Request for Amendment Donor to Political Party Disclosure Return – Organisations 2016–17 FINANCIAL YEAR Completing the return:  This request for amendment should be used to amend a 2016–17 Donor to Political Party Disclosure Return – Organisations lodged with the AEC.  This request for amendment is to be completed with reference to the Financial Disclosure Guide for Donors to Political Parties.  Further information is available at www.aec.gov.au.  This request for amendment will be available for public inspection from Thursday 1 February 2018 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) of the Commonwealth Electoral Act 1918. NOTE: This form is for the use of organisations only. Please use the form Request for Amendment – Donor to Political Party Disclosure Return – Individuals if you are completing a return for an individual. Details of organisation that made the donation

Name

Address

Suburb/town State Postcode

ABN ACN 2016–17 return details Is this the first amendment Yes No How many other Request for to the return? Amendments have been lodged? 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 – Organisations 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 have made due and reasonable inquiries of the organisation on whose behalf I am authorised to complete this form. I understand that submitting an incomplete, false or misleading return is an offence under section 315 of the Commonwealth Electoral Act 1918.

Signature Date

Enquiries and returns Funding and Disclosure 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 (06/17) – Page 1 of 5 How to complete this form:  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.

Part 1a: Other business names

No change to previous information OR Provide details of changes or amendments to the information previously provided.

Original Entry Trading name

Amended Entry Trading name

Original Entry Trading name

Amended Entry Trading Name

Part 1b: Related bodies corporate No change to previous information OR Provide details of changes or amendments to the information previously provided.

Original Entry Name Postal address

Suburb/town State Postcode

ABN ACN

Amended Entry Name Postal address

Suburb/town State Postcode

ABN ACN

Original Entry Name

Postal address

Suburb/town State Postcode

ABN ACN

Amended Entry Name

Postal address

Suburb/town State Postcode

ABN ACN

If insufficient space, please attach additional sheets.

DAR_1 (06/17) – Page 2 of 5 Part 2: Donations made No change to previous information OR Provide details of changes or amendments to the information previously provided.

Value of Party details Date of donation 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 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. ** Donation is a gift within the meaning of Division 4 – Disclosure of donations, in Part XX the Commonwealth Electoral Act 1918.

DAR_1 (06/17) – Page 3 of 5

Part 3: Donations received No change to previous information OR

Provide details of changes or amendments to the information previously provided.

Value of Received from Date of donation 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 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. ** Donation is a gift within the meaning of Division 4 – Disclosure of donations, in Part XX the Commonwealth Electoral Act 1918.

DAR_1 (06/17) – Page 4 of 5

Registered Political Party and Branch Codes CODE Party / Branch SPP #Sustainable 21ST 21st Century Australia

ALP-ACT Australian Labor Party (ACT Branch) AJP Animal Justice Party AFP-NSW Australia First Party (NSW) Incorporated ALP-NSW Australian Labor Party (N.S.W. Branch) ACH Australian Christians ALP-NT Australian Labor Party (Northern Territory) Branch ACP ALP-QLD Australian Labor Party (State of Queensland) CAL Australian Country Party ALP-SA Australian Labor Party (South Australian Branch) CYC Australian Cyclists Party ALP-TAS Australian Labor Party (Tasmanian Branch) AEQ Australian Equality Party (Marriage) ALP-VIC Australian Labor Party (Victorian Branch) ALA Australian Liberty Alliance

ALP-WA Australian Labor Party (Western Australian Branch) APEP Australian People’s Party

ALP-FED Australian Labor Party (ALP) PROG Australian Progressives ARF Australian Recreational Fishers Party CLR-NSW Country Labor Party ASP Australian Sex Party DLP-NSW Democratic Labour Party NSW Branch AWP Australian Workers Party DLP-QLD Democratic Labour Party - Queensland Branch CDP Christian (Fred Nile Group) CEC Citizens Electoral Council of Australia DLP-VIC Democratic Labour Party - Victorian Branch CRNT Consumer Rights & No-Tolls DLP-WA Democratic Labour Party - WA Branch CLP-NT Country Liberals (Northern Territory) DLP Democratic Labour Party CM CountryMinded

FFP-QLD - QLD DHJP Derryn Hinch’s Justice Party FFP-SA Family First Party - SA DLRA Drug Law Reform Australia FFP-VIC Family First Party - VIC GLT Glenn Lazarus Team FFP Family First Party NMP Health HEM Help End Marijuana Prohibition (HEMP) Party GRN-ACT Australian Greens, Australian Capital Territory Branch IMO Involuntary Medication Objectors (Vaccination/Fluoride) Party GRN-NSW The Greens NSW JLN Jacqui Lambie Network GRN-NT Australian Greens, Northern Territory Branch KAP Katter’s GRN-QLD Queensland Greens LDP Liberal Democratic Party GRN-SA Australian Greens (South Australia) LAOL Love Australia or Leave GRN-TAS Australian Greens, Tasmanian Branch MAP Mature Australia Party GRN-VIC The Australian Greens - Victoria XEN Nick Xenophon Team GRN-WA The Greens (WA) Inc NCP Non-Custodial Parents Party (Equal Parenting) GRN-FED Australian Greens SOL – (Empowering the People!)

ODR Outdoor Recreation Party (Stop the Greens) LIB-ACT of Australia - ACT Division ONA Pauline Hanson’s One Nation LIB-NSW Liberal Party of Australia, NSW Division PIR LNP-QLD Liberal National Party of Queensland REP Renewable Energy Party LIB-SA Liberal Party of Australia (S.A. Division) RUA LIB-TAS Liberal Party of Australia - Tasmanian Division FUT Science Party LIB-VIC Liberal Party of Australia (Victorian Division) SPA Secular Party of Australia LIB-WA Liberal Party (W.A. Division) Inc SUN Seniors United Party of Australia LIB-FED Liberal Party of Australia SFP Shooters, Fishers and Farmers Party NAT-SA National Party of Australia (S.A.) Inc. SMK Smokers Rights Party NAT-VIC National Party of Australia - Victoria SAL Socialist Alliance NAT-NSW National Party of Australia - N.S.W. SEP Socialist Equality Party NAT-WA National Party of Australia (WA) Inc ARTS The NAT-FED National Party of Australia AMHP The Australian Mental Health Party

VEP Voluntary Euthanasia Party

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DAR_1 (06/17) – Page 5 of 5