RAA Emergency Water Infrastructure Rebate

About You > Properties > Infrastructure > Payment Details > Supporting Documents > Declaration

>  About You
  Properties
  Payment Details
  Supporting Documents
  Declaration

Please read the Emergency Water Infrastructure Rebate 3 program guidelines before proceeding with this application.

You will be required to upload a number of documents during this application. Please ensure you have a digital copy of the following documents:

Council Rates Notice(s) for all properties where works will be completedLease Agreement if you are the Lessee of a property where works will be completedTax Invoices for works that are completeMost recent Tax Returns & Financial Statements for your Farm Business

Providing all details of all documents with this application will ensure the most efficient processing of your application.

Which option best describes the nature of your business?

Grazier

Horticulture

If your business does not fall into either of these categories then you are not eligible for this grant program.

PRODUCT CATALOG ID

I have read and understand the program guidelines

AgreeDisagree

You must read the program guidelines before applying for this grant.

Do you receive the majority (>50%) of your Gross income from Primary Production under normal seasonal circumstances OR meet industry concessions? (Refer guidelines eligibility 3.e for more details)

AgreeDisagree

Unfortunately you are not eligible for this grant program.

I do not have gross off-farm assets exceeding $5000000, excluding funds in a registered super fund. (Refer guidelines eligibility 3.f for more details)

AgreeDisagree

Unfortunately you are not eligible for this grant program.

I confirm I will not be claiming invoices under this application for items that have been recovered through insurance or a government grant for a declared natural disaster event

AgreeDisagree

Unfortunately you are not eligible for this grant program.

You are about to make an application for assistance from the Commonwealth and NSW Governments. Your application will be reviewed by our trained assessors. Applications are not auto-approved. False or misleading statements may be a criminal offence leading to penalties as well as causing delays in making payments to applicants who are in genuine need.

I understand and wish to continue with this application

About You > Properties > Infrastructure > Payment Details > Supporting Documents > Declaration

✓  About Youx
✓  Properties
>  Payment Details
  Supporting Documents
  Declaration

Please specify other

Third Party Details

Firm Name

First Name

Last Name

Phone

Landline: +61298721111 / Mobile: +61417000000

Mobile

Mobile: +61417000000

Email

Please note the RAA may seek permission from the applicant to discuss this application with you.

About You > Properties > Infrastructure > Payment Details > Supporting Documents > Declaration

✓  About Youx
✓  Properties
>  Payment Details
  Supporting Documents
  Declaration

Bank Details

Account Holder Name

Bank/Credit Union Name

BSB Number

Account Number

About You > Properties > Infrastructure > Payment Details > Supporting Documents > Declaration

✓  About You
✓  Properties
✓  Payment Details
>  Supporting Documents
  Declaration

Upload Tax Return

Most recent Tax Returns & Financial Statements for your Farm Business. Include individual Taxation Returns and a current listing of all Assets and Liabilities held by each:

Individual members of a Partnership/ Family Trust
Individual Director(s)/Shareholder(s) of all Companies

Please black out, hide or remove any Tax File Numbers from these documents.

Do you want to provide a copy of your tax return?

Yes

No

Upload Tax Return

Please ensure file sizes are 2.5MB or less

Does the applicant give permission for RAA to contact their accountant to obtain information regarding this application?

Yes

No

Would you like to provide the details of the applicant's accountant?

Yes

No

Please note the RAA may seek permission from the applicant to discuss this application with their accountant.

Accountant Details

Firm Name

First Name

Last Name

Phone

Landline: +61298721111 / Mobile: +61417000000

Mobile

Mobile: +61417000000

Email

Supporting Documentation

Please upload any other relevant documentation/information (e.g. maps, photos).

Do you want to provide any supporting documentation?

Yes

No

Supporting Documentation

Additional Comments

Any comments about your application you would like the Assessment Officer to know

About You > Properties > Infrastructure > Payment Details > Supporting Documents > Declaration

✓  About You
✓  Properties
✓  Payment Details
✓  Supporting Documents
>  Declaration

General Statement*

Not providing the information requested in this application or providing false or misleading or incomplete information may impact on the ability of the Authority to accurately assess your application. Failure to provide such information may result in the Authority refusing your application.

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 application 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 application 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. Information regarding your application may also be discussed and exchanged with the nominated contact persons listed by you in your application.

The NSW Rural 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. Calls to "1800" numbers from your home phone are free. Calls from public phones and mobiles may be timed and attract charges.

Your Statement*

I understand and declare that:

1. I have read, understood and will comply with the scheme guidelines.

2. The information I have provided in this application is true and correct.

3. If I am applying on behalf of a sole trader, partnership, trust or corporation, I have the authority to make this application on its behalf.

4. The business meets the criteria for an eligible business for the scheme.

5. I will be required to repay any overpayment I receive.

6. When asked for financial information, I must provide my personal tax returns in addition to financial information for all business entities with which I have a formal interest including companies, partnerships, trusts and self-managed super funds.

7. The invoices for this application have not been used to secure any other NSW Government funding. (i.e. I have not been reimbursed for these invoices in the past).

8. I authorise RAA to discuss this application with relevant private/public authorities, financial lending institutions and accountants, including my nominated financial counsellor/advisor. If required, I will provide documents from the relevant authority to permit the RAA to do this.

9. I authorise the RAA to share information provided in my application with other NSW or Commonwealth Government agencies for the purpose of coordinating the administration and assessment of related Government programs.

10. Any assistance received under this scheme will be applied in accordance with the scheme guidelines and the RAA may conduct an audit or inspection or seek verification through official third parties as needed.

11. The NSW Rural Assistance Authority can make relevant enquiries to ensure I receive my correct entitlement.

12. I will seek independent financial advice to understand the taxation implications of assistance granted to me, if needed.

13. Statistics will be collected and analysed in such a way as to protect my anonymity.

14. I agree to provide feedback in relation to this scheme.

15. I have obtained/will obtain all required work approvals and permits prior to commencing work, and I understand the need for any development to be ecologically sustainable, in accordance with the Rural Assistance Act 1989 No97.

To allow this claim to be assessed, I/we authorise the release of information by relevant authorities, including Commonwealth, state/territory or local authorities to the NSW Rural Assistance Authority relating to the works completed and being claimed for in this form.

I agree

Thank you for completing the Emergency Water Infrastructure Rebate Application.

Please check "I agree" in order to submit your application.

Applicant	Rural Financial Counsellor
Accountant	Family/Friend
Other

Beef	Dairy
Pigs	Sheep
Poultry	Intensive Livestock
Cropping	Mixed Farming
Horticulture	Viticulture
Aquaculture	Permanent Planting
Other

complexUnitIdentifier	complexUnitType
formattedAddress	postalCode
streetNumber	streetName
streetType	addressId
lgaPid	geoLatitude
geoLongitude	postalDeliveryNumber
postalDeliveryType	pointfullStreet
pointcity	pointstateProvince

Street	City
State	Postcode / Local Government Area as per rates notice

complexUnitIdentifier	complexUnitType
formattedAddress	postalCode
streetNumber	streetName
streetType	addressId
lgaPid	geoLatitude
geoLongitude	postalDeliveryNumber
postalDeliveryType	pointfullStreet
pointcity	pointstateProvince