RAA Natural Disaster Relief Grant Form

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raa_home  About You  >  Assistance Required  >  Accountant Details  >  Supporting Documents  >  Declaration

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    Assistance Required
    Accountant Details
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    Declaration






Please provide your 6 digit BP number

There are currently no available declarations for the type selected





A Trust is not an eligible borrowing type





e.g. Director, Manager, Partner, etc







Previous / Involvement Details



Previous / Involvement Details



Parties and associated entities to the business
Note: If Trust, list trustee company/individual(s)




DD/MM/YYYY

Key Contact Information




DD/MM/YYYY

Please enter a valid Australian number




Contact Person Information




DD/MM/YYYY

Please enter a valid Australian number



Property Address
Business Address
Address of Sporting Club or Not for Profit Organisation






per rates notice



Postal Address





raa_home  About You  >  Assistance Required  >  Accountant Details  >  Supporting Documents  >  Declaration

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Assistance Required















Insurance Details





raa_home  About You  >  Assistance Required  >  Accountant Details  >  Supporting Documents  >  Declaration

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Bank Details




raa_home  About You  >  Assistance Required  >  Accountant Details  >  Supporting Documents  >  Declaration

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✓  Assistance Required
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    Declaration


Accountant's Details




Numbers only: No spaces or hyphens


Rural Financial Counsellor's Details




Numbers only: No spaces or hyphens


raa_home  About You  >  Assistance Required  >  Accountant Details  >  Supporting Documents  >  Declaration

✓  About You
✓  Assistance Required
✓  Accountant Details
>  Supporting Documents
    Declaration


  

Please ensure file sizes are 2.5MB or less

Please ensure file sizes are 2.5MB or less


Copy of rates notice, gas bill, electricity bill, phone bill, or lease agreement

from Australian Taxation Office or registration from Department of Fair Trading

Can be supplied post assessment. No payments will be made on quotations
Upload Tax Return
Most recent Tax Returns & Financial Statements for your Farm Business
Include individual Taxation Returns and a current listing of all Assets and Liabilities held by each:

 Individual members of a Partnership/ Family Trust
 Individual Director(s)/Shareholder(s) of all Companies

Please ensure file sizes are 2.5MB or less

Please ensure file sizes are 2.5MB or less
   
Supporting Documentation
Please upload any other relevant documentation/information

raa_home  About You  >  Assistance Required  >  Accountant Details  >  Supporting Documents  >  Declaration

✓  About You
✓  Assistance Required
✓  Accountant Details
✓  Supporting Documents
>  Declaration


General Statement*
Any person who knowingly and with intent to defraud the Authority or another person, files an application for assistance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent act, which is a crime under the Crimes Act 1900 and subjects the person to criminal penalties.

Privacy*
The information in this application is provided voluntarily and is being collected by the Authority for purposes related to the administration of the scheme of assistance under which you have applied, including the assessment of the effectiveness of the scheme. This may involve disclosing the information in this application to contractors engaged by the Authority or to either State or Commonwealth government agencies. We will supply you with details of those that we have disclosed information to, if you apply to us in writing. Information regarding your application may also be discussed and exchanged with the nominated contact persons listed by you in your application.

Not providing the information requested in this application or providing false or misleading or incomplete information may impact on the ability of the Authority to accurately assess your application.

The NSW Rural Authority agrees to take all reasonable measures to ensure that the personal information collected by it is stored securely.

You may access or correct your personal information by contacting the Authority by telephone on 1800 678 593 (toll free) or by writing to: Manager Administration, NSW Rural Assistance Authority, Locked Bag 23, ORANGE, NSW, 2800. Calls to "1800" numbers from your home phone are free. Calls from public phones and mobiles may be timed and attract charges.

Your Statement*
I/We understand and declare that:

1.  I have read, understood and I will comply with the guidelines.

2.  The information I have provided in this application is true and correct. 

3.  If I am applying on behalf of a partnership, trust or corporation, I have the authority to make this application on its behalf.

4.  The business listed in this application: 
• suffered direct damage as a result of the event, and 
• is an eligible business.
5.  It is intended that the business will be re-established within the affected area.

6.  Any overpayment will be recovered.

7.  I/We have made a claim for insurance where eligible, or insurance has been refused or the payout does not cover all costs, and proof of this claim is attached.

