Amount approved (whole $ only) $ Date / / Applicant Type Individual Title: Mr Ms other …………………………………. Given names: Surname: Do you have Australian citizenship or permanent residency status? Yes No Group/unincorporated body name: Collectives or cooperatives are community groups or groups of artists that are not incorporated and must be auspiced by an incorporated organisation, or an individual with an ABN. One person must be nominated as the accountable representative of the collective for management, reporting and financial matters. Accountable person in group: Organisation name: Eligible organisations include arts and cultural not-for-profit organisations and Australian companies that are either based in or able to demonstrate how their project will directly benefit arts and culture. Accountable person in organisation (name and role): What is your status? organisation’s legal (eg limited by guarantee; incorporated; etc) Australian Business Number (ABN) Details Will you/your organisation Yes Provide your ABN details below – be responsible for the financial management of No An auspicing body will be administering any grant that I receive on my/our – the grant if this application behalf. Complete section 1.8 below organisation’s is successful? What is your ABN?: In what name is the ABN registered? What is your trading name or professional name (if relevant)? Yes No Are you registered for GST? Auspiced Application Only complete this section if you are nominating an accountable organisation or individual to administer the grant on your behalf who will also be responsible for submitting a financial report at the end of the project. Certification of Auspicing Organisation / Individual Details Go to last page Who is your auspicing arrangement with? an incorporated organisation an individual with an ABN Name of auspicing organisation or individual: Contact person for auspicing organisation: Position of contact person (if relevant): ABN of auspicing organization or individual Are you registered for GST? Yes No Postal address of auspicing organisation or individual: Suburb/Town: State: Postcode: Telephone: Mobile: Email:
Amount approved (whole $ only) $ Date / / Applicant Type Individual Title: Mr Ms other …………………………………. Given names: Surname: Do you have Australian citizenship or permanent residency status? Yes No Group/unincorporated body name: Collectives or cooperatives are community groups or groups of artists that are not incorporated and must be auspiced by an incorporated organisation, or an individual with an ABN. One person must be nominated as the accountable representative of the collective for management, reporting and financial matters. Accountable person in group: Organisation name: Eligible organisations include arts and cultural not-for-profit organisations and Australian companies that are either based in or able to demonstrate how their project will directly benefit arts and culture. Accountable person in organisation (name and role): What is your organisation’s legal status? (eg limited by guarantee; incorporated; etc) Australian Business Number (ABN) Details Will you/your organisation be responsible for the financial management of the grant if this application is successful? Yes – Provide your ABN details below No – An auspicing body will be administering any grant that I receive on my/our organisation’s behalf. Complete section 1.8 below What is your ABN?: In what name is the ABN registered? What is your trading name or professional name (if relevant)? Are you registered for GST? Yes No Auspiced Application Only complete this section if you are nominating an accountable organisation or individual to administer the grant on your behalf who will also be responsible for submitting a financial report at the end of the project. Certification of Auspicing Organisation / Individual Details Go to last page Who is your auspicing arrangement with? an incorporated organisation an individual with an ABN Name of auspicing organisation or individual: Contact person for auspicing organisation: Position of contact person (if relevant): ABN of auspicing organization or individual Are you registered for GST? Yes No Postal address of auspicing organisation or individual: Suburb/Town: State: Postcode: Telephone: Mobile: Email: