/ Grant Application

Grant Application

Your Organisation's Details
This should be the same as the bank account name.
Street address and PO Box number
Contacts
Please supply two contacts from your organisation with addresses and both business and after hours phone numbers.
About Your Organisation
Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf pdf doc docx xls xlsx.
Bank Details
About The Grant
Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf pdf doc docx xls xlsx.
Please be specific about the detailed use of the grant.
If applicable.
Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.
Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.
Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.
Please attach more than one quote for this project (if applicable).
$
Grant Amount
Declaration
  • We declare that the information provided in this grant application is true and correct, to the best of our knowledge, and we have the authority to make the application on behalf of the applicant.
  • This organisation fully understands that any and all grant monies received from the Invercargill Licensing Trust can only be used for the purpose for which the grant was approved. Copies of invoices, receipts and bank statements (where applicable), along with any unspent funds, will be returned to the Invercargill Licensing Trust after the funds have been applied towards the purpose for which the grant was made.
  • We authorise the Invercargill Licensing Trust to retain information pertaining to this application and to disclose that information as deemed necessary by the Invercargill Licensing Trust for any purpose, including the publication of grants.
  • We have read, understand and accept all the conditions applicable to this application for a grant. The funds will only be used for the purpose applied for in this application.

Please use your mouse to sign in the signature box above.

Please use your mouse to sign in the signature box above.