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Point Chevalier Veterans Their Families and Community Trust Grant Application Form

Use the form below to apply to the Point Chevalier Veterans Their Families and Community Trust Grant round.

Note this form is for individuals and families (not organisations)

Please make sure you have read our Guidance Notes and checked your eligibility before applying. If you are unsure, or have any questions about your application, please contact Auckland Foundation. You can save your progress, and come back to complete the form at any time, as long as you use the same computer/device.

If you or someone you know needs additional support, there are several services available to veterans in Aotearoa New Zealand. These include: Veterans’ Affairs New Zealand,....

If you need support completing this form please contact the Welfare Officer for the Pt. Chev RSA on admin@ptchevrsa.co.nz or +64 9 846 8673

 

General Information
First name of applicant *
Last name of applicant *
Applicant Date of birth *
Residential address *
Contact email address *
Contact phone number *
Full name of the Veteran/Service person (if the applicant is a partner/family member)
Veteran/Service person's Date of Birth
Service the veteran belongs to. E.g. Navy, Army, Airforce etc
Military Service number of the Service Person / Veteran
save progress
Grant Request Details
Date of Visit 1 *
Type of Expense 1 *
Amount Charged 1 *
Amount Approved 1 *
Date of Visit 2
Type of Expense 2
Amount Charged 2
Amount Approved 2
Date of Visit 3
Type of Expense 3
Amount Charged 3
Amount Approved 3
Date of Visit 4
Type of Expense 4
Amount Charged 4
Amount Approved 4
Date of Visit 5
Type of Expense 5
Amount Charged 5
Amount Approved 5
Date of Visit 6
Type of Expense 6
Amount Charged 6
Amount Approved 6
Attach files here for the above question if needed (jpeg, png, word doc, excel, csv, or pdf. 50MB Max)
save progress
Payment of Grants
All grants are paid by direct credit into a bank account. Please complete details bellow and provide evidence to verify the bank account details. (Applications for services/goods will be paid directly to the supplier.)
Bank Account Name *
Full Bank Account Number *
Proof of Bank Account (please upload a screenshot or image) * (jpeg, png, word doc, excel, csv, or pdf. 50MB Max)
save progress
Evidence
Please supply any evidence to support this application. Evidence is: invoices, quotes, bank statements, medical documents, referral letters.
File upload here (jpeg, png, word doc, excel, csv, or pdf. 50MB Max)
File upload here (jpeg, png, word doc, excel, csv, or pdf. 50MB Max)
File upload here (jpeg, png, word doc, excel, csv, or pdf. 50MB Max)
save progress
Declaration
This information to be true and correct * Confirm these expenses have not been claimed from any other RSA or organisation (or insurance provider) * Information may be shared with other organisations that can assist * This form will be submitted to PT CH
save progress
Information Sharing
By signing this application form; you consent to the Auckland Foundation sharing information with, and gathering information from, other organisations or private persons, for the purpose of assessing the application.
save progress
Declaration
Please write your name in the field provided as confirmation of your application *
Please write the name of the person who filled out the form, if not the applicant
Date *