Fee Waiver Request (up to $2,000) Form

Part 1: Application Information

Address Line 1, Suburb/Town, State/Province, Postcode, and Country are required.
Must be an Australian phone number.
If yes, please provide ABN in the following box.
If yes, please let us know which financial year funding was received in the following box.

Part 2: Fee Waiver Request

If you answered no, please make sure you fill out a Venue Lodgement / Hire Booking Form.
Please Note: Applications for up to $2000 and under will not need to be referred to Council for a resolution and will be assessed within 21 days at the latest.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Upload any additional documents to support your application.

Part 3: Bank Account Details

Council's preferred method of payment is EFTPOS.

Part 4: Declaration

I have read the guidelines relating to the Fee Waiver Request and certify to the best of my knowledge the information provided in this submission is true and correct and that the application has been submitted with the full knowledge and agreement of the Group/Organisation applying.

Privacy and Personal Information Protection Notice

We are collecting this information to process your request. We may not be able to do so without it. Supplying this information is voluntary and it will not be used for any other purpose without seeking your consent. We will store your personal information on our systems or in our offices, where it will be used by our staff and contractors. Other people can request access to it under the Government Information (Public Access) Act 2009. You can ask us to suppress your personal information from a public register and we will consider your request in line with the Privacy and Personal Information Protection Act 1998. Our Privacy Management Plan sets out how you can access or correct your personal information. Please visit www.wentworth.nsw.gov.au for a copy of the plan.