NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au EF.756A Documents The following material must be lodged with this form if you have disclosed receiving any reportable political donations: Copies of receipts and acknowledgments (including unused receipts) issued to donors who have made reportable political donations in the half-yearly period. To facilitate the audit you may provide the following documents: • Copies of loan agreements/loan records shown in Section 8 of this form. This form must be completed by: The person responsible for an elected member who is: • a Member of the NSW Parliament and is a member of a State registered party – the party agent. • a local government councillor or mayor and is a member of a local or State government registered party – the elected member OR with mutual agreement – the party agent. • not a member of a registered party – the elected member. Disclosure period The half-year period 1 July 2020 to 31 December 2020. This form is due by 28 January 2021. What needs to be disclosed: Use this form to disclose political donations received or made, including: • small political donations (under $1,000); • reportable political donations ($1,000 or more); • annual or other subscriptions paid to a party; • contributions, entry fees or other payments to participate in a fundraising venture or function; • reportable loans ($1,000 or more); and • contributions made by the elected member into the campaign account. A political donation made by a person or entity of less than $1,000 is to be disclosed as a reportable political donation if that donation and other, separate political donations made by the person or entity to the same recipient within the same financial year (from 1 July – 30 June) would, if aggregated, total $1,000 or more. When to lodge Return completed form by 28 January 2021, using the contact details at the bottom of this page. Penalties apply for failing to comply. Amendments If you need to amend this declaration, use form EF.757A. Privacy The information collected on this form will be used by the NSW Electoral Commission to undertake its statutory and administrative functions relating to elections, public funding, donations disclosures and lobbying. Not supplying all the information requested may delay or prevent the processing of this form. The form is held by the NSW Electoral Commission and accessible by relevant staff and its contractors. If required or authorised by law, information on this form may be made available for public inspection. It may also be disclosed to other persons or entities if required or authorised by law. We may also use your contact details to send you information or reminders about your responsibilities in relation to elections or lobbying or to invite you to participate in surveys. You can find additional information in the NSW Electoral Commissions Privacy Management Plan concerning access to and correction of your personal information. Please note that disclosures of political donations received and made and electoral expenditure incurred are published on the NSW Electoral Commission’s website. Half-yearly disclosure for an elected member (1 July – 31 December 2020)
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NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au
EF.756A
Documents
The following material must be lodged with this form if you have disclosed receiving any reportable political donations:
Copies of receipts and acknowledgments (including unused receipts) issued to donors who have made reportable political donations in the half-yearly period.
To facilitate the audit you may provide the following documents:
• Copies of loan agreements/loan records shown in Section 8 of this form.
This form must be completed by:The person responsible for an elected member who is:
• a Member of the NSW Parliament and is a member of a State registered party – the party agent.• a local government councillor or mayor and is a member of a local or State government registered party
– the elected member OR with mutual agreement – the party agent.
• not a member of a registered party – the elected member.
Disclosure periodThe half-year period 1 July 2020 to 31 December 2020.
This form is due by 28 January 2021.
What needs to be disclosed:Use this form to disclose political donations received or made, including:
• small political donations (under $1,000);• reportable political donations ($1,000 or more);• annual or other subscriptions paid to a party;• contributions, entry fees or other payments to participate in a fundraising venture or function;• reportable loans ($1,000 or more); and• contributions made by the elected member into the campaign account.
A political donation made by a person or entity of less than $1,000 is to be disclosed as a reportable political donation if that donation and other, separate political donations made by the person or entity to the same recipient within the same financial year (from 1 July – 30 June) would, if aggregated, total $1,000 or more.
When to lodgeReturn completed form by 28 January 2021, using the contact details at the bottom of this page. Penalties apply for failing to comply.
Amendments If you need to amend this declaration, use form EF.757A.
PrivacyThe information collected on this form will be used by the NSW Electoral Commission to undertake its statutory and administrative functions relating to elections, public funding, donations disclosures and lobbying. Not supplying all the information requested may delay or prevent the processing of this form. The form is held by the NSW Electoral Commission and accessible by relevant staff and its contractors. If required or authorised by law, information on this form may be made available for public inspection. It may also be disclosed to other persons or entities if required or authorised by law. We may also use your contact details to send you information or reminders about your responsibilities in relation to elections or lobbying or to invite you to participate in surveys. You can find additional information in the NSW Electoral Commissions Privacy Management Plan concerning access to and correction of your personal information.
