Whenua Maori Fund Application Form (Page 3 of 6) in pdf

Whenua Maori Fund Application Form Page 3

5. Provider Details (if Provider identified)

If you know who you would like to do the work please provide details of the organisation you would like

to deliver the project (the provider organisation) [discussion with Te Puni Kōkiri regional staff may be

required].

Name

Postal

Address

Physical

Landline

Phone

Mobile

Type of

Organisation

Company Office

Include number where applicable

Registration

GST Registered

Include GST number

Principal

Please provide the name(s) and contact details for the principal provider within the provider organisation.

Provider(s)

6. Conflicts of Interest

Please provide details of any conflicts of interest between the application organisation and the provider

organisation [discussion with Te Puni Kōkiri staff may be required].

Conflicts of

Identify any known conflicts of interest between the applicant organisation and the provider organisation

Interest

7. Other Engagement

Has the application been discussed with other government agencies / potential funding partners?

Detail

Please describe other agencies and/or partners that this application has been discussed with.

Engagement

Page 3 of 6

Whenua Maori Fund Application Form Page 3