Request for Amendment Donor to Political Party and Political Campaigners Disclosure Return – Organisations 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 – 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 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) 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 and Political Campaigners 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

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 completing this return Name

Capacity or position

Postal address

Suburb/town State Postcode

Telephone number ( ) Fax number ( )

Email address

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 6 Request and Certification

I request the Electoral Commission amend the Donor to Political Party and Political Campaigners 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 a false or misleading return is an offence under Division 137.1 of the Criminal Code Act 1995.

Signature Date

DAR_1 (06/21) – Page 2 of 6

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 (06/21) – Page 3 of 6 Part 2: Donations made to a political party No change to previous information OR Provide details of changes or amendments to the information previously provided.

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 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 (06/21) – Page 4 of 6

Part 3: 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.

DAR_1 (06/21) – Page 5 of 6

Part 4: 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 $ .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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