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Ko Wai Mātou
Whenua
Tangata
Tahua
Pānui

Ko Wai Mātou
Whenua
Tangata
Tahua
Pānui

Licence Subsidy

Home » Licence Subsidy

1. Applicant Details

First Names *

Last Name *

Physical Address

Street Address

City

ZIP / Postal Code

Email Address *

Contact Number *

Date of Birth *

2. Shareholder Details

Are you a Shareholder *YesNo

Shareholder Number *

Shareholder Name *

3. Whakapapa

2nd Generation *Your Mother/Father

3rd Generation *Your Nan/Koro

4th GenerationYour Great Grandparent/s

Please select the marae and hapū you whakapapa to *

4. Waka Kotahi

Reimbursement for *RestrictedFull

H/T Class *12345

Please provide a copy of the paid receipt. Receipt submitted must be no longer than 12 months from the day the applicant passes their test. *

No file chosen

5. Bank Details

Account Name *

Account Number *

Please attach verified bank account details. *

No file chosen

6. Signature

By signing below, you are confirming that:

1. The information contained in this application is true and correct.

2. The Trust may collect information about this applicant from any third parties in respect of this application.

Signature *

Start signing your signature here

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