Sport and Recreation Disaster Recovery Program – Application Form
Sport and Recreation Disaster Recovery Program - Application Form
This form can be submitted by email, in person or by post to your local Sport and Recreation Services office. See the Sport and Recreation Disaster Recovery Program guidelines for details or call 13 74 68.
Applicants must be located in areas defined under the Natural Disaster Relief and Recovery Arrangements (NDRRA).
Funding is provided in two levels. Refer to the program guidelines for detailed information regarding eligibility, insurance requirements and the application process.
Section 1 - Organisation details
Applicant organisation details
1 Which Natural Disaster Relief and Recovery Arrangements (NDRRA) declared disaster affected your organisation?
2 Have you already received financial assistance (from another source such as your insurer, QRAA or from Council) for the specific items that you wish to claim for in this application?
Yes – if this funding or insurance did not cover the total cost of damage, or you are applying to cover the insurance excess, continue to Question 3.
Yes – if the funding or insurance covered all costs incurred you are not eligible for support from this program.
No – please continue to Question 3.
3 What is your organisation’s full legal/incorporated name?
4 Under which Act are you incorporated? (Tick the relevant box)
Associations Incorporation Act 1981 (Qld)
Corporations Act 2001 (Cwlth)
Cooperatives Act 1997 (Qld)
Corporations (Aboriginal and Torres Strait Islander) Act 2006 (Cwlth)
Other (please specify)
5 What is your incorporation number?
6 Do you have an Australian Business Number (ABN)?
Yes
ABNNo – your organisation will need to apply for an ABN at www.ato.gov.au before any payment can be made.
7 Are you registered for Goods and Services Tax (GST)?
Yes
Registration date / / / /No
8 Who is the accountable officer for your organisation? (e.g. President, Chief Executive Officer.)
Mr/Mrs/Ms/MissFirst name
Surname
Position title
Telephone
Fax
Mobile
Email address
(This person is responsible for project coordination and meeting with departmental representatives)
9 Who is the contact person for this project? (This person is responsible for project coordination and meeting with departmental representatives.)
As above – if same as accountable officer.
Mr/Mrs/Ms/MissFirst name
Surname
Position title
Telephone
Fax
Mobile
Email address
10 What are your organisation’s address details? (Please complete all fields.)
Street addressSuburb/Town
State / QLD / Postcode
As above – if postal address is the same as organisation’s address (otherwise, please complete postal address fields below).
Postal addressSuburb/Town
State / QLD / Postcode
11 What is the physical address of the property where damage has occurred? (Please complete all fields.)
As above – if same as organisation’s address (otherwise, please complete fields below).
Street addressSuburb/Town
State / QLD / Postcode
Lot number
Registered plan
(e.g. Lot 21 Registered Plan RP736671)
Section 2 – Funding requested
12 What sport/recreation activities will the funding support? (e.g. netball, cricket.)
13 Outline the damage that was a direct result of the disaster declared event:
14 Is the facility currently operational?
Yes
No – please provide photographic evidence or organise for a Sport and Recreation Services (SRS) Officer to do a brief inspection of the damage to determine eligibility.
15 If you answered Yes to Question 14, can the club provide evidence (invoices/proof of payment) that its own funds were used to repair the damage?
Yes – proceed to Question 16.
No – consult an SRS Officer for support with your application.
Level 1 funding: Immediate clean-up
16 Please use the following table to outline how your organisation will expend the grant.
Please detail any equipment damaged, services and hire costs for repairs and any clean-up items required.
*Note: Funding requested from the program will be dependent on whether the organisation is registered for GST. If your organisation is registered for GST, please enter the requested amount excluding GST. For organisations registered for GST the department will pay the GST amount at the same time as paying the approved funding.
If your organisation is NOT registered for GST, please enter the requested amount as the total including GST.
