In order to be able to resume this form later, please enter your email and choose a password.
About You > Properties > Assistance Required > Payment Details > Supporting Documents > Declaration
> About You Properties Payment Details Supporting Documents Declaration
✓ About Youx ✓ Properties > Payment Details Supporting Documents Declaration
✓ About You > Properties Payment Details Supporting Documents Declaration
✓ About You ✓ Properties ✓ Payment Details > Supporting Documents Declaration
Please upload up to 5 photographs showing direct damage to the affected property. All submitted photographs must not contain any explicit, graphic, or otherwise inappropriate content. For examples of acceptable images to submit, please refer to the program information webpage for further information.
✓ 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 Collection Notice
The information in this application is provided voluntarily and is being collected by the NSW Rural Assistance Authority (‘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 a third party engaged by the Authority or to either State or Commonwealth government agencies. The Authority will supply you with details of those parties that the Authority has disclosed information to if you apply to the Authority in writing. Information regarding this application may also be discussed and exchanged by the Authority with the authorised nominated contact persons listed by you as part of your application.
The Authority agrees to take all reasonable measures to ensure that the personal information collected by the Authority 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 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 in accordance with the scheme guidelines.
5. I will be required to repay to the NSW Rural Assistance Authority (‘the Authority’) any overpayment I receive or any payment I receive that is not in accordance with the scheme.
6. When asked for financial information, I may be required to 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 claimed under this application have not been recovered through insurance or used to secure any other government funding and I have not been reimbursed for these invoices in the past.
8. I authorise the Authority 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 Authority to do this.
9. I authorise the Authority 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. The Authority may use and provide the information provided by me in relation to this application to a third party engaged by the Authority for the purposes of assessing the effectiveness of the scheme.
11. Any assistance received under this scheme will be applied in accordance with the scheme guidelines and the Authority may conduct an audit or inspection or seek verification through official third parties as needed.
12. The Authority can make relevant enquiries to ensure I receive my correct entitlement.
13. I will seek independent financial advice to understand the taxation implications of assistance granted to me, if needed.
14. Statistics will be collected and analysed in such a way as to protect my anonymity.
15. The Authority will store, retain and dispose of the information provided by me in relation to this application in accordance with the State Records Act 1998.
16. I agree to provide feedback in relation to this scheme.
17. 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. I will provide evidence of these approvals and permits if asked.
18. I/We understand that this application will automatically be considered for the maximum grant amount specified in the program guidelines and that I must provide valid tax invoices and proof of payment for eligible expenses to be able to claim payment under the application.