NFP rates based financial assistance

Property and contact details

Name of organisation *

Contact name *

Assessment number *The assessment number is listed on your rates and water usage notices.

Property street address *

Postal address *

Preferred daytime phone number *

Email Address *

Organisation information

Primary purpose (main use) of the premises *

Length of time organisation has existed *

Approx. number of people serviced by organisation *

Profit-making activities

Does your organisation sub-lease any part of the premises? *

YesNo

Sub-lessee name 1

Sub-lessee activity 1

Sub-lessee annual rent $

Sub-lessee name 2

Sub-lessee activity 2

Sub-lessee 2 annual rent $

Sub-lessee 3 name

Sub-lessee 3 activity

Sub-lessee 3 annual rent $

Does your organisation have poker machines at the premises? *

YesNo

Constitution *

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Attach a copy of the organisation's Constitution which clearly states the prohibitions on any member of the organisation making a private profit or gain, either from ongoing operations of the organisation or as a result of distribution of assets if the organisation is wound up.

Evidence of registration with ACNC (if applicable)

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Attach evidence of the organisation's registration with the Australian Charities and Not-for-profit Commission for endorsement as a Tax Concession Charity with the Australian Taxation Office.

Additional supporting documents

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You can upload any other relevant information that supports the organisation as a non-profit entity or otherwise exists for a community purpose.

Labour details

Does your organisation rely mainly on volunteer labour? *

YesNo

If yes, indicate percentage of volunteer labour

Does your organisation have considerable paid labour? *

YesNo

If yes, indicate percentage of paid labour

Benefits and need

Please detail how your organisation provides substantial benefit to the community *

Please detail why your organisation needs rates-based financial assistance *

Declaration

Authorised Officer's name *

Authorised Officer's position title *

I declare that the information provided is true and accurate, and that I am an Authorised Officer of the organisation. *

Cairns Regional Council – Information Privacy Statement

Your personal information has been collected for the purpose of change of address notification. The collection of your information is authorised under the Local Government Act2009. You are providing personal information which will be used for the purpose of delivering services and carrying out Council business. Your personal information is handledin accordance with the Information Privacy Act 2009 and will be accessed by persons who have been authorised to do so. Your information will not be given to any other personor agency unless you have given Council permission to or the disclosure is required by law.