Details / Amount needed ($) (exc. GST)$
$
$
$
$
$
$
$
$
TOTAL ESTIMATED DAMAGE (exc. GST) / $
TOTAL ESTIMATED DAMAGE (incl. GST) / $
TOTAL REQUESTED FROM THIS PROGRAM / $
V1.1 – 30 October 2017 1
Sport and Recreation Disaster Recovery Program – Application Form
Section 3
Declaration
Before submitting your application you need to agree to the terms and conditions. These are available on the department's website or please read Appendix 2.
Privacy Notice – regarding the information provided in the application
The Department of National Parks, Sport and Racing is collecting the information in the Sport and Recreation Disaster Recovery program (the program) application form to assess applications for funding under the program. Information will also be used to help the department monitor and evaluate programs and resources. This information will only be accessed and used by authorised employees within the department, and approved contractors appointed by the department to conduct a program evaluation.
The department will disclose details of approved funding and details of accountable officers (such as name, position in the organisation, and telephone number) to local members of Parliament. Information on approved organisations and details of approved projects, such as funding approved and location of the project will also be made available on the department’s website and may be provided to local governments and relevant sport and recreation organisations for the purpose of advice on approved project information. Your information will not be disclosed to any other parties unless authorised or required by law, subject to the above.
If you have any further questions regarding privacy, please contact the department’s Privacy Contact Officer at .
Please have an authorised delegate of your organisation’s management committee complete the details below and sign for, and on behalf of, your organisation.
I acknowledge and agree that in order to process this application, the department will enter the details from this application form into its grant management system, and that the information entered by the department will be exactly as it appears in this form (except for minor typographical errors). The application will be assessed on the basis of this information.
I declare that:
· I have been authorised by the applicant organisation to submit this Application for Funding under the Sport and Recreation Disaster Recovery Program.
· all information relating to the organisation is true andcorrect.
· I have read the Funding Terms and Conditions in Appendix 2 and that the organisation will abide by these terms and conditions if this application is successful.
NamePosition
Signature
Date
Organisation contact details will be included in a database for future mail outs and emails. If you do not wish to receive this information, please tick the box below:
I would not like to be included in a mailing list for further mail outs and emails about the department's services and initiatives in my local area.
Appendix 1 - Payment by Electronic Funds Transfer
The Department of National Parks, Sport and Racing (the department), can provide prompt payment by Electronic Funds Transfer (EFT). Payment by this method is faster, more convenient and more secure.
This form is used to arrange payment of funding and must be completed by all organisations that are to receive funding from the department.
Please note the following:
· You will receive a remittance advice giving details of the invoices/items paid. If you do not nominate an email address or a fax number, the advice will be posted on the day the transfer is made.
· All sections of the form must be completed. If you do not know the BSB number, please obtain this information from your financial institution.
· Please advise the department if you change any details of your bank account, or the email address/fax number to which the remittance advice should be sent.
· The department is under no obligation to verify the bank account details provided.
· Payment will be deemed to have been made when the department has instructed its bank to credit your nominated account.
· The department will not be responsible for delays in payment or errors due to factors outside reasonable control of the department. These may include, but are not limited to, delays or errors in the banking system or errors in the account details provided below.
· The organisation agrees to repay the department on demand any payments credited to the organisation in error, and the department reserves the right to offset the amount of any overpayment credited to the organisation in error against any future debt or liability owing by the department to the organisation.
Organisation details (Legal name must be the name as listed on the Incorporation Certificate and/or Australian Business Register. Bank account name below must match the legal name)
Legal name(incorporated/listed on Aus. Business Register)
ABN
Postal address
Telephone
Fax
Bank details (These details must match information provided in an official bank statement to verify bank details, including the account name, BSB and account number. Ensure details are clearly printed and accurate)
Account name(must match legal name)
BSB number / -
Account number
Full name of bank or institution
Organisation authorisation (An appropriate delegate must complete this form e.g. CEO, President, Secretary or Treasurer)
NamePosition
Signature
Date
The Department of National Parks, Sport and Racing (the department), is collecting the information on this form to create/update your details on our financial management system. The department is authorised to collect this information under the Financial Accountability Act 2009. This information will only be accessed by authorised employees within the Department. The department may give some or all of this information to your financial institution and the Queensland Audit Office. This information will only be accessed by authorised employees within the Department. Your information will not be disclosed to any other parties unless authorised or required by law. If you have any questions regarding your privacy, please contact .
