Annual return for an associated entity	
			
For the [insert year] financial year	
This return covers the period:	1 July
[insert year]	to	30 June [insert year]		
			
Associated entity details	
			
Name of associated entity:			
			
Address of associated entity:			
		Postcode:		
			
Details of person completing the return	
			
Name of financial controller:			
			
Capacity/position with the associated entity:			
			
Daytime contact number:			
			
Email:			
			
I certify that the information contained in this return and its attachments is true and complete.	
Signature of reporting agent:		/        /		
			
Please refer to the Election funding, expenditure and financial disclosure [insert year] handbook when completing this form.  Authority for collecting information in this form is in section 231B of the Electoral Act 1992.  Information in the form will be made public at the beginning of September [insert year], as required by section 234 of the Electoral Act.	
What must be declared?
•	The associated entity must provide details of receipts (both donations and other receipts), payments and debts relevant to the [insert year] financial year.
•	The associated entity must, with some exceptions (see the handbook), provide details of all those from whom any amount was received.
•	If the associated entity is indebted for $1000 or more to the same person or organisation, the details of the person or organisation owed the debt must be shown.
•	Details of those who deposited capital that was subsequently paid to, or used for the benefit of, a political party or MLA must also be shown (see the handbook for more information).	
	
Enquiries and returns should be addressed to:
ACT Electoral Commission,  PO Box 272, CIVIC SQUARE ACT 2608
Ground Floor, North Building, London Circuit, Civic Square, Canberra City, ACT 2601	
Phone: 6205 0224	Fax: 6205 0382	Email: elections@act.gov.au	Web: www.elections.act.gov.au	
The due date for lodging this return is [insert day] 31 July [insert year]	
Information on this page is made public except for the financial controller’s email and phone number.
Summary of receipts, payments and debts

	1.  Receipts 		
			
		Amounts paid into ACT election account	Amounts paid into federal election account	Amounts paid into other accounts	Total receipts		
	Gifts						
	Other receipts						
	Total						
	For a gift-in-kind, include the value of the receipt allocated to the relevant account above.		
	Details of all receipts of any amount, including the name and address of each payer, must be itemised at part 5 on page 3.  (See the handbook for exceptions to this requirement.)		
			
	2.  Small anonymous gifts 		
			
	Of the receipts shown at 1 above, show the amount of small anonymous gifts received.		
	A small anonymous gift means a gift made anonymously that is less than $250.		
			
	Total small anonymous gifts		

	3.  Payments 		
			
	Payments made from ACT election account	Payments made from federal election account	Payments made from other accounts	Total payments		
						
	If a payment made by a person on behalf of the associated entity was a gift-in-kind (such as paid advertising), include the value of the payment allocated to the relevant account above.		
			
	4.  Outstanding debts as at 30 June [insert year] 		
			
	Debts outstanding in ACT election account	Debts outstanding in federal election account	Debts outstanding in other accounts	Total debts outstanding		
						
	For outstanding debts totalling $1000 or more owed to the same person or organisation, complete the required details on page 4.

Information on this page is made public.
5.  Details of all receipts *	
* See the handbook for exceptions to this requirement.	
	Name of person, organisation, unincorporated association, trust fund or foundation	For a person or organisation — address		Date
received	Type of receipt ()	Amount or value allocated to ACT election account	Amount or value allocated to federal election account	Amount or value allocated to other accounts		
		For an unincorporated association — names and addresses of members of the executive committee	For a company — ABN							
		For a trust fund or foundation — names and addresses of the trustees			Gift	Gift-in-kind	Other receipt					

												

												

												

												
			
	Gifts-in-kind	If any gift is a gift-in-kind, then the value of the gift-in-kind should be notionally allocated to the relevant account, even though no money may have been actually deposited into that account.  If a gift is a gift-in-kind, provide the following details:		
	Description of the gift 	How the gift was valued	Value of the gift 		

					
	
Information on this page is made public except for how a gift-in-kind is valued.

	6.  Outstanding debts as at 30 June [insert year] totalling $1000 or more		
			
	Provide the details of persons and organisations to whom an amount totalling $1000 or more is owed.		
			
	Name	Address	Total
amount
owed	Amount owed
from ACT election account	Amount owed
from federal election account	Amount owed
from other accounts		

								

								

								

								

								

								

	7.  Persons and organisations who deposited capital		
	See the handbook before completing this section.		
	Name	Address	Total
amount
deposited	Amount
deposited
into
ACT
election account	Amount
deposited
into
federal
election
account	Amount
deposited
into
other
accounts		

								

								

Information on this page is made public.