Please note that disclosures of political donations received and made and electoral expenditure incurred are published on the NSW Electoral Commission’s website.
Half-yearly disclosure for an elected member(1 July – 31 December 2020)
mailto:fdc%40elections.nsw.gov.au?subject=http://elections.nsw.gov.auhttps://www.elections.nsw.gov.au/About-us/Policy-library/Privacy-Management-Plan
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NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au EF.756A Page 1 of 8
Checklist
Section 2: Elected member details entered
Section 3: Declaration signed
All relevant sections of this disclosure form completed
Section 1: Disclosure period
Half-year: 1 Date: 01 / 07 / 2020 to 31 / 12 / 2020
Section 2: Elected member details
ELECTED MEMBER GIVEN NAME/S (AS ON THE ELECTORAL ROLL) ELECTED MEMBER SURNAME (AS ON THE ELECTORAL ROLL) NAME OF STATE DISTRICT OR LEGISLATIVE COUNCIL OR LOCAL COUNCIL
If the Person Responsible is the party agent, list the full name of the party agent and the registered party below:
PARTY AGENT GIVEN NAME/S (AS ON THE ELECTORAL ROLL) PARTY AGENT SURNAME (AS ON THE ELECTORAL ROLL)
FULL NAME OF PARTY
Section 3: Declaration
This form must be signed by the Person Responsible for making disclosures (see the cover page, ‘This form must be completed by’).
I, GIVEN NAME/S (AS ON THE ELECTORAL ROLL) SURNAME (AS ON THE ELECTORAL ROLL)
declare that all disclosures required to be made in relation to the half-yearly period have been made and are true and correct. I have used my best endeavours in preparing this disclosure declaration and understand that giving false or misleading information is a serious offence.
DD / MM / YYYY
SIGNATURE OF PERSON RESPONSIBLE DATE (ELECTRONIC SIGNATURES ARE NOT ACCEPTED)
OFFICE USE ONLY
MP
Councillor
DD / MM / YYYY
DISTRICT/AREA REGISTRATION NO. DATE RECEIVED PROCESSED BY FADMS DISCLOSURE RECORD NO. FILE NO.
Half-yearly disclosure for an elected member (1 July – 31 December 2020) EF.756A
mailto:fdc%40elections.nsw.gov.au?subject=http://elections.nsw.gov.au
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NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au EF.756A Page 2 of 8
Section 4: Contributions made into the campaign account
Disclose here any personal funds deposited into the campaign account during the half-yearly period, or into the party’s campaign account when the party agent is the person responsible to disclose on behalf of the elected member.
Date contribution was made
Term of each contribution paid into the campaign account(e.g. candidate to be reimbursed if unused)
Amount ($)
TOTAL
Note: Self-funding amounts are not required to be disclosed again on the form as donations received.
Section 5: Small political donations received (not at a fundraising function or venture)
Disclose here any small political donations received by the elected member during this half-yearly period.
$
TOTAL NUMBER OF DONORS WHO EACH DONATED TOTAL VALUE LESS THAN $1,000 IN TOTAL
If more space is required please complete and attach an additional page from the approved form.
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NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au EF.756A Page 3 of 8
Section 6: Reportable political donations received (not at a fundraising function or venture)
Disclose here any reportable political donations received by the elected member in the half-yearly period (not at a fundraising function or venture). A reportable political donation is a donation of $1,000 or more, or a donation of less than $1,000 that, when aggregated with other donations made by the same donor to the same recipient in the financial year, total $1,000 or more. Donations can be monetary or non-monetary (in-kind).
Date donation received
Name of donora. name of individual;b. registered business name of entity;c. name of unincorporated association and names of members of
executive committee of the association; ord. title of trust fund or name of foundation and names of trustees
of trust fund or foundation
Address of donora. residential address of individual; b. registered official address of entity;c. address of members of executive committee of
unincorporated association; ord. address of trustees of the fund or foundation
Business number(ABN/ACN/other)
Receipt no. Gift type(i.e. monetary/non-monetary)
Purpose(i.e.State/LG)
Amount or value of donation ($)
M/N
M/N
M/N
M/N
M/N
M/N
M/N
M/N
TOTAL
If more space is required please complete and attach an additional page from the approved form.