Appendix 2 – Funding Terms and Conditions
The following terms and conditions will apply to the funding if this application is approved. If Your application is successful, a letter of approval will be issued from the Minister for Sport or the Department.
1. In these Funding Terms and Conditions, capitalised words and phrases have the following meaning:
a. ‘We’ or ‘Us’ or ‘Department’ means the State of Queensland through the Department of National Parks, Sport and Racing.
b. ‘You’ ‘Your’ or ‘Organisation’ means the organisation specified in the application form in Section 1 under the heading ‘Full legal incorporated name’ which has been approved to receive funding under the Sport and Recreation Disaster Recovery Program.
c. ‘Approved Funding’ means that amount as stipulated in Your notification letter.
d. ‘Approved Items / Works’ means the items and/or works outlined in Section 2 of the application form and approved by Us, unless varied in Your notification letter, then it means those items and/or works outlined in Your notification letter.
e. ‘Funding Agreement’ means Your notification letter (including any attachments), these Funding Terms and Conditions (or, if required under clause 7, the additional funding agreement), this application form (excluding these Funding Terms and Conditions) and the Program Guidelines. Where any inconsistency exists between these documents, the provisions will take precedence in that order to the extent necessary to resolve the inconsistency.
f. ‘Program Guidelines’ means the Sport and Recreation Disaster Recovery Program Guidelines available at http://www.qld.gov.au/recreation/sports/funding/disaster-recovery/.
g. ‘Your notification letter’ means the letter issued to You by the Department (being, either the Department’s letter of approval or a letter following the Minister for Sport’s letter of approval).
2. The Department reserves the right to withdraw the Sport and Recreation Disaster Recovery Program or make changes at any time. Any changes to the program will be publicly advertised on the Department’s website at www.npsr.qld.gov.au.
3. In consideration of You complying with the Funding Agreement, We will provide You with the Approved Funding within 10 business days of the later of the following:
a. the date of Your notification letter (or execution of an additional funding agreement, if required);
b. Your provision of Your ABN to Us;
c. Your completed EFT form; and
d. a copy of Your bank statement which details Your account information or a letter from the financial institution with details of the Your account for the payment of the Approved Funding.
4. Your use of the Approved Funding will be deemed as acceptance of the Funding Agreement. We may in our absolute discretion, require You to enter into an additional funding agreement (for example, if We determine this is required based on severity of damage or the amount of funding approved). If Your notification letter requires entry into an additional funding agreement, then these Funding Terms and Conditions will not apply and additional funding agreement will apply instead upon execution of that agreement, We will not make any payment of the Approved Funding until the additional funding agreement is signed.
5. The Funding Agreement commences on the day the Approved Funds are deposited into Your bank account and ends 30 days after the submission of all reports and acquittals under clause 8 to Our satisfaction, unless terminated earlier in accordance with clause 15 or 16.
6. You warrant that the person submitting the application form and agreeing to be bound by the Funding Agreement is authorised to do so on behalf of the Organisation.
7. Payment will be made by electronic transfer in accordance with the bank account details specified in the EFT form provided with Your application form. It is Your responsibility to immediately notify Us of any changes to Your bank details by providing either a bank statement which details Your account information or a letter from the financial institution with details of the Your account for the payment of the Approved Funding.
8. You must:
a. use the Approved Funding by the date that is 12 months after the date of Your notification letter for the purposes set out in the Program Guidelines and for the Approved Items / Works and for no other purpose;