Gambling and Racing Control Act 1999, s 53D						
COMMUNITY CONTRIBUTIONS INFORMATION
FINANCIAL REPORT BY A CLUB
(Pursuant to section 166 of the Gaming Machine Act 2004)

APPLICABLE FINANCIAL YEAR:  ____________________________		
					
Licence Number:			Venue:		

		$	
A.		GROSS GAMING MACHINE REVENUE (GGMR)
(Total after deducting players’ winnings (excluding linked jackpots) and any amount set aside under a linked-jackpot arrangement for the payment of jackpot payouts)		
B.	24% OF GGMR		
C.	GAMING MACHINE TAX LIABILITY
(Tax payable under section 159 of the Act)		
D.	TOTAL NET GAMING MACHINE REVENUE (NGMR) [ABC]		
E.	TOTAL VALUE OF CLAIMED COMMUNITY CONTRIBUTIONS		
F.	CLAIMED COMMUNITY CONTRIBUTIONS AS A % OF NGMR [E/D x 100]		
G.	REQUIRED COMMUNITY CONTRIBUTIONS (D x 0.07)		
H.	EXCESS/(DEFICIT) OF CLAIMED COMMUNITY CONTRIBUTIONS COMPARED
TO REQUIRED CONTRIBUTIONS (EG)		
I.	VALUE OF CONTRIBUTIONS TO REGISTERED POLITICAL PARTIES AND THEIR ASSOCIATED POLITICAL ENTITIES 		

Signature of person submitting report:			Date:	                /            /	
					
Position in corporation: