Donor to Political Party Individuals

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Request for Amendment Donor to Political Party and Political Campaigners Disclosure Return – Individuals FINANCIAL YEAR 2018-19

Completing the Return: • This request for amendment should be used to amend a 2018-19 Donor to Political Party and Political Campaigners Disclosure Return - Individuals lodged with the AEC. • This request for amendment is to be completed with reference to the Financial Disclosure Guide for Donors to Political Parties and Political Campaigners. • This request for amendment will be available for public inspection from 3 February 2020 at www.aec.gov.au. • Any supporting documentation included with this request for amendment may be treated as part of a public disclosure and displayed on the AEC website. • The information on this request for amendment is collected under s319A(2) the Commonwealth Electoral Act 1918.

NOTE: this form is for the use of individuals only. Please use the form Request for Amendment - Donor to Political Party and Political Campaigners Disclosure Return – Organisations if you are completing a return for an organisation. 2018-19 Return details Is this the first amendment Yes No How many other Request for to the return? Amendments have been lodged?

Details of person who made the donation Name Postal address

Suburb/town State Postcode Telephone number ( ) Fax number ( )

Email address

Request and Certification I request the Electoral Commission amend the Donor to Political Party and Political Campaigners Return – Individuals as detailed in this request for amendment. I certify that the information contained in this request for amendment and its attachments is true and complete to the best of my knowledge, information and belief. I understand that submitting a false or misleading return is an offence under Division 137.1 of the Criminal Code Act 1995.

Signature Date

Enquiries and returns Disclosure and Compliance Phone: 02 6271 4552 should be addressed to: Australian Electoral Commission Fax: 02 6293 7655 Locked Bag 4007 Email: [email protected] Canberra ACT 2601

Office use only Date received

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Part 1: Donations made to a political party No change to previous information OR Provide details of changes or amendments to the information previously provided. How to complete this table: • If you are amending an existing entry, complete the ‘Original Entry’ item as it appeared on the original return and then write the amendment in full at the ‘Amended Entry’ item. • If adding a completely new entry, write N/A in the ‘Original Entry’ item and complete the ‘Amended Entry’ item in full’. • Amounts should be reported on a GST inclusive basis.

Value of donation* Party details Date of donation (GST inclusive)

Original Name/Party code $ .00 Entry Postal address Suburb/Town State Postcode Amended Name/Party code $ .00 Entry Postal address Suburb/Town State Postcode Original Name/Party code .00 Entry Postal address Suburb/Town State Postcode Amended Name/Party code .00 Entry Postal address Suburb/Town State Postcode Original Name/Party code $ .00 Entry Postal address Suburb/Town State Postcode Amended Name/Party code $ .00 Entry Postal address Suburb/Town State Postcode Original Name/Party code $ .00 Entry Postal address Suburb/Town State Postcode Amended Name/Party code $ .00 Entry Postal address Suburb/Town State Postcode

If insufficient space, please attach additional sheets.

* In this form donation is a gift within the meaning in section 287(1) of the Electoral Act.

DAR_1 (05/19) – Page 2 of 6 Part 2: Donations made to a political campaigner No change to previous information OR Provide details of changes or amendments to the information previously provided. How to complete this table: • If you are amending an existing entry, complete the ‘Original Entry’ item as it appeared on the original return and then write the amendment in full at the ‘Amended Entry’ item. • If adding a completely new entry, write N/A in the ‘Original Entry’ item and complete the ‘Amended Entry’ item in full’. • Amounts should be reported on a GST inclusive basis.

Value of donation* Campaigner details Date of donation (GST inclusive)

Original Name $ .00 Entry Postal address Suburb/Town State Postcode Amended Name $ .00 Entry Postal address Suburb/Town State Postcode Original Name .00 Entry Postal address Suburb/Town State Postcode Amended Name .00 Entry Postal address Suburb/Town State Postcode Original Name $ .00 Entry Postal address Suburb/Town State Postcode Amended Name $ .00 Entry Postal address Suburb/Town State Postcode Original Name $ .00 Entry Postal address Suburb/Town State Postcode Amended Name $ .00 Entry Postal address Suburb/Town State Postcode

If insufficient space, please attach additional sheets.

* In this form donation is a gift within the meaning in section 287(1) of the Electoral Act.

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Part 3: Donations received No change to previous information OR

Provide details of changes or amendments to the information previously provided. How to complete this table: • If you are amending an existing entry, complete the ‘Original Entry’ item as it appeared on the original return and then write the amendment in full at the ‘Amended Entry’ item. • If adding a completely new entry, write N/A in the ‘Original Entry’ item and complete the ‘Amended Entry’ item in full. • Amounts should be reported on a GST inclusive basis.

Value of donation* Received from Date of donation (GST inclusive)

If insufficient space, please attach additional sheets.

* * In this form donation is a gift within the meaning in section 287(1) of the Electoral Act.

