General Statement *
Any person who knowingly and with intent to defraud the NSW Rural Assistance Authority (RAA) 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.
The information in this application is provided voluntarily and is being collected by the RAA 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 RAA to accurately assess your application.
The RAA 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 RAA 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 declare that:
1. The information provided in this form is correct.
2. The primary production business listed above is an eligible primary production business.
3. I have read the Guidelines in relation to the assistance applied and understand the conditions and requirements therein.
I/we understand that:
- Deliberately giving false or misleading information is a serious offence.
- The NSW Rural Assistance Authority can make relevant enquiries to ensure I receive my correct entitlement.
- Any overpayment will be recovered.
- Personal information is protected and can be given to someone else where state/territory or Commonwealth legislation requires or where i give permission.
- Statistics may be collected and analysed in such a way as to protect my anonymity.
- 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.
- I/we authorise the release of information by relevant authorities, including Commonwealth, state/territory or local authorities to the NSW Rural Assistance Authority relating to my/our application for a Drought Assistance Fund Loan.
- I/we agree to provide feedback in relation to this Scheme.