Individual

Reporting a gift (donation) made

State

Your details

Name*

Address*

Reporting a Gift made to State Candidate

Recipient's Name *

Street*

Suburb*

State*

Postcode*

Gift Particulars

Description of Gift *

Amount*

Date made *

Are you the source of the gift? *

Yes

No

As you are not the source of the Gift you have made, you need to disclose the below details about the source.

The source of the above Gift is...

Name *

Street*

Suburb*

State*

Postcode*

Names and residential or business addresses of the members of the executive committee of the association*

Is this amount a political donation? *

Yes

No

$0.00

Current Total