DAR_1 (05/19) – Page 4 of 6 Registered Political Party and Branch Codes NAT-SA National Party of Australia (S.A.) Inc. CODE Party / Branch NAT-VIC National Party of Australia – Victoria NAT-NSW National Party of Australia – N.S.W. ACP-FED Australian Conservatives NAT-WA National Party of Australia (WA) Inc ACP-ACT Australian Conservatives (ACT) NAT-FED National Party of Australia ACP-NSW Australian Conservatives (NSW) LDP-FED Liberal Democratic Party ACP-NT Australian Conservatives (NT) LDP-ACT Liberal Democratic Party (ACT Branch) ACP-QLD Australian Conservatives (Qld) LDP-NSW Liberal Democratic Party (NSW Branch) ACP-SA Australian Conservatives (SA) LDP-QLD Liberal Democratic Party (QLD Branch) ACP-TAS Australian Conservatives (Tas) LDP-SA Liberal Democratic Party (SA Branch) ACP-VIC Australian Conservatives (Vic) LDP-VIC Liberal Democratic Party (Victoria Branch) ACP-WA Australian Conservatives (WA) Liberal Democratic Party (WA Branch) LDP-WA ALP-ACT Australian Labor Party (ACT Branch) SPP #Sustainable Australia ALP-NSW Australian Labor Party (N.S.W. Branch) AJP Animal Justice Party Australian Labor Party (Northern Territory ALP-NT Branch) AFP-NSW Australia First Party (NSW) Incorporated ALP-QLD Australian Labor Party (State of Queensland) AAPH Australian Affordable Housing Party Australian Labor Party (South Australian ALP-SA ABF Australian Better Families Branch) ACH Australian Christians ALP-TAS Australian Labor Party (Tasmanian Branch) CAL Australian Country Party ALP-VIC Australian Labor Party (Victorian Branch) AUD Australian Democrats Australian Labor Party (Western Australian ALP-WA Branch) APEP Australian People’s Party ALP-FED Australian Labor Party (ALP) PROG Australian Progressives CLR-NSW Country Labor Party AWP Australian Workers Party XEN Centre Alliance DLP-NSW Democratic Labour Party (DLP) NSW Branch CPP Child Protection Party Democratic Labour Party (DLP) – Queensland DLP-QLD Christian Democratic Party (Fred Nile Group) Branch CDP Democratic Labour Party (DLP) – Victorian CEC Citizens Electoral Council of Australia DLP-VIC Branch Climate Action! Immigration Action! SOL DLP-WA Democratic Labour Party (DLP) – WA Branch Accountable Politicians! DLP Democratic Labour Party (DLP) of Australia CLP-NT Country Liberals (Northern Territory) DHJP Derryn Hinch’s Justice Party Australian Greens, Australian Capital Territory GRN-ACT FRASER ANNING'S CONSERVATIVE Branch FACN NATIONAL PARTY GRN-NSW The Greens NSW GRN-NT Australian Greens, Northern Territory Branch NMP Health Australia Party GRN-QLD Queensland Greens HEM Help End Marijuana Prohibition (HEMP) Party GRN-SA Australian Greens (South Australia) ICAN Independents For Climate Action Now Involuntary Medication Objectors GRN-TAS Australian Greens, Tasmanian Branch IMO (Vaccination/Fluoride) Party GRN-VIC The Australian Greens - Victoria JLN Jacqui Lambie Network GRN-WA The Greens (WA) Inc KAP Katter’s Australian Party GRN Australian Greens LAOL Love Australia or Leave

NCP Non-Custodial Parents Party (Equal Parenting) LIB-ACT Liberal Party of Australia – ACT Division ONA Pauline Hanson’s One Nation LIB-NSW Liberal Party of Australia, NSW Division PIR Pirate Party Australia LNP-QLD Liberal National Party of Queensland REAS Reason Australia LIB-SA Liberal Party of Australia (S.A. Division) RPA Republican Party of Australia LIB-TAS Liberal Party of Australia – Tasmanian Division RUA Rise Up Australia Party LIB-VIC Liberal Party of Australia (Victorian Division) FUT Science Party LIB-WA Liberal Party (W.A. Division) Inc. SPA Secular Party of Australia LIB-FED Liberal Party of Australia SUN Seniors United Party of Australia SFP Shooters, Fishers and Farmers Party

SAL Socialist Alliance SEP Socialist Equality Party

ARTS The Arts Party

DAR_1 (05/19) – Page 5 of 6 AMHP The Australian Mental Health Party GAP The Great Australian Party TSBP The Small Business Party TTP The Together Party TWP The Women's Party TSSA Tim Storer Independent SA UAPP United Australia Party VNS Victorian Socialists VEP Voluntary Euthanasia Party FLUX VOTEFLUX.ORG | Upgrade Democracy! WAP WESTERN AUSTRALIA PARTY ALA Yellow Vest Australia

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