WORKSAFE CLUB SAFETY FUND - APPLICATION FORM SECTION 1 APPLICANT DETAILS – CLUB NAME: ID #: LEAGUE NAME: Do you have an Y / N ABN: ABN? Are you registered Y / N Incorporation #: for GST? Please note: If your club does not have an ABN you are required to complete a Statement by Supplier Form, which can be obtained from the Australian Taxation Office website www.ato.gov.au – CONTACT NAME: CLUB POSITION: POSTAL ADDRESS: POST CODE: EMAIL ADDRESS: H W PHONE: M F SECTION 2 DIRECT CREDIT DETAILS – BANK NAME: BANK ADDRESS: ACCOUNT NAME: BSB #: ACCOUNT #:
WORKSAFE CLUB SAFETY FUND - APPLICATION FORM SECTION 1 – APPLICANT DETAILS CLUB NAME: ID #: LEAGUE NAME: Do you have an ABN? Y / N ABN: Are you registered for GST? Y / N Incorporation #: Please note: If your club does not have an ABN you are required to complete a Statement by Supplier Form, which can be obtained from the Australian Taxation Office website – www.ato.gov.au CONTACT NAME: CLUB POSITION: POSTAL ADDRESS: POST CODE: EMAIL ADDRESS: PHONE: H W M F SECTION 2 – DIRECT CREDIT DETAILS BANK NAME: BANK ADDRESS: ACCOUNT NAME: BSB #: ACCOUNT #: