Grant Application

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

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.)

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Please upload a copy of the receipts related to your application if applying for a Health Grant or any other supporting info

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Please upload a copy of your verified bank details for us to pay any funds into

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Please sign below confirming the information provided is correct:

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