RAA Claim Request Form

Applicant Details > Claim Details > Declaration

General Claim Requests

Applicant Details

First Name

Last Name

Email Address

ABN

Include spaces, e.g: 12 312 312 312

BP Number

Numbers only, beginning with 2 (e.g. 2545678)

Case Number

Which program are you submitting invoices for?

Will this be your final claim?

YesNo

Please confirm the event you are submitting a claim for

Which option best describes the nature of your business?

Grazier

Horticulturist

Please select your industry:

AgricultureHorticultureAquaculture

PRODUCT CATALOG ID

SCSG INDUSTRY

To submit invoices for this program, please use the Additional Invoices form.

Please use the Special Disaster Grant Claim Request Form to submit invoices for this program.

Applicant Details > Claim Details > Declaration

You can add multiple invoices by clicking the Add another invoice link at the bottom of the box.

Invoice

For Graziers, invoice must be from 01/07/2018 onwards.

For Horticulturists, invoices must be from 01/07/2019 onwards.

Minimum invoice amount is $500.

Amount

$

Does the amount entered include GST?

Yes

No

Upload Tax Invoice

Please ensure file sizes are 2.5MB or less

Date of Invoice

Tax Invoice Reference Number

Supplier Name

Supplier ABN

Include spaces, e.g: 12 312 312 312

Description of Works

SCSG PRODUCT RESOURCE CODE ID

OTHER PRODUCT RESOURCE CODE ID

AmountExclGST

FINAL PRODUCT RESOURCE CODE ID

AmountInclGST

FinalAmount

Proof of Payment

Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Proof of Payment Documents

Please ensure file sizes are 2.5MB or less

Supporting Documentation

Please upload any other relevant documentation/information

Supporting Documentation

Please ensure file sizes are 2.5MB or less

Applicant Details > Claim Details > Declaration

You are no longer able to update your bank account details via this form. If you would like to update your bank account for payments please contact the RAA by calling 1800 673 596 or email rural.assist@raa.nsw.gov.au .

General Statement & Privacy

General Statement

Any person who knowingly and with intent to defraud the Authority or another person, files an application for assistance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent act, which is a crime under the Crimes Act 1900 and subjects the person to criminal penalties.

Privacy

The information in this claim is provided voluntarily and is being collected by the Authority for purposes related to the administration of the scheme of assistance under which you have applied, including the assessment of the effectiveness of the scheme. This may involve disclosing the information in this claim to contractors engaged by the Authority or to either State or Commonwealth government agencies. We will supply you with details of those that we have disclosed information to, if you apply to us in writing.

Not providing the information requested in this claim or providing false or misleading or incomplete information may impact on the ability of the Authority to accurately assess your claim.

The Authority agrees to take all reasonable measures to ensure that the personal information collected by it is stored securely.

You may access or correct your personal information by contacting the Authority by telephone on 1800 678 593 (toll free) or by writing to: Manager Administration, NSW Rural Assistance Authority, Locked Bag 23, ORANGE, NSW, 2800.

I agree *

Thank you for your claim