Elections ACT

Election return by a donor to
candidates, non-party groups or specified bodies	
following the ACT Legislative Assembly election held on	Insert election date 		
	
Please refer to the Funding and financial disclosure handbook, Third parties when completing this form.	
	
The due date for lodging this return is [insert date 15 weeks after polling day]
(15 weeks after polling day)	
	
Enquiries and returns should be addressed to:

ACT Electoral Commission
PO Box 272
CIVIC SQUARE ACT 2608	
Telephone: 6205 0224	Fax: 6205 0382	Email: elections@act.gov.au	Website: www.elections.act.gov.au	
			
Donor details	
			
Name of person or organisation making the donation:			
			
Postal address of person or organisation making the donation:			
	Postcode:                    		
			
Details of person completing the return	
			
Full name of person completing the return:			
			
Capacity/position of person completing the return:			
			
(A return for an organisation should be signed by an appropriate officer, such as the company secretary or finance manager.  See the Funding and financial disclosure handbook, Third parties.)	
			
Postal address of person completing the return:			
	Postcode:                    		
			
Contact telephone:			
			
I certify that the information contained in this return and its attachments is true and complete.	
Agent’s signature:	/          /          		
			
This form is  Approved Form AF2004-29 under section 340A of the Electoral Act 1992
	Election return by a donor - Page 2 of 2
	
Gifts to candidates, non-party groups or specified bodies	
	
This return covers the period:	Insert date 30 days after previous ACT election	to	Insert date 30 days after election		
This return covers gifts made to candidates, non-party groups or specified bodies from 31 days after the previous Legislative Assembly election until 30 days after polling day for the current election.	
Details of gifts to be disclosed	
Where one donation was made of, or a number of donations were made totalling:	
•	$1500 or more to the same candidate or non-party group; or
•	$1500 or more to the same specified body;	
list, in the table below, the name and address of each person or organisation receiving the donation, along with the date and value of each gift.	
Please refer to the definition of gifts in the Funding and financial disclosure handbook, Third parties for information on the kinds of gifts required to be disclosed in this return.	
					
	Name and address of person, group or body receiving the gift	Brief description of the gift if other than money	Date gift made	Value of gift		
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	If space is insufficient please attach additional sheets