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Your Organisation's Details

Organisation Address(Required)

Contacts

Please supply two contacts from your organisation with a brief description of their roles and their mobile numbers.
Contact Name(Required)
Contact Name(Required)

Grant Amount

About The Grant

Please be specific about the detailed use of the grant.
Is funding request for Wages?(Required)

About Your Organisation

Does your organisation work with children?(Required)
Do you have a Child Protection Policy?(Required)
Is your organisation registered with the Charities Commission?(Required)
Are you GST registered?(Required)
(refer www.nzbn.govt.nz)

Budgets

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      Has the organisation applied for, or received funds, in the last 12 months from any other source? i.e. CTS, ICC, Lotteries, MSD, MBIE, Government Wage Subsidy, Sponsorships(Required)

      Bank Details

      Personal account are not permitted.

      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 ILT 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 ILT after the funds have been applied towards the purpose for which the grant was made.
      • We authorise the ILT to retain information pertaining to this application and to disclose that information as deemed necessary by the ILT 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.

      • If you are unable to provide the second signature at the time of application please contact one of our team on 03 211 3640.
      Agreement(Required)

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      Copy and send this URL to the second person for them to sign and complete the form.

      Name(Required)
      Name(Required)
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      Please use your mouse to sign in the signature box above.

      If you are unable to provide the second signature at the time of application, please click on the Save and Continue Later button below to generate a URL.

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      Invercargill Licensing Trust
      Address:P O Box 1771, 252 Dee Street
      Phone: 03 211 3750
      Email: info@iltfoundation.org.nz
      Invercargill Licensing Trust
      Address:252 Dee Street
      Phone:03 211 3640
      Email:ilt@ilt.co.nz
      Facebook: /InvercargillLicensingTrust
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