8.  When asked for financial information, I must provide my personal tax returns in addition to financial information for all business entities with which I have a formal interest including companies, partnerships and self-managed super funds. 

9.  The invoices for this application have not been used to secure any other NSW government funding. (i.e. I have not been reimbursed for these invoices in the past).

10. I authorise RAA to discuss this application with relevant private/public authorities, financial lending institutions and accountants, including my nominated financial counsellor/advisor. If required, I will provide documents from the relevant authority to permit the RAA to do this. 

11. Any assistance received under this scheme will be applied in accordance with the scheme guidelines and the RAA may conduct an audit or inspection to ensure I have complied.

12. I have obtained/will obtain all required work approvals and permits prior to commencing work, and I understand the need for any development to be ecologically sustainable.

13. I will provide feedback in relation to this scheme if requested. 

14. Any statistics collected and analysed will be done in such a way to protect my anonymity.

15. The NSW Rural Assistance Authority can make relevant enquiries to ensure I receive my correct entitlement.

16. Prior to applying for this assistance I/we sought independent financial advice and the taxation implications of any assistance granted has been explained to me.

17. Statistics may be collected and analysed in such a way as to protect my anonymity.

18. I/We agree to provide feedback in relation to this Scheme.
General Statement*
Any person who knowingly and with intent to defraud the Authority or another person, files an application for assistance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent act, which is a crime under the Crimes Act 1900 and subjects the person to criminal penalties.

Privacy*
The information in this application is provided voluntarily and is being collected by the Authority for purposes related to the administration of the scheme of assistance under which you have applied, including the assessment of the effectiveness of the scheme. This may involve disclosing the information in this application to contractors engaged by the Authority or to either State or Commonwealth government agencies. We will supply you with details of those that we have disclosed information to, if you apply to us in writing. Information regarding your application may also be discussed and exchanged with the nominated contact persons listed by you in your application.

Not providing the information requested in this application or providing false or misleading or incomplete information may impact on the ability of the Authority to accurately assess your application.

The NSW Rural Authority agrees to take all reasonable measures to ensure that the personal information collected by it is stored securely.

You may access or correct your personal information by contacting the Authority by telephone on 1800 678 593 (toll free) or by writing to: Manager Administration, NSW Rural Assistance Authority, Locked Bag 23, ORANGE, NSW, 2800. Calls to "1800" numbers from your home phone are free. Calls from public phones and mobiles may be timed and attract charges.

Your Statement*
I/We understand and declare that:

1.  I have read, understood and I will comply with the guidelines.

2.  The information I have provided in this application is true and correct. 

3.  If I am applying on behalf of a partnership, trust or corporation, I have the authority to make this application on its behalf.

4.  The Sporting Club or Not for Profit Organisation listed in this application: 
• suffered direct damage as a result of the event, and 
• is an eligible Sporting Club or Not for Profit Organisation
.
5.  It is intended that the Sporting Club or Not for Profit Organisation will be re-established within the affected area.

6.  Any overpayment will be recovered.

7.  I/We have made a claim for insurance where eligible, or insurance has been refused or the payout does not cover all costs, and proof of this claim is attached.

8.  When asked for financial information, I must provide my personal tax returns in addition to financial information for all business entities with which I have a formal interest including companies, partnerships and self-managed super funds. 

9.  The invoices for this application have not been used to secure any other NSW government funding. (i.e. I have not been reimbursed for these invoices in the past).

10. I authorise RAA to discuss this application with relevant private/public authorities, financial lending institutions and accountants, including my nominated financial counsellor/advisor. If required, I will provide documents from the relevant authority to permit the RAA to do this. 

11. Any assistance received under this scheme will be applied in accordance with the scheme guidelines and the RAA may conduct an audit or inspection to ensure I have complied.

12. I have obtained/will obtain all required work approvals and permits prior to commencing work, and I understand the need for any development to be ecologically sustainable.

13. I will provide feedback in relation to this scheme if requested. 

14. Any statistics collected and analysed will be done in such a way to protect my anonymity.

15. The NSW Rural Assistance Authority can make relevant enquiries to ensure I receive my correct entitlement.

16. Prior to applying for this assistance I/we sought independent financial advice and the taxation implications of any assistance granted has been explained to me.

17. Statistics may be collected and analysed in such a way as to protect my anonymity.

18. I/We agree to provide feedback in relation to this Scheme.
   
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