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NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au EF.756A Page 4 of 8
Section 7: Donations received at a fundraising function or venture
Section 7A: Event details of fundraising function(s) or venture(s)Disclose here any fundraising functions or ventures held by or on behalf of the elected member during this half-yearly period.
Date of function or venture
Brief description of the event Purpose(i.e.State/LG)
Net (N) or Gross (G)
Proceeds ($)
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
N/G
Note: The gross total of Section 7A must equal the sum of totals of 7B and 7C TOTAL
If more space is required please complete and attach an additional page from the approved form.
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NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au EF.756A Page 5 of 8
Section 7: Donations received at a fundraising function or venture (continued)
Section 7B: Small political donations received at fundraising function(s) or venture(s)Disclose here any small political donations made to or for the benefit of the elected member as part of any fundraising function or venture during this half-yearly period.
Date of function or venture
Brief description of the event(as detailed in Section 7A)
Purpose(i.e.State/LG)
Total number of donors who each donated less than $1,000 in total
Total value of small donations ($)
TOTAL
If more space is required please complete and attach an additional page from the approved form.
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NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au EF.756A Page 6 of 8
Section 7: Donations received at a fundraising function or venture (continued)
Section 7C: Reportable political donations received at fundraising function(s) or venture(s)Disclose here any reportable political donations received by the elected member in the half-yearly period (at a fundraising function or venture). A reportable political donation is a donation of $1,000 or more, or a donation of less than $1,000 that, when aggregated with other donations made by the same donor to the same recipient in the financial year, total $1,000 or more. Donations can be monetary or non-monetary (in-kind).
Date donation received
Name of donora. name of individual;b. registered business name of entity;c. name of unincorporated association and
names of members of executive committee of the association; or
d. title of trust fund or name of foundation and names of trustees of trust fund or foundation
Address of donora. residential address of individual; b. registered official address of entity;c. address of members of executive
committee of unincorporated association; or
d. address of trustees of the fund or foundation
Business number(ABN/ACN/other)
Receipt no. Gift type(i.e. monetary/non-monetary)
Purpose(i.e.State/LG)
Brief description of the event (as detailed in Section 7A)
Amount or value of donation ($)
M/N
M/N
M/N
M/N
M/N
M/N
TOTAL
If more space is required please complete and attach an additional page from the approved form.
mailto:fdc%40elections.nsw.gov.au?subject=http://elections.nsw.gov.au
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NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au EF.756A Page 7 of 8
Section 8: Reportable loans received
Disclose here any loans for $1,000 or more , including multiple loans (of any value) from the same lender to the same recipient within the half-yearly period, which when combined, total $1,000 or more. Credit card transactions are included as loans, and must be disclosed if they total $1,000 or more from the same provider to the same recipient within the half -yearly period. Repayments on loans received should also be disclosed here.
Date loan received
Name of lendera. name of individual;b. registered business name of entity;c. name of unincorporated association and
names of members of executive committee of the association; or
d. title of trust fund or name of foundation and names of trustees of trust fund or foundation
Address of lendera. residential address of individual; b. registered official address of entity;c. address of members of executive
committee of unincorporated association; or
d. address of trustees of the fund or foundation
Business number(ABN/ACN/other)
Term, conditions and repayments on loan(e.g. the interest rate, term of the loan and repayments on the principal of the loan not including payments of interest)
Amount or value of loan ($)
TOTAL
If more space is required please complete and attach an additional page from the approved form.
mailto:fdc%40elections.nsw.gov.au?subject=http://elections.nsw.gov.au
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NSW Electoral Commission | GPO Box 4046, SYDNEY NSW 2001 | P 1300 022 011 | F 02 9290 5410 | E [email protected] | elections.nsw.gov.au EF.756A Page 8 of 8
Section 9: Small political donations made
Disclose here any political donations made by the elected member during this half-yearly period to a NSW candidate, group of candidates, local government councillor, Member of Parliament, party, third-party campaigner or associated entity. Annual or other subscriptions made to a party for membership or affiliation of less than $1,000 should be disclosed as small political donations made.
