This amount will be used for state 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).

I have not exceeded the donation cap of $6,300 to Country Labor Party or $2,800 to elected Members or Candidates of Country Labor in the 2018/19 financial year.

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 Country Labor disclosing my name and the amount of my donation on its website if my donation equals or exceeds $1,000 during a financial year.

This amount will be used for state 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).

I have not exceeded the donation cap of $6,300 to the Australian Labor Party (NSW Branch) or $2,800 to elected Members or Candidates of the Australian Labor Party (NSW Branch) in the 2018/19 financial year.

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 the Australian Labor Party (NSW Branch) disclosing my name and the amount of my donation on its website if my donation equals or exceeds $1,000 during a financial year.

This amount will be used for federal campaign expenses.

I declare that this payment is not made on behalf of tobacco related business entities.

Section 314AC of the Electoral Act 1918 (Cth) requires amounts of more than $13,800 received from an individual or organisation in the 2018/19 financial year to disclosed to the Australian Electoral Commission. The information on this form is collected for that purpose.