Request for Amendment 
Associated Entity Disclosure Return
2016–17 FINANCIAL YEAR		
Completing the amended return:
•	This request for amendment should be used to amend a 2016–17 Associated Entity Disclosure Return lodged with the AEC.
•	This request for amendment is to be completed with reference to the Financial Disclosure Guide for Associated Entities.
•	Further information is available at www.aec.gov.au.
•	Requests for amendment to a 2016–17 return will be available for public inspection from Thursday 1 February 2018 at www.aec.gov.au. 
•	Any supporting documentation included with this request for amendment may be treated as part of a public disclosure and displayed on the AEC website.
•	The information on this request for amendment is collected under s 319A(2) of the Commonwealth Electoral Act 1918. 
Name of associated entity	     				
Postal address	     				
	Suburb/town
	     	State      	Postcode      	
With which political party, or parties, is the entity associated?
	     	
	     	

2016–17 return details		
Is this the first amendment 
to the return?	Yes			No			How many other Request for Amendments have been lodged?	     		

Financial controller details	
Name of financial controller	     	
Capacity or position	     	
Postal address	     	
	Suburb/town	     	State     	Postcode       	
Telephone number	(   )        	Fax number  (   )        	
Email address	     	

Financial controller’s request and certification	
I request the Electoral Commission amend the Associated Entity Disclosure Return as detailed in this request for amendment.
I certify that the information contained in this request for amendment and its attachments is true and complete to the best of my knowledge, information and belief. I have made due and reasonable inquiries of the organisation on whose behalf I am authorised to complete this form.
I understand that submitting an incomplete, false or misleading return is an offence under section 315 of the Commonwealth Electoral Act 1918.
	
Signature				
		Date	     	

Enquiries and returns 
should be addressed to: 	Funding and Disclosure
Australian Electoral Commission
Locked Bag 4007
Canberra ACT 2601	Phone:	02 6271 4552
Fax:	02 6293 7655
Email:	fad@aec.gov.au	

Office use only
Date received		

How to complete this form:
•	If you are amending an existing entry, complete the ‘Original Entry’ item as it appeared on the original return and then write the amendment in full at the ‘Amended Entry’ item.
•	If adding a completely new entry, write N/A in the ‘Original Entry’ item and complete the ‘Amended Entry’ item in full.
•	Amounts should be reported on a GST inclusive basis.

Part 1a: Other business names	
No change to previous information	   OR	

Provide details of changes or amendments to the information previously provided. 
	
	Original Entry	Trading name	     	
	Amended Entry	Trading name	     	

Part 1b: Related bodies corporate	
No change to previous information	   OR	

Provide details of changes or amendments to the information previously provided.
	
	Original Entry	Name	     	
		Postal address	     	
		Suburb/town	     	State      	Postcode    	
	Amended Entry	Name	     	
		Postal address	     	
		Suburb/town	     	State      	Postcode     	

Part 1c: Unions	
No change to previous information	   OR	

Provide details of changes or amendments to the information previously provided.
	
	Original Entry	Name	     	
		Postal address	     	
		Suburb/town	     	State      	Postcode    	
	Amended Entry	Name	     	
		Postal address	     	
		Suburb/town	     	State      	Postcode     	
If insufficient space, please attach additional sheets.

	

Part 2a: Total receipts for financial year 1 July 2016 to 30 June 2017		
No change to previous information	   	OR 	

Previous total receipts	$      		.00	Amended total receipts	$      	.00	

Part 2b: Amount calculated to be value of gifts-in-kind		
No change to previous information	   	OR 	

Previous gifts-in-kind	$      		.00	Amended gifts-in-kind	$      	.00	

Part 3: Amounts of more than $13,200 received in financial year 1 July 2016 to 30 June 2017	
No change to previous information	   OR	
Provide details of changes or amendments to the information previously provided.	
Received from	Amount received (GST inclusive)	Donation or other receipt*	
Original 
Entry	Name	     	$      	.00	     	
	Postal address	     				
	Suburb/town	     	State    	Postcode     		
Amended 
Entry	Name	     	$      	.00	     	
	Postal address	     				
	Suburb/town	     	State    	Postcode     		
Original 
Entry	Name	     	$      	.00	     	
	Postal address	     				
	Suburb/town	     	State    	Postcode     		
Amended 
Entry	Name	     	$      	.00	     	
	Postal address	     				
	Suburb/town	     	State    	Postcode     		
Original 
Entry	Name	     	$      	.00	     	
	Postal address	     				
	Suburb/town	     	State    	Postcode     		
Amended 
Entry	Name	     	$      	.00	     	
	Postal address	     				
	Suburb/town	     	State    	Postcode     		

If insufficient space, please attach additional sheets.
				
*	Please indicate whether this was a ‘donation’ or ‘other receipt’. The AEC contacts donors to ensure they are aware of their disclosure obligations and unnecessary contact with other persons is avoided if the nature of the receipt is shown. 

Part 4: Total payments for financial year 1 July 2016 to 30 June 2017	
No change to previous information	   OR	
Previous total payments	$      		.00	Amended total payments	$      	.00	

Part 5: Total debts as at 30 June 2017	
No change to previous information	   OR	
Previous total debts	$      		.00	Amended total debts	$      	.00	

Part 6: Debts of more than $13,200 as at 30 June 2017	
No change to previous information	   OR	
Provide details of changes or amendments to the information previously provided.
	
Creditor details	Amount owed (GST inclusive)	Financial or 
non-financial institution)	
Original 
Entry	Name	     	$      	.00	       	
	Street/postal 	     				
	Suburb/town	     	State    	Postcode     	
	
Amended 
Entry
	Name	     	$      	.00	       	
	Street/postal 	     				
	Suburb/town	     	State    	Postcode     		
Original 
Entry	Name	     	$      	.00	       	
	Street/postal 	     				
	Suburb/town	     	State    	Postcode     	
	
Amended 
Entry
	Name	     	$      	.00	       	
	Street/postal 	     				
	Suburb/town	     	State    	Postcode     		
Original 
Entry	Name	     	$      	.00	       	
	Street/postal 	     				
	Suburb/town	     	State    	Postcode     	
	
Amended 
Entry
	Name	     	$      	.00	       	
	Street/postal 	     				
	Suburb/town	     	State    	Postcode     		

	
If insufficient space, please attach additional sheets.				

Part 7: Capital contributions	
No change to previous information	   OR	
Provide details of changes or amendments to the information previously provided.
Note: All amounts are GST inclusive.

Contributor details	Gross amount contributed
(GST inclusive)	
Original 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     	
	
Amended 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     		
Original 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     	
	
Amended 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     		
Original 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     	
	
Amended 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     		
Original 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     	
	
Amended 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     		
Original 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     	
	
Amended 
Entry	Name	     	$      	.00	
	Street/postal 	     		
	Suburb/town	     	State    	Postcode     		

If insufficient space, please attach additional sheets.