BENDIGO BANK



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Hawkesbury Community Financial Services Limited

Franchisee of North Richmond and

Richmond Community Bank® branches

Sponsorship/Donation Application

Introduction

Hawkesbury Community Financial Services Limited owns and operates North Richmond and Richmond Community Bank® branches, which is a franchise of Bendigo and Adelaide Bank Limited ABN 11 068 049 178, the holder of Australian Financial Services Licence AFSL No. 237879. Hawkesbury Community Financial Services Limited is an authorised representative (No. 265382) of Bendigo and Adelaide Bank Limited. The banking products offered by the Community Bank® Branch are issued by Bendigo Bank Limited.

North Richmond and Richmond Community Bank® branches concentrate on meeting the needs of customers for easily understood financial services which add to their family's well-being, and a commitment to enhancing the prospects of their communities.

Sponsorship/Donation Application

Hawkesbury Community Financial Services Ltd (HCFS) is calling for applications from Community Groups within the Hawkesbury City local government area for support to help them advance their cause for the local Hawkesbury Community.

Your organisation is invited to apply for an award under the Sponsorship/Donations Programme funded by HCFS, the franchisee of Bendigo Community Bank® at North Richmond, as part of its charter to distribute Community Bank® profits back into the local community.

Community Organisations are those groups or organisations that undertake voluntary or paid work for the local Hawkesbury Community as their primary objective. Community Groups and organisations include those featuring government and community services, recreation, sport, environmental action, cultural activities, education, employment, housing, transport, health and social welfare.

The Sponsorship/Donation Application must be submitted on this form, which must set out in detail your intended purpose for the use of the funds. All applications will be considered by HCFS.

A Sponsorship/Donation Application does not mean that a sponsorship/donation can or will be made. All applications shall be considered in accordance with the HCFS Community Support Policy.

Applicant Information

| | |

|Organisation Name | |

|Contact Person | |

|Email Address | |

|Daytime Number | |Mobile Number | |

|Australian Business | |Registered for GST? |Yes No |

|Number (ABN) | | | |

|Approved Deductible Gift Recipient (DGR) | Yes No |

Organisation Address

|Street Address | |

|Suburb | |

|State | Post Code |

|Postal Address | |

|(if different to above) | |

|Suburb | |

|State | Post Code |

Organisation Information

Please provide further information about your organisation.

|When was you organisation established? |Month | |Year | |

|How many paid employees? | |

|How many volunteers contribute time to your organisation? | |

|Approximately how many people receive services or benefit from your organisation? | |

Current Banking

|We bank with North Richmond Community Bank® Branch | Yes No |

|We bank with Richmond Community Bank® Branch | Yes No |

Previous Sponsorships/Donations

Have you previously been assisted by a Bendigo Community Bank® Branch? If yes please provide details.

| |

| |

| |

Purpose of Sponsorship/Donation

Request Description (What do you want the money for? Please describe your request.)

|Funds will be used to |

| |

| |

| |

| |

Sponsorship/Donation Estimated Cost

|Item |Nature of Expense |Amount $ |

|1 | | |

|2 | | |

|3 | | |

|4 | | |

| |Total Cost |$ |

| |Applicants / Other Contributions |$ |

| |Total Funds Requested this Application | |

| | |$ |

Details of contributions from other organisations towards your project

| |

| |

| |

| |

| |

Certification by the Applicant:

• I am authorised, on behalf of the Community Group or Organisation named in this application, to make this application.

• I declare that all the information provided by me on behalf the Community Group or Organisation named in this application, is true and correct.

|Applicants Signature | |

|Applicants Name | |Date | |

The Directors

Hawkesbury Community Financial Services Limited

P.O. Box 340

North Richmond NSW 2754

Please refer any questions to Tony Weller on (02) 4571 2988 or 0439 712 988.

Privacy statement

Bendigo and Adelaide Bank Limited is part of the Bendigo and Adelaide Bank Group (the Group / we). We collect your personal information to help process your application. Unless you advise us otherwise, we will also provide you with offers and information related to our products and services. We may share your personal information with third parties, related companies in the Group, and our joint venture partners and franchisees so that you can be told about financial products and services offered or distributed by them. We may also need to disclose your personal information to organisations that carry out functions on the Group’s behalf (“service providers”) such as mailing houses, plastic card bureaux, rewards program managers, IT service providers, lawyers, collection agents and advisors acting for the Group, insurers, other credit providers and credit reporting agencies. If you do not wish to receive any marketing material from us please call us on 1300 361 911.

If any part of your information is not provided Bendigo Bank may not be able to process your application. We may use your personal information to confirm your details (for example contacting your employer to confirm your employment and income details). We treat this as confidential and only disclose it to others where necessary.

Some of the organisations we disclose your personal information to may be located overseas. Where an organisation is located overseas, we will either take reasonable steps to ensure that it complies with Australian privacy laws or we will seek your consent to the disclosure. If you need to gain access to and seek correction of your personal information and credit-related personal information, please contact us on 1300 361 911.

You should read our Privacy Policy which contains information about: a. how you can access and seek correction of your personal information; b. how you can complain about a breach of the privacy laws by us and how we will deal with a complaint; c. if we will disclose personal information to overseas entities, and where practicable, which countries those recipients are located in. Our Privacy Policy is available on our website .au or by telephoning 1300 361 911.

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