$ TOTAL NUMBER OF RECIPIENTS OF SMALL DONATIONS MADE TOTAL VALUE
Section 10: Reportable political donations made
Disclose here any reportable political donations made by the elected member in the half-yearly period including any membership or affiliation fees paid to a party. A reportable political donation is a donation of $1,000 or more, or a donation of less than $1,000 that, when aggregated with other donations made by the same donor to the same recipient in the financial year, total $1,000 or more. Donations can be monetary or non-monetary (in-kind).
Date donation made
Name of recipient(i.e. NSW party, elected member, candidate, group, third-party campaigner, or associated entity)
Receipt no. Gift type(i.e. monetary/non-monetary)
Purpose(i.e.State/ LG)
Amount or value of donation ($)
M/N
M/N
M/N
M/N
M/N
M/N
M/N
M/N
M/N
TOTAL
If more space is required please complete and attach an additional page from the approved form.
Once you have completed all sections as required, please lodge using the details at the bottom of this form.
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mailto:fdc%40elections.nsw.gov.au?subject=http://elections.nsw.gov.au
Check Box 14: OffElected member given name: Elected member surname: Name of state district: Party agent given name: Party agent surname: Full name of party: Given name: Surname: Print Form 26: Day 17: Month 17: Year 17: S4 date 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17:
S4 term 1: S4 amount 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17:
S4 term 2: S4 term 3: S4 term 4: S4 term 5: S4 term 6: S4 term 7: S4 term 8: S4 term 9: S4 term 10: S4 term 11: S4 term 12: S4 term 13: S4 term 14: S4 term 15: S4 term 16: S4 term 17: S4 term 18: S4 Total: Total number of donors S5: Total S5: S6 total value: S6-Donation received 1: 0: 1: 2: 3: 4: 5: 6: 7:
S6-Name of donor 1: 0: 1: 2: 3: 4: 5: 6: 7:
S6-Address of donor 1: 0: 1: 2: 3: 4: 5: 6: 7:
S6-Bus no 1: 0: 1: 2: 3: 4: 5: 6: 7:
S6-Receipt no 1: 0: 1: 2: 3: 4: 5: 6: 7:
S6 Gift type 1: 0: []1: []2: []3: []4: []5: []6: []7: []
S6-Purpose 4: 0: []1: []2: []3: []4: []5: []6: []7: []
S6 Value 1: 0: 1: 2: 3: 4: 5: 6: 7:
S7A Total: S7A Date of function 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17: 18: 19: 20: 21: 22:
S7A Brief description of the event 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17: 18: 19: 20: 21: 22:
S7A Purpose 1: 0: []1: []2: []3: []4: []5: []6: []7: []8: []9: []10: []11: []12: []13: []14: []15: []16: []17: []18: []19: []20: []21: []22: []
S7A Net or Gross 1: 0: [ ]1: [ ]2: [ ]3: [ ]4: [ ]5: [ ]6: [ ]7: [ ]8: [ ]9: [ ]10: [ ]11: [ ]12: [ ]13: [ ]14: [ ]15: [ ]16: [ ]17: [ ]18: [ ]19: [ ]20: [ ]21: [ ]22: [ ]
S7A Proceeds 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17: 18: 19: 20: 21: 22:
S8B Date of function or venture 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17: 18: 19: 20: 21:
S8B Description of event 1: S8B Purpose 1: []S8B Total number of donors 1: S8B Total value of donations 1: 0: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17: 18: 19: 20: 21:
S8B Description of event 2: S8B Purpose 2: []S8B Total number of donors 2: S8B Description of event 3: S8B Purpose 3: []S8B Total number of donors 3: S8B Description of event 4: S8B Purpose 4: []S8B Total number of donors 4: S8B Description of event 5: S8B Purpose 5: []S8B Total number of donors 5: S8B Description of event 6: S8B Purpose 6: []S8B Total number of donors 6: S8B Description of event 7: S8B Purpose 7: []S8B Total number of donors 7: S8B Description of event 8: S8B Purpose 8: []S8B Total number of donors 8: S8B Description of event 9: S8B Purpose 9: []S8B Total number of donors 9: S8B Description of event 10: S8B Purpose 10: []S8B Total number of donors 10: S8B Description of event 11: S8B Purpose 11: []S8B Total number of donors 11: S8B Description of event 12: S8B Purpose 12: []S8B Total number of donors 12: S8B Description of event 13: S8B Purpose 13: []S8B Total number of donors 13: S8B Description of event 14: S8B Purpose 14: []S8B Total number of donors 14: S8B Description of event 15: S8B Purpose 15: []S8B Total number of donors 15: S8B Description of event 16: S8B Purpose 16: []S8B Total number of donors 16: S8B Description of event 17: S8B Purpose 17: []S8B Total number of donors 17: S8B Description of event 18: S8B Purpose 18: []S8B Total number of donors 18: S8B Description of event 19: S8B Purpose 19: []S8B Total number of donors 19: S8B Description of event 20: S8B Purpose 20: []S8B Total number of donors 20: S8B Description of event 21: S8B Purpose 21: []S8B Total number of donors 21: S8B Description of event 22: S8B Purpose 22: []S8B Total number of donors 22: S8B Total no donors: S8B Total: S8C Donation received 1: 0: 1: 2: 3: 4: 5:
S8C Name of donor 1: S8C Address of donor 1: S8C Bus no 1: S8C Receipt number 1: S8C Gift type 2: []S8C Purpose 1: []S8C Brief description of event 1: S8C Amount 1: 0: 1: 2: 3: 4: 5:
S8C Name of donor 2: S8C Address of donor 2: S8C Bus no 2: S8C Receipt number 2: S8C Gift type 3: []S8C Purpose 2: []S8C Brief description of event 2: S8C Name of donor 3: S8C Address of donor 3: S8C Bus no 3: S8C Receipt number 3: S8C Gift type 4: []S8C Purpose 3: []S8C Brief description of event 3: S8C Name of donor 4: S8C Address of donor 4: S8C Bus no 4: S8C Receipt number 4: S8C Gift type 5: []S8C Purpose 4: []S8C Brief description of event 4: S8C Name of donor 5: S8C Address of donor 5: S8C Bus no 5: S8C Receipt number 5: S8C Gift type 6: []S8C Purpose 5: []S8C Brief description of event 5: S8C Name of donor 6: S8C Address of donor 6: S8C Bus no 6: S8C Receipt number 6: S8C Gift type 7: []S8C Purpose 6: []S8C Brief description of event 6: S8C Total: S9 Date loan received 1: 0: 1: 2: 3:
S9 Name of lender 1: S9 Address of lender 1: S9 Bus no 1: S9 Term on loan 1: S9 Value 1: 0: 1: 2: 3:
S9 Name of lender 2: S9 Address of lender 2: S9 Bus no 2: S9 Term on loan 1 2: S9 Name of lender 3: S9 Address of lender 3: S9 Bus no 3: S9 Term on loan 1 3: S9 Name of lender 4: S9 Address of lender 4: S9 Bus no 4: S9 Term on loan 1 4: S9 Total: S10 total recipients: S10 total value: S11 Date donation made 1: 0: 1: 2: 3: 4: 5: 6: 7: 8:
S11 Name of recipient 1: S11 Receipt number 1: S11 Gift type 11: []S11 Purpose 1: []S11 Amount 1: 0: 1: 2: 3: 4: 5: 6: 7: 8:
S11 Name of recipient 2: S11 Receipt number 2: S11 Gift type 12: []S11 Purpose 2: []S11 Name of recipient 3: S11 Receipt number 3: S11 Gift type 13: []S11 Purpose 3: []S11 Name of recipient 4: S11 Receipt number 4: S11 Gift type 14: []S11 Purpose 4: []S11 Name of recipient 5: S11 Receipt number 5: S11 Gift type 15: []S11 Purpose 5: []S11 Name of recipient 6: S11 Receipt number 6: S11 Gift type 16: []S11 Purpose 6: []S11 Name of recipient 7: S11 Receipt number 7: S11 Gift type 17: []S11 Purpose 7: []S11 Name of recipient 8: S11 Receipt number 8: S11 Gift type 18: []S11 Purpose 8: []S11 Name of recipient 9: S11 Receipt number 9: S11 Gift type 19: []S11 Purpose 9: []S11 Total: Check Box 9: OffCheck Box 15: OffCheck Box 16: Off
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