Responsible person consent – Fundraisers
Fundraising Act 1998
1. Are you an incorporated association incorporated outside of Victoria?Under the Fundraising Act 1998, an incorporated association incorporated outside of Victoria who proposes to register as a fundraiser must appoint a responsible person. The responsible person must be a member of the governing body of the association.
Yes
Please complete this form – go to question 2.
No
You are not required to complete this form.
2. Details of incorporated association
Name of fundraising incorporated association
Association number
Registered address
Include postcode. PO Boxes not accepted.
Daytime telephone number
Mobiles OK. If a landline, include area code.
Email address
3. Details of responsible person
Name of responsible person
Address
If different from registered address above.
Daytime telephone number
Mobiles OK. If a landline, include area code.
Email address
4. Declaration and signature of responsible person
· I consent to being the responsible person for the purposes of the Fundraising Act 1998 for the incorporated association listed in this form.
· I understand that by consenting I am responsible for ensuring that the incorporated association complies with all the obligations placed on the association by the Fundraising Act 1998.
· I understand that the penalty for not meeting the obligation imposed on me as the responsible person for the incorporated association is 120 Victorian penalty units (in excess of $18,0000
Signature of responsible person Type name if lodging online or sign if lodging by post.
Date
dd/mm/yyyy
Privacy
For privacy information, please refer to the Privacy statement page on the Consumer Affairs Victoria website (consumer.vic.gov.au/privacy).
How to lodge
Post:
Consumer Affairs Victoria
GPO Box 4567
Melbourne VIC 3001
Assistance:
Telephone: 1300 13 54 52
NRS: 133 677
ABN: 32 790 228 959
Email:
Web: consumer.vic.gov.au/fundraisers
(08/2016)
consumer.vic.gov.au/fundraisers Page 2 of 2