New Zealand Gazette – 1992 – No. 26

Page 542

✨ Grant Claim Form



2 3

  1. Name(s) of other consultant(s) involved in the project (if any):

Role(s) of other consultant(s) in the project:

  1. The project commenced on ____ (date).

It was/is due to be completed on ____ (date).

The project has run to under/over budget.

Give reason(s) if over or under budget:

  1. Has the project been carried out in accordance with the
    Terms of Reference? YES/NO

If NO give details.

  1. My total fee for the project is $__.

I have received payment of this fee in full/part payment
of $__ on __ (date).

The payment I have received is in respect of
____ days/hours of my time at a daily/an hourly rate of $__
and ____ days/hours(s) of other consultant(s) time at
daily/hourly rate(s) of $__.

Disbursements of $__ are included in the fee. These
are in respect of:

  1. Do you have a financial interest in the project, in the
    business for which the project was carried out, or in a
    parent, associate or subsidiary of that business? YES/NO

If YES give details

  1. I declare that:
  • I undertake to advise the Business Development Board if I
    refund whole or part of the fee;
  • I understand that if incorrect or misleading information
    has been provided this may result in the Business
    Development Board withholding payment of the grant;
  • the information provided above is true and correct.

Signature: __

Name: ___

Date: ___

THE NEW ZEALAND GAZETTE

No. 26



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✨ LLM interpretation of page content

🏭 Expert Assistance Grant Scheme Claim and Report Form (continued from previous page)

🏭 Trade, Customs & Industry
Grant, Claim Form, Report Form, GST, Income Tax Act, Business Development, Consultant, Claimant