Charitable Recyclers Rebate Program (CRR)

Charitable Recyclers Rebate Program (CRR)

Application form

This application form is for use by charitable recyclers that operate within the Perth metropolitan area to apply for funding under the Charitable Recyclers Rebate program. (CRR)

Further information on the program is contained in the Guidelines - Charitable Recyclers Rebate program available from:

CLAIM PERIOD

Enter the relevant period(s) and year for which funding is being claimed:

Period 1: January – March
Period 2: April – June
Period 3: July – September
Period 4: October – December

Claim period(s)
Year(s)

ORGANISATION DETAILS

Organisation name

Address

Street

Suburb

Postcode

State

Postal address

Street

Suburb

Postcode

State

CONTACT PERSON

Title

First name

Last name

Position

Phone

ELIGIBILITY DETAILS
Is the organisation a licensed charity under the Western Australian Charitable Collections Act 1946? / ☐YES ☐NO
Has the organisation obtained Deductible Gift Recipient Status from the Australian Tax Office? / ☐YES ☐NO
Does the organisation collect or receive donated goods at public drop-off or donation points such as charity bins or shopfronts in the Perth metropolitan region, in accordance with a community service or activity that benefits the community? / ☐YES ☐NO
Are the collection activities undertaken voluntary or not-for-profit and with no commercial interest (they are undertaken exclusively to support the charitable purpose of the organisation)?
If no, please provide details of commercial interests that benefit from the collection activities. / ☐YES ☐NO
Does the organisation sell or allow its brand to be used by commercial operators to solicit donated goods?
If yes, provide details on the commercial operators that use the brand and the purpose that the goods are solicited for. / ☐YES ☐NO

DETAILS OF CLAIM

Is this rebate claimed for waste that has been disposed of at a landfill(s) licensed by the Department of Water and Environmental Regulation (DWER)?

☐YES ☐NO

What is the total quantity of eligible waste disposed of to landfill during the quarter?

___ tonnes

Has the landfill levy been applied to the waste disposed?

☐YES ☐NO

Total value (dollar amount) of your claim for the quarter (landfill levy cost associated with disposing of the quantity of waste to landfill in the quarter)

/ $ (excl GST)

SUPPORTING DOCUMENTATION CHECKLIST

Funding will only be provided if the relevant supporting documentation is submitted
Have you completed and attached your claim summary form?
The claim summary form is available from: / ☐YES ☐NO
Are the relevant receipts/documents to substantiate the claim attached? / ☐YES ☐NO
Does the attached documentation include the following information:

the quantity of waste disposed for which a rebate is being claimed;

/ ☐YES ☐NO

the date of the disposal;

/ ☐YES ☐NO

the name of the DWER licensed landfill(s) to which the waste was disposed;

/ ☐YES ☐NO

the name of the entity that disposed of the waste (charitable recycler or commercial waste service provider); and

/ ☐YES ☐NO

thetotal cost of waste disposal (levy component separated out if possible).

/ ☐YES ☐NO
Have you attached your tax invoice (made out to the Department of Water and Environmental Regulation) to supportyour claim? / ☐YES ☐NO

DECLARATION

To be signed by the Chair, President or Chief Executive of the applicant organisation.

I certify that to the best of my knowledge the statements made in this application are true.

SignatureDate

FULL NAME:
POSITION TITLE:

Applications must be electronic and lodged through our public submissions portal:

Applicants will be notified that their applications have been received by automated email.

If you are experiencing problems, please email or call Waste Programs – Waste Grants Officer on 6364 6962.

Charitable Recyclers Rebate (CRR)1