General Trust Fund Application

New Zealand Thoroughbred Racing

This is an ELECTRONIC APPLICATION. Printing the form and filling it out by hand will result in your application being ineligible.

This form is to be used by:

Licensed Jockeys and Apprentice Jockeys;
Licensed Trainers;
Licensed Stablehands;
Employers of Licensed Apprentices and Stablehands,

(or, where applicable, their family members) to apply to the General Trust Fund (the GTF) for a Financial Hardship Grant.

Link: General Trust fund Policy

Financial Hardship

Financial Hardship Grants are made at the full discretion of the Trustees of the GTF, having regard to the overall financial capacity of the applicant (or their family members in the case of funeral expenses).

As a guide, such Grants may include a financial contribution toward:

the costs of living with (including vehicle or home modifications), or rehabilitating from, a serious injury that are not covered by ACC;
immediate costs incurred by the family members of an injured Licence holder in intensive care;
the cost of living for a licence holder who has entered and continues to engage in a drug or alcohol rehabilitation programme that is approved by NZTR. Such grants would be paid weekly and be contingent on initial and continuing provider reports evidencing continuing positive engagement in the treatment programme;
tuition for a licence holder considering retraining for a new career;
the direct funeral costs in respect of a licence holder; or
any other purpose that the Trustees of the GTF consider is consistent with the general intents of the GTF.

Applications for Financial Hardship Grants to meet training fees or agistment costs of owned racehorses will not be considered.

PLEASE NOTE: All relevant fields must be answered, and all attachments must be submitted with the application. Any failure to do so will prevent your application being processed. Applications to the GTF for a Financial Hardship Grant are to be supported by the following documentation:

Documentation from ACC (claim letter, payment summary)
Supporting documents for additional costs during recovery phase
Medical Certificate or A&E admission
Any other documentation to support the funding request

Financial Hardship Application Type

Costs of living with (including vehicle or home modifications) or rehabilitating from a serious injury that are not covered by ACCImmediate costs incurred by family members of an injured Licence holder in intensive careCost of living for a Licence holder who has entered and continues to engage in a drug or alcohol rehabilitation programme that is approved by NZTR. Such grants would be paid weekly and be contingent on initial and continuing provider reports evidencing continuing positive engagement in the treatment programmeTuition for a Licence holder considering retraining for a new career;Other purpose consistent with the general intents of the GTF

Name*

First NameLast Name

Licence Type*

Email*

example@example.com

Phone Number*

Place where injury occurred (if applicable)?

Date of injury incident or when the serious illness was diagnosed (if applicable)?*

Date

Brief details of the injury incident, serious illness or other circumstances giving rise to the application for a Financial Hardship Grant?*

Please upload your medical certificate (if applicable)*

Weekly Expenses (list of additional expenses during recovery phase)

	Expense type	Expense frequency	Insert Amount
Expense
Expense
Expense
Expense
Expense
Expense
Expense
TOTAL

Income (list income received during recovery phase)

	Period of Cover	Income Frequency	Insert Amount
ACC
Employer
Other
TOTAL

Details surrounding request for cost of living (please provide as much detail as possible)

One Off Expenses

	Expense type	Reason	Insert Amount
Expense
Expense
Expense
TOTAL

Details surrounding request for one off payment (please provide as much detail as possible)

Please upload any supporting documentation

Application Amount *

New Zealand Thoroughbred Racing has my CURRENT bank details*

YesNo

Please upload a screenshot of Bank Account details*

Signature*

Any payment to the applicant by the Trustees from the GTF does not represent any admission of liability on the part of the GTF or its Trustees, NZTR and/or the NZTR member clubs (including any agents, officers or employees of NZTR or such clubs) to the applicant. By applying for and accepting a Financial Hardship Grant from the GTF, the applicant agrees that the payment made by the Trustees on behalf of the GTF, NZTR and/or the NZTR member clubs (including any agents, officers or employees of NZTR or such clubs), is in full and final settlement of any and all of the applicant’s rights against the GTF and its Trustees, NZTR or an NZTR member club (including any agents, officers or employees of NZTR or any such club) in relation to or arising out of the matter giving rise to the application to the GTF for a Financial Hardship Grant.

Bank Details

Signature