Kaumātua Grant Application

1. Personal Details

Individual SHNIf known

First Names *First and middle names

Last Name *

Whānau Trust SHN

Whānau Trust Name

Date of Birth *

Day

Month

Year

Phone *

Email Address *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Upload ID here *

No file chosen

This can either be a Birth Certificate, Passport, Drivers Licence, Kiwi Access (18+ card) or Gold Card

New Zealand Bank Account

If you have a New Zealand Bank Account please complete the following:

Bank Account Name

Bank Account Number

Australian Bank Account

If you have an Australian Bank Account please complete the following:

Bank Account Name

Bank Account Number

BSB Number

IRD Number

Upload Verified Bank Details *

No file chosen

This can either be a Bank Slip, Bank Statement or screenshot of your Online Banking

Signature *