Donor to Political Party and Political Campaigner Amendment Form

Request for Amendment Donor to Political Party and Political Campaigners Disclosure Return – Individuals FINANCIAL YEAR 2020-21

Completing the Return:  This request for amendment should be used to amend a 2020-21 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 Tuesday 1 February 2022 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 s 319A(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. 2020-21 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/tow n 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

DAR_1 (06/21) – Page 1 of 4

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/Tow n State Postcode Amended Name/Party code $ .00 Entry Postal address Suburb/Tow n State Postcode Original Name/Party code .00 Entry Postal address Suburb/Tow n State Postcode Amended Name/Party code .00 Entry Postal address Suburb/Tow n State Postcode Original Name/Party code $ .00 Entry Postal address Suburb/Tow n State Postcode Amended Name/Party code $ .00 Entry Postal address Suburb/Tow n State Postcode Original Name/Party code $ .00 Entry Postal address Suburb/Tow n State Postcode Amended Name/Party code $ .00 Entry Postal address Suburb/Tow n 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 (06/21) – Page 2 of 4 Part 2: Donations made to a political campaigner

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

Original Name $ .00 Entry Postal address Suburb/Tow n State Postcode Amended Name $ .00 Entry Postal address Suburb/Tow n State Postcode Original Name .00 Entry Postal address Suburb/Tow n State Postcode Amended Name .00 Entry Postal address Suburb/Tow n State Postcode Original Name $ .00 Entry Postal address Suburb/Tow n State Postcode Amended Name $ .00 Entry Postal address Suburb/Tow n State Postcode Original Name $ .00 Entry Postal address Suburb/Tow n State Postcode Amended Name $ .00 Entry Postal address Suburb/Tow n 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 (06/21) – Page 3 of 4

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 (06/21) – Page 4 of 4 Registered Political Party and Branch Codes AJP Animal Justice Party AFP-NSW Australia First Party (NSW) Incorporated CODE Party / Branch AAHP Australian Affordable Housing Party

ABF Australian Better Families ALP-ACT Australian Labor Party (ACT Branch) ACH Australian Christians ALP-NSW Australian Labor Party (N.S.W. Branch) AUD Australian Democrats Australian Labor Party (Northern Territory ALP-NT CAL Australian Federation Party Branch) APEP Australian People’s Party ALP-QLD Australian Labor Party (State of Queensland) PROG Australian Progressives Australian Labor Party (South Australian ALP-SA AWP Australian Workers Party Branch) XEN Centre Alliance ALP-TAS Australian Labor Party (Tasmanian Branch) CPP Child Protection Party ALP-VIC Australian Labor Party (Victorian Branch) CDP Christian Democratic Party (Fred Nile Group) Australian Labor Party (Western Australian CEC Citizens Electoral Council of Australia ALP-WA Branch) Climate Emergency Action Alliance: Vote SOOPA ALP-FED Australian Labor Party (ALP) Planet UAPP Clive Palmer's United Australia Party CLR-NSW Country Labor Party DHJP Derryn Hinch’s Justice Party

FRASER ANNING'S CONSERVATIVE DLP-NSW Democratic Labour Party (DLP) NSW Branch FACN NATIONAL PARTY Democratic Labour Party (DLP) – Queensland DLP-QLD NMP Health Australia Party Branch HEM Help End Marijuana Prohibition (HEMP) Party Democratic Labour Party (DLP) – Victorian DLP-VIC Branch ICAN Independents CAN DLP-WA Democratic Labour Party (DLP) – WA Branch IMO Informed Medical Options Party JLN Jacqui Lambie Netw ork DLP Democratic Labour Party (DLP) of Australia KAP Katter's Australian Party (KAP)

Australian Greens, Australian Capital Territory LAOL Love Australia or Leave GRN-ACT Branch NOG No 5G Party Online Direct Democracy - (Empow ering the GRN-NSW The Greens NSW SOL People!) GRN-NT Australian Greens, Northern Territory Branch ONA Pauline Hanson’s One Nation GRN-QLD Queensland Greens PIR Pirate Party Australia GRN-SA Australian Greens (South Australia) REAS Reason Australia RPA Republican Party of Australia GRN-TAS Australian Greens, Tasmanian Branch RPT Rex Patrick Team GRN-VIC The Australian Greens - Victoria FUT Science Party GRN-WA The Greens (WA) Inc SPA Secular Party of Australia GRN Australian Greens SUN Seniors United Party of Australia SFP Shooters, Fishers and Farmers Party LIB-ACT Liberal Party of Australia – ACT Division SAL Socialist Alliance SEP Socialist Equality Party LIB-NSW Liberal Party of Australia, NSW Division Sustainable Australia Party – Stop SPP LNP-QLD Liberal National Party of Queensland Overdevelopment / Corruption LIB-SA Liberal Party of Australia (S.A. Division) AMHP The Australian Mental Health Party GAP The Great Australian Party LIB-TAS Liberal Party of Australia – Tasmanian Division TSBP The Small Business Party LIB-VIC Liberal Party of Australia (Victorian Division) TTP The Together Party LIB-WA Liberal Party (W.A. Division) Inc. TWP The Women's Party LIB-FED Liberal Party of Australia TMP Transport Matters Party CLP-NT Country Liberal Party (NT) VNS Victorian Socialists VEP Voluntary Euthanasia Party NAT-SA National Party of Australia (S.A.) Inc. FLUX VOTEFLUX.ORG | Upgrade Democracy! NAT-VIC National Party of Australia – Victoria WAP WESTERN AUSTRALIA PARTY NAT-NSW National Party of Australia – N.S.W. ALA Yellow Vest Australia NAT-WA National Party of Australia (WA) Inc NAT-FED National Party of Australia

LDP-FED Liberal Democratic Party LDP-ACT Liberal Democratic Party (ACT Branch) LDP-NSW Liberal Democratic Party (NSW Branch) LDP-QLD Liberal Democratic Party (QLD Branch) LDP-SA Liberal Democratic Party (SA Branch) LDP-VIC Liberal Democratic Party (Victoria Branch) LDP-WA Liberal Democratic Party (WA Branch)