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Community Support Application Form


Please note it is very important that bank details are entered correctly. Please refer to the bank statement for the hall for the exact account name, BSB and account number. This will greatly assist processing of eligible donations.
Application Details
Applicant first name*
Applicant last name*
Applicant postal address*
Suburb/Town*
State*
Postcode*
Best contact number*
Email address*
Name of community hall*
Address of hall*
ABN (if your hall has one)
NMI (National Meter Identifier is a unique number assigned to the meter at your hall and is listed on the energy bill)*
Is your hall not-for-profit, non-commercial?*

Do you receive funding from a third party, including your local Council for day-to-day operation of the hall?*

If yes, where does the funding come from and what is it for?
Should your application be successful, please provide bank account details for the group or hall as donations will be made by EFT only.
Please ensure the account name, BSB and account number are exactly as they appear on the bank statement.
Account name*
BSB*
Account number*
Please outline the groups that utilise the hall and describe their activities (must add up to 100%)
Group 1 name*
Group 1 activity*
Group 1 % of total hall use
Group 2 name
Group 2 activity
Group 2 % of total hall use
Group 3 name
Group 3 activity
Group 3 % of total hall use
Group 4 name
Group 4 activity
Group 4 % of total hall use
I declare this hall meets the eligibility criteria, the information provided is accurate and true and the hall is a not-for-profit, non-commercial facility servicing the local community.*
Please enter the text shown above:
 

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