Sport New Zealand
Accountability Report Form
Rural Travel Fund
Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
1. Organisation Details
Organisation Name
I / We
This Accountability Form must be completed and returned to Waitomo District Council within
two months of your projects completion.
being authorised parties of the above Organisation hereby certify that the grant we received was spent
on the project approved and that any specic conditions associated with this grant have been met.
Amount of travel subsidy
Estimated cost of travel per year for the club/organisation
2. Fund / Travel Details
Please give details of how money was spent by providing a detailed breakdown i.e. petrol, car/bus hire
(Please provide evidence of expenditure, eg. receipts/invoices)
$
$
$
Distance travelled to local sport competition
Please give a brief description of the benets that have been achieved with these funds
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We solemnly declare that all details contained in this report are true and correct to the best
of our knowledge and that we have the authority to provide this information on behalf of our
organisation.
Name
3. Declaration
Name
Signature
Signature
Position
Position
Date
Date
In your opinion, did the Rural Travel Fund assit your team/organisation in order to increase
participation in your local sport competition in rural areas? Please comment
Please attach
Receipts of Rural Travel Fund allocations
Rural Travel Fund account statements
Any other supporting documentation
Please send completed applications to:
Waitomo District Council
PO Box 404
Te Kuiti 3941
Ph: 07 878 0800
Fax: 07 878 7771
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