Office Use Only
Application Status
Please select
Approved
Declined
Completed
Incomplete
Type of Grant
Please select
Travel Only
Travel & Accommodation
Amount Approved
Date of Meeting
-
Day
-
Month
Year
Date
DOCUMENT CHECKLIST
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OMR2 Shareholder Information
Who is the owner or beneficiary?
*
Please select
I am the owner
I am the owner (Father)
I am the owner (Mother)
I am a Beneficiary of an Individual Shareholder
I am a Beneficiary of a Whanau Trust
Whanau Trust Name
*
The full name of the Whanau Trust as it appears in the Maori Land Court Registry
Shareholder Name
*
The full name of the Individual Shareholder as it appears in the Maori Land Court Registry
Your Whakapapa Link to Omataroa Trust?
Please select
Mother's side
Father's side
Is the applicant a minor ?
*
Please select
Yes
No
A minor is an applicant who is aged 17 years and younger
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Parent Details
Parent Name
*
First Name
Last Name
Your BE Number
*
Type as BE111111. Contact the office if unknown.
E-mail
*
Phone Day
-
Area Code
Phone Number
Mobile
*
-
Area Code
Phone Number
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Applicant Details
Applicant Name
*
First Name
Middle Name
Last Name
Gender
*
Male
Female
Date of Birth
*
Please select a day
1
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Day
Please select a month
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Month
Please select a year
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Year
Current Date
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Day
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Year
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Age
Mobile
*
-
Area Code
Phone Number
Phone Day
-
Area Code
Phone Number
E-mail
example@example.com
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Grant Purpose
Main Grant Purpose
*
Please select
Travel Only
Travel & Accommodation
Briefly explain grant purpose
*
Location of Treatment
*
To qualify for the travel grant you must have travelled 70km in total from your home address
Date of Appointment
*
-
Day
-
Month
Year
Date
Travel Costs
Upload 2025 specialist letter or appointment card
*
BROWSE TO FILE
Cancel
of
Accommodation Costs
Upload 2025 Tax Invoice or receipt of accommodation costs
*
BROWSE TO FILE
Tax invoice/receipt of accommodation costs must coincide with the dates of treatment
Cancel
of
Has your bank details changed
Please select
Yes
No
Bank Account Details
The grant is to be paid to either an applicant, parent/guardian Please make sure you enter the correct account number to avoid delays in payment
Account Name
*
NZ Bank Account No.
*
Enter like this 00-0000-0000000-00.
Upload bank verification
*
Browse Files
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Declaration
Applicant Name
*
Type Name
Date Signed
*
-
Day
-
Month
Year
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