Registered political party annual return [insert year] - Page 1 of 3

Elections ACT

Registered political party 
annual return for the [insert year] financial year	
	This return covers the period:	1/  7  /[insert year]	to	/    /[insert year]		
		1/7/[insert year] or the date the party became registered		30/6/[insert year] or the date the party was deregistered		
Please refer to the Funding and financial disclosure handbook for annual returns when completing this form.	
	
The due date for lodging this return is [insert day and date]	

Enquiries and returns should be addressed to:	
	
Postal address:	Elections ACT, PO Box 272, Civic Square ACT 2608		
Physical address:	Ground Floor, North Building, London Circuit, Civic Square, Canberra City, ACT 2601	
	
Telephone: 6205 0224	Fax: 6205 0382	Email: elections@act.gov.au	Website: www.elections.act.gov.au	
	
Party details	
			
Name of party:			
			
Postal address:			
	Postcode:                    		
			
Reporting agent’s details 
(If a reporting agent has not been appointed, the Registered Officer of the party must complete the return)	
			
Name of reporting agent:			
			
Postal address:			
	Postcode:                    		
			
Email:			
			
I certify that the information contained in this return and its attachments is true and complete.	
Signature of person completing return:	/          /          		
			
Approved Form AF2010 –114 approved by the Electoral Commissioner, on 10 June 2010, under section 340A of the Electoral Act 1992.
This approval revokes the form AF2008-45
	Registered political party annual return [insert year] - Page 2 of 3
	
Receipts	
	
1.  Total receipts this financial year	$		
This total includes all receipts of the party.	
Importantly:	
•	receipts of all party units must be included in the total;
•	all transactions, including those of less than $1000, must be included in the total;
•	no category of receipts is to be excluded (for example, membership fees and 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 for annual returns).	
	
2.  Persons and organisations from whom $1000 or more was received	
•	In the table below, list the name, address and the total amount received for those persons and organisations from whom $1000 or more was received.
•	In determining whether the $1000 threshold has been reached, amounts of less than $1000 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		
Approved Form AF2010 –114 approved by the Electoral Commissioner, on 10 June 2010, under section 340A of the Electoral Act 1992.
This approval revokes the form AF2008-45
	Registered political party annual return [insert year] - Page 3 of 3
	
Payments	
			
3.  Total payments this financial year	$		
This total includes all payments by the party.	
Importantly:	
•	payments of all party units must be included in the total;
•	all transactions, including those of less than $1000, must be included in the total;
•	no category of payments to be excluded (for example, wages and salaries are included); and
•	all figures must be gross.	
	
Outstanding debts as at 30 June	
			
4.  Total debts as at 30 June	$		
This total includes all debts, overdrafts and unpaid accounts of the party.	
Importantly:	
•	debts of all party units must be included in the total;
•	all debts, including those of less than $1000, must be included in the total;
•	no category of debt is to be excluded; and
•	all figures must be gross.	
	
5.  Persons and organisations to whom $1000 or more is owed	
In the table below, list the name, address and the total amount outstanding for those persons and organisations to whom $1000 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		
Approved Form AF2010 –114 approved by the Electoral Commissioner, on 10 June 2010, under section 340A of the Electoral Act 1992.
This approval revokes the form AF2008-45