Disclosure Statement

This amount will be used for campaign expenses.

I declare that:

If the donation is made in an individual capacity, I am enrolled on the electoral roll; and if the donation is made by an organisation, the ABN provided above is true and accurate.

This donation is not made by or on behalf of a “prohibited donor” (being a property developer’, ‘tobacco industry business entity’ or ‘liquor or gambling industry business entity’), or a ‘close associate’ of a ‘prohibited donor’ as defined in Division 6 of Part 3 of the Election Funding Act 2018 (NSW).

If you make a political donation of $1,000 or more (in a single contribution or aggregated within a financial year), you must complete and lodge a declaration with the NSW Electoral Commission in accordance with section 12 of the Electoral Funding Act 2018. A political donation includes a contribution or entry fee or an annual or other subscription. You must also disclose a political donation of less than $1,000 if the total amount of political donations made by you in respect of the same party (or associated entity), elected member, group, candidate, third-party campaigner or person in the same financial year is $1,000 or more. Penalties apply for failing to lodge a declaration. I authorise and consent to Night Time Industries Association disclosing my name and the amount of my donation on its website if my donation equals or exceeds $1,000 during a financial year.