numbers.

Contact Name *

Address *

Phone (B/H) *

Phone (A/H) *

Contact Name *

Address *

Phone (B/H) *

Phone (A/H) *

About Your Organisation

What is the legal status and purpose of your organisation? *

How many people belong to the organisation applying? *

How many people would benefit from this grant? *

Is your organisation registered with the Charities Commission? *

Charities Commission registration number *

Are you Donee Status registered? *

Are you GST registered? *

GST No. *

Please attached a copy of the Organisation's latest Financial Statements *

Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf pdf doc docx xls xlsx.

Bank Details

Applicant Organisation's Bank *

Branch *

Account Number *

Name of Account *

Personal account are not permitted.

About The Grant

Please attach a copy of the applicant’s resolution to apply for funding. This must be certified as true and correct by the Secretary of the applicant society, e.g. Committee minutes/resolution (If applicable)

Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf pdf doc docx xls xlsx.

What is the grant to be used for? *

Please be specific about the detailed use of the grant.

Date of event

Month

Day

Year

If applicable.

Please upload any applicable quotes which are required in your cost breakdown/budget.

Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

File 2

Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

File 3

Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

Please supply a Cost Breakdown/Budget *

Please attach more than one quote for this project (if applicable).

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

Please provide details *

Amount applied for * $

Grant Amount

Total Amount Requested from Invercargill Licensing Trust in words *

$ *

Declaration

We declare that the information provided in this grant application is true and correct, to the best of our knowledge, and we have the authority to make the application on behalf of the applicant.
This organisation fully understands that any and all grant monies received from the Invercargill Licensing Trust can only be used for the purpose for which the grant was approved. Copies of invoices, receipts and bank statements (where applicable), along with any unspent funds, will be returned to the Invercargill Licensing Trust after the funds have been applied towards the purpose for which the grant was made.
We authorise the Invercargill Licensing Trust to retain information pertaining to this application and to disclose that information as deemed necessary by the Invercargill Licensing Trust for any purpose, including the publication of grants.
We have read, understand and accept all the conditions applicable to this application for a grant. The funds will only be used for the purpose applied for in this application.

I have read the above declaration and understand the conditions of this application *

I have read the above declaration and understand the conditions of this application

Name *

Position *

Signature

Clear signature

Please use your mouse to sign in the signature box above.

I have read the above declaration and understand the conditions of this application *

I have read the above declaration and understand the conditions of this application

Name *

Position *

Signature

Clear signature

Please use your mouse to sign in the signature box above.

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ILT - Invercargill Licensing Trust

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