Grant Application
Please note that health grants are only for shareholders in NWTL or beneficiaries of a whānau trust who are shareholders in NWTL (One per year).
Shareholder Name
First Name
Last Name
If you are applying under a Whānau Trust - enter the name of the trust below
First Name
Last Name
Whānau Trust Trustee Approval - If you are applying under a Whānau Trust, you need two trustees (cannot be the applicant) to approve. Please list the name and contact details for the two trustees who have approved your application.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Please tell us what you require a NWTL Grant for (Health - medical costs etc.):
Have you applied for fund from any other source?
(Yes/No)
Please upload a copy of your ID (Passport, Drivers licence etc.)
Browse Files
Cancel
of
Please upload a copy of the receipts related to your application if applying for a Health Grant or any other supporting info
Browse Files
Cancel
of
Please upload a copy of your verified bank details for us to pay any funds into
Browse Files
Cancel
of
Please sign below confirming the information provided is correct:
Submit
Should be Empty: