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Local candidate return

Reporting a loan received after 20/01/2020

Local

Candidate details

Candidate*

Event*

Address *

Reporting a Loan received from an individual

Name *

Street*

Suburb*

State*

Postcode*

Country*

Loan Particulars

Terms & conditions*

Amount*

Date loan received *

Date paid back

Date loan due*

Market rate charged?*

Yes

Individual's Occupation*

Is the individual employed, self-employed or otherwise engaged in an industry?*

Yes

Industry*

Does the Individual have an interest in a local government matter that is greater than that of other persons in the local government area?*

Yes

Nature of interest*

Is this Individual the source of the Loan?*

Yes

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*

Country*

Individual's Occupation*

Is the individual employed, self-employed or otherwise engaged in an industry?*

Yes

Industry*

Type of business conducted by corporation*

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

Are the funds derived from a trust account of a lawyer or accountant under the instructions of a person?*

Yes

Name of instructor who is in substance the giver of the gift or lender*

Does the have an interest in a local government matter that is greater than that of other persons in the local government area?*

Yes

Nature of interest*

Does the corporation have a holding company?*

Yes

Names and residential or business addresses of the directors or members of the executive committee of the holding company*

$0.00

Current Total

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