Community Drought Support Grant Application Form - Business/Entity
Please complete this form if you are a business/entity applying for the funding
Full Name of Contact Person
Are you currently experiencing financial difficulties which make it hard for you to pay for utilities, food, fuel or other personal expenses
No - You are not eligible for assistance
Yes - Please attach evidence to support your claim (e.g bank statement, overdue invoice etc)
Please describe the affect that the drought/flood has had on you and/your family, and why you require financial assistance to support you at this time.
Where would you like the payment made
Branch Number (BSB)
Account Number (this cannot be your credit card)
Name of bank, building society or credit union
Attach your files here
I declare that the information provided on this form is true and correct.
Should be Empty: