Agent for political party

Reporting a gift received

State

Registered political party details

Agent full name*

Political party *

Reporting a Fundraising Contribution received from an individual

Name of contributor *

Email Address

Street*

Suburb*

State*

Postcode*

Fundraising Contribution Particulars

Description of Gift Received *

Amount*

Date contributed *

Is this Individual the source of the Fundraising Contribution? *

Yes

No

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

The source of the above Fundraising Contribution is...

Name*

Street*

Suburb*

State*

Postcode*

Names and residential or business addresses of the trustees of the fund or other persons responsible for the funds of the foundation*

Is this amount a political donation? *

Yes

No

Unknown

$0.00

Current Total