Agent for political party

Reporting a gift received

State

Registered political party details

Agent full name*

Political party *

Reporting a Gift received from an individual

Name *

Email Address

Street*

Suburb*

State*

Postcode*

Gift Particulars

Description of Gift Received *

Amount*

Date made *

Is this Individual the source of the Gift? *

Yes

No

As the donor is not the source of the Gift you have received, 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 trustees of the fund or other persons responsible for the funds of the foundation*

Is this amount a political donation? *

Yes

No

Unknown

Was this amount received by or for an electoral committee for an electoral district? *

Yes

No

Which electoral district was the committee established for? *

$0.00

Current Total