Agent for political party

Reporting a loan received

State

Registered political party details

Agent full name*

Political party *

Reporting a Loan received from a corporation

Name of Loan Provider*

Street*

Suburb*

State*

Postcode*

Loan Particulars

Terms & conditions*

Amount*

Date loan received*

Date loan due*

Date paid back

Market rate charged?*

Yes

No

Is this Corporation the source of the Loan? *

Yes

No

As the donor is not the source of the Loan you have received, you need to disclose the below details about the source.

The source of the above Loan 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

Unknown

$0.00

Current Total