Robe River Kuruma Charitable Trust Distribution Application Form

Please tick each point to confirm you have read and understand the declaration you are signing. *

Declaration #2 *

I understand that all information contained within and attached to this application may be shared with RRKAC and KML.

Declaration #3 *

I understand that it is my responsibility to ensure that my contact details are correct and that I am contactable by RRKAC. I am aware that if I am not contactable for a period of seven days from the date of applying for assistance, my application will be withdrawn and not processed. I will be required to make a new application for further assistance.

Declaration #4 *

I understand that the bills/items to be paid will be paid direct to the supplier only.

Declaration #5 *

I understand that if I have reached the maximum annual limit for this funding type, my application will be rejected.

Declaration #6 *

I will not sell, swap or exchange any items, products, fuel, food, gift cards or equipment purchased by the trust directly or by me through gift cards for personal gain.

Declaration #7 *

I understand that I (or any person who assisted me to complete the form) may be contacted regarding my application if further information is required for assessment and prioritisation purposes.

Declaration #8 *

Should my application be successful I am fully responsible for the repairs and maintenance of any goods or the utilisation of services once acquired.

Declaration #9 *

If my application is successful, I will inform RRKAC of any chance in my financial circumstances.

Declaration #10 *

I agree that if I am found misusing KML Charitable Trust Funds in any way that I may be disqualified from accessing further funding from the Charitable Truast for a period of up to 12 months.

Declaration #11 *

I agree to ALL terms and requirements of the KML Charitable Trust Fund policies, including the Members Support Program Policy.

Declaration #12 *

Declaration #13 *

I understand that my application will be processed by RRKAC within TEN (10) business days once all required supporting documentation has been received. I am aware that any attempts made by me to bypass any steps in the process will be seen as a deliberate breach of process and will disqualify me from accessing further funding from the Charitable Trust for a period of up to 12 months.

Declaration #14 *

I confirm I am a registered beneficiary of the Kuruma Marthudunera Limited Trust

Applicant Signature *

Date *

If you received help to complete this form please supply details below:

Phone

Signature

Please confirm your preferred method of contact for all RRKAC communications and notices, this will be updated on your profile for future mail-outs *

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