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 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.
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.
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/We 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 listed in this application:
a. suffered direct damage to their assets and/or a significant loss of income as a result of the storms and floods of March 2021.
b. is an eligible business.
5. It is intended that the business will be re-established within the affected area.
6. I will be required to repay any overpayment I receive.
7. I have made a claim for insurance where eligible, or insurance has been refused or the payout does not cover all costs, and I can provide evidence of this if required.
8. 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 and self-managed super funds.
9. 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).
10. 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.
11. I authorise the RAA to share information provided in my application with other NSW or Commonwealth Government agencies for the purpose of co-ordinating the administration and assessment of related Government programs.
12. 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.
13. The NSW Rural Assistance Authority can make relevant enquiries to ensure I receive my correct entitlement.
14. I will seek independent financial advice to understand the taxation implications of assistance granted to me, if needed.
15. Statistics will be collected and analysed in such a way as to protect my anonymity.
16. I agree to provide feedback in relation to this scheme.
17. I confirm that funds will be used for items not covered by insurance.