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Community Organisation Application Form

Information about your community organisation.

Organisation Information

Name of Organisation

Postal Address

Suburb

State

Postcode

Phone Number

Fax Number

Email Address

Website Address

Parent Body

Status of Organisation

Incorporated

Not Incorporated

Local Government

State Government

Commonwealth Government

Other

ABN

Organisation Outline

Please provide a brief description of who you are and what you do.

Information about Volunteer Coordinator / Manager

Volunteer Coordinator / Manager

(Appropriate contact person)

Address

(If different from organisation)

Suburb

State

Postcode

Phone Number

Fax Number

Email Address

Public Liability and Volunteer Personal Accident Insurance Information

IMPORTANT NOTE: Your organisation must have Public Liability and Volunteer Personal Accident Insurance to be eligible for the Volunteer Referral Service. Please provide current up-to-date copies of the certificate of currency.

Public Liability Insurance Details

Policy Expiry:

Policy Provider:

Policy Number:

Personal Accident Insurance Details

Policy Expiry: (Required)

Policy Provider:

Policy Number:

Permission from Authorised Person

Please read the following statement and indicate your agreement

I understand the information provided on this form may be made available to other agencies and to the general public
I hereby acknowledge, accept and support the Principles of Volunteering when utilising volunteers for this Organisation

Position Title:

Name:

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Community Organisation Application Form

Public Liability and Volunteer Personal Accident Insurance Information

Permission from Authorised Person

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