Associated entity annual return [insert year] - Page 1 of 4

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 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	
			
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:                    		
			
Email:			
			
I certify that the information contained in this return and its attachments is true and complete.	
Financial controller’s signature:	/          /          		
			
Approved Form AF2010 - 115  approved by the Electoral Commissioner, on 10 June 2010, under s. 340A of the Electoral Act 1992.  
This approval revokes the form AF2008-47
	Associated entity annual return [insert year] - 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 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 for annual returns).	
	
2.  Persons and organisations from whom any amount was received	
•	In the table below, list the name, address and the total amount received for those persons and organisations from whom any amount was received.  However, do not include amounts received from, and details of, individuals where the amount received is for the supply of liquor or food under a liquor license or for the playing of gaming machines under a gaming license, or where the amount received was for membership of the entity and the membership fee is less than $50 per year.
•	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 -115   approved by the Electoral Commissioner, on 10 June 2010, under s. 340A of the Electoral Act 1992.  
This approval revokes the form AF2008-47.
	Associated entity annual return [insert year] - 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 $1000, 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 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 $1000, 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 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		
Approved Form AF2010 -115   approved by the Electoral Commissioner, on 10 June 2010, under s. 340A of the Electoral Act 1992.  
This approval revokes the form AF2008-47
	Associated entity annual return [insert year] - 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 $1000, must be included;
•	no category of debt is to be excluded; and
•	all figures must be gross.	
	
6.  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 -115   approved by the Electoral Commissioner, on 10 June 2010, under s. 340A of the Electoral Act 1992.  
This approval revokes the form AF2008-47.