Elections ACT

Associated entity annual return	
	for the period:	1/7/[insert year]	to	30/6/[insert year]		
			
Please refer to the Funding and financial disclosure handbook, Associated entities when completing this form.	
	
The due date for lodging this return is [insert date 16 weeks after the end of the financial year]	
	
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	
			
Associated entity details	
			
Name of associated entity:			
			
Postal address:			
	Postcode:                    		
			
Financial controller’s details 	
			
Name of financial controller:			
			
Capacity/position with the
associated entity:			
			
Postal address:			
	Postcode:                    		
			
I certify that the information contained in this return and its attachments is true and complete.	
Financial controller’s signature:	/          /          		
			
This form is  Approved Form AF2004-34 under section 340A of the Electoral Act 1992
	Associated entity annual return - Page 2 of 4
	
Receipts	
	
1.  Total receipts this financial year	$		
This total includes all receipts of the associated entity.	
Importantly:	
•	receipts throughout all sections of the associated entity must be included in the total;
•	all transactions, including those of less than $1500, must be included;
•	no category of receipts is to be excluded (for example, loans received are included);
•	all figures must be gross; and
•	this total includes monetary receipts and gifts-in-kind (as defined in the Funding and financial disclosure handbook, Associated entities).	
	
2.  Persons and organisations from whom $1500 or more was received	
•	In the table below, list the name, address and the total amount received for those persons and organisations from whom $1500 or more was received.
•	In determining whether the $1500 threshold has been reached, amounts of less than $1500 need not be counted.
•	Where a loan has been received from a source other than a recognised financial institution, details of the terms and conditions of that loan must also be disclosed.	
					
	Name	Address	Amount received		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
	If space is insufficient please attach additional sheets		

	Associated entity annual return - Page 3 of 4
	
Payments	
			
3.  Total payments this financial year	$		
This total includes all payments by the associated entity.	
Importantly:	
•	payments throughout all sections of the associated entity must be included in the total;
•	all transactions, including those of less than $1500, must be included;
•	no category of payments to be excluded (for example wages and salaries are included); and
•	all figures must be gross.	
			
Capital	
			
4.  Persons and organisations who deposited capital	
Where any payment included at item 3 Total payments this financial year was:	
•	paid to or for the benefit of one or more registered political parties, ballot groups, or MLAs; and
•	paid out of funds generated from capital of the entity;	
list in the table below the name, address and the total of capital deposits for all persons who contributed to the capital of the associated entity in this financial year.	
Importantly:	
•	all transactions, including those of less than $1500, must be included;
•	all capital deposits must be included whether or not those deposits directly generated the funds used to make a payment to, or for the benefit of, a political party, ballot group or MLA;
•	include all deposits made, not a total of deposits net of withdrawals/repayments or a balance as at 30 June; and
•	do not include capital deposits that have been disclosed on a previous return.	
	
	Name	Address	Total capital		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
	If space is insufficient please attach additional sheets		

	Associated entity annual return - Page 4 of 4
	
Outstanding debts as at 30 June	
			
5.  Total debts as at 30 June	$		
This total includes all debts, overdrafts and unpaid accounts of the associated entity.	
Importantly:	
•	debts outstanding throughout all sections of the associated entity must be included in the total;
•	all debts, including those of less than $1500, must be included;
•	no category of debt is to be excluded; and
•	all figures must be gross.	
	
6.  Persons and organisations to whom $1500 or more is owed	
In the table below, list the name, address and the total amount outstanding for those persons and organisations to whom $1500 or more is owed.  All amounts must be included when determining if the threshold has been reached.	
	Name	Address	Amount Owed		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
	If space is insufficient please attach additional sheets