Request for Amendment Donor to Political Party Disclosure

Return – Individuals FINANCIAL YEAR 2008-2009

Completing the Return:

• This request for an amended return should be used by by individuals who made a gift or donation to a registered political party (or a State branch), or to another person or organisation with the intention of benefiting a registered political party, to amend a 2008-2009 Donor to Political Party Return – Individuals, lodged with the AEC. • Further information is available at www.aec.gov.au. • This return will be available for public inspection from Monday 1 February 2010 at www.aec.gov.au. • Any supporting documentation included with this return may be treated as part of a public disclosure and displayed on the AEC website. • The information on this return is collected under 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 Disclosure Return – Organisations if you are completing a return for an organisation.

Details of person who made the donation Name

2008-2009 Return details Is this the first amendment Yes  No  How many other Request for to the return? Amendment have been made?   Details of person completing this return Name

Capacity or position 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 Return – Individuals as detailed in this form. I certify that the information contained in this request and its attachments is true and complete. I understand that giving false or misleading information is a serious offence.

Signature Date

Enquiries and returns Funding and Disclosure Phone: 02 6271 4552 should be addressed to: Australian Electoral Commission Fax: 02 6271 4555 PO Box 6172 Email: [email protected] Kingston ACT 2604

Office use only Date received Registration No D/ /A

DAR_3 (07/09) – Page 1 of 4

1. Donations made No change to previous information OR Provide details of changes or amendments to the information previously provided. Note: All amounts are GST inclusive. How to complete this table: If you are amending an existing entry, write out both the original entry and the amended entry in full. If adding a completely new entry, write N/A in the ‘Original Entry’ line.

Party details Date of donation Value of donation

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.

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2. Donations received No change to previous information OR

Provide details of changes or amendments to the information previously provided. Note: All amounts are GST inclusive. How to complete this table: If you are amending an existing entry, write out both the original entry and the amended entry in full. If adding a completely new entry, write N/A in the ‘Original Entry’ line.

Received from Date of donation Value of donation

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.

DAR_3 (07/09) – Page 3 of 4 Registered Political Party and Branch Codes CODE Party / Branch

DEM-FED Australian Democrats LIB-FED of DEM-NSW Australian Democrats – NSW LIB-NSW Liberal Party of Australia – NSW DEM-VIC Australian Democrats – VIC LIB-VIC Liberal Party of Australia – VIC DEM-QLD Australian Democrats – QLD LNP-QLD Liberal National Party of Queensland DEM-WA Australian Democrats – WA LIB-WA Liberal Party (WA Division) Inc. DEM-SA Australian Democrats – SA LIB-SA Liberal Party of Australia – SA DEM-ACT Australian Democrats – ACT LIB-TAS Liberal Party of Australia – TAS LIB-ACT Liberal Party of Australia – ACT GRN-FED Australian Greens GRN-NSW The Greens NSW NAT-FED National Party of Australia GRN-VIC The Australian Greens – VIC NAT-NSW National Party of Australia – NSW GRN-QLD Queensland Greens NAT -VIC National Party of Australia – VIC GRN-WA The Greens (WA) Inc NAT-WA National Party of Australia (WA) Inc. GRN-SA Australian Greens – SA NAT -SA National Party of Australia (SA) Inc. GRN-TAS Australian Greens – TAS GRN-ACT Australian Greens – ACT ONA-FED One Nation GRN-NT Australian Greens – NT ONA-VIC One Nation – VIC ONA-QLD One Nation – QLD ALP-FED ONA-WA One Nation – WA ALP-NSW Australian Labor Party – NSW ONA-SA One Nation – SA ALP-VIC Australian Labor Party – VIC ALP-QLD Australian Labor Party – QLD FLP-FED Australian Fishing and Lifestyle Party ALP-WA Australian Labor Party – WA CAR-FED ALP-SA Australian Labor Party – SA CEC-FED Citizens Electoral Council of Australia ALP-TAS Australian Labor Party – TAS CCC-FED ALP-ACT Australian Labor Party – ACT COM-FED Conservatives for Climate and Environment ALP-NT Australian Labor Party – NT CCE-FED Incorporated

CDP-FED Christian (Fred Nile CLR-FED Country Labor Party Group) HOV-FED Hear Our Voice CDP-WA Christian Democratic Party (Fred Nile Group) – WA LDP-FED Liberal Democratic Party NCP-FED Non-Custodial Parents Party (Equal Parenting) DLP-FES Democratic Labor Party of Australia CLP-NT Northern Territory Country Liberal Party DLP-NSW Democratic Labor Party – NSW NDP-FED Nuclear Disarmament Party of Australia DLP-QLD Democratic Labor Party – QLD PUA-FED Pauline’s United DLP-WA Democratic Labor Party – WA SOL-FED Senator On-Line

FFP-FED SAL-FED Socialist Alliance FFP-NSW Family First Party – NSW SEP-FED Socialist Equality Party FFP-VIC Family First Party – VIC ASP-FED The Australian Shooters Party FFP-QLD Family First Party – QLD FPY-FED The Fishing Party FFP-WA Family First Party – WA WWW-FED What Women Want (Australia) FFP-SA Family First Party – SA YNP-FED Young National Party of Australia

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