SKYCITY Queenstown Casino Community Trust Grant Application Form All fields marked * are required. Thank you for submitting a grant application. Your application has been successfully sent and will be complete when you finish the declaration form attached. You will receive confirmation SKYCITY Queenstown Casino Community Trust has received your application within the next 10 working days. Please find attached the declaration form which you are required to complete, sign and send with your supporting documents. Below you will also find a checklist to assist with this process. Declaration Form Please print this page and post along with your supporting documents to: SKYCITY Queenstown Casino Community Trust PO Box 1242 Queenstown To be received no later than 1 August 2008. If this information is not provided, SKYCITY Queenstown Casino Community Trust will be unable to process your application and therefore it will not be considered. Any Questions? Please telephone 0800 SKYCITY (0800 759 2489) and ask for the Community Trust Secretary/Treasurer Supporting Documents Please provide us with a copy of the items listed below: (If for some reason you can’t please let us know why.) Photocopy of your organisation’s IRD charitable status approval (if appropriate) Annual Accounts which provide the detail in Question 4.2 (i.e. your most recent accounts) A copy of your organisation’s Constitution / Rules / Deed of Trust / Charter Your Annual Report A photocopy of the latest bank statement for each account held. Check List Have you provided: The Declaration Form All the supporting documents as outlined above. Any Questions? Please telephone 0800 SKYCITY (0800 759 2489) and ask for the Community Trust Secretary/Treasurer

Your Organisation The Project Project Funding Organisation Finances Section 1 - Your Organisation Please answer all the questions (If not applicable please enter N/A) and supply all the information required in support.   *1.1 Your Organisation Name   *1.2 Address Street District/City Postal Address Telephone Facsimile Website   *1.3 Contact Person Name Position Telephone (Business) Telephone (Residential) Facsimile (Business) Facsimile (Residential) Email: Preferred method of communication and time (during the day after hours, etc)   *1.4 Are you a: Charitable Trust Registered Charity Trust Incorporated Society Other? If other, please specify   *1.5 Name of key people in your organisation (Please enter N/A if not applicable) Patron Vice Patron Chair Person Chief Executive Secretary Treasurer Trustees/Board/Committee Members Auditor Accountant   *1.6 When was your organisation established?   *1.7 Is your organisation GST registered? Yes   No   *1.8 Tell us about the focus and purpose of your organisation and what you are wanting to achieve   *1.9 Is your organisation part of, or managed by, any other organisation / authority? Yes   No If yes please supply details Tip Sheet Section 2 - The Project *2.1 Please give a full description of your organisation's project or purpose for which Trust funding is sought.   *2.2 Tell us why this project should be funded. How is it meeting a significant community need? Include who and how many people will benefit.   *2.3 If this application is for the purchase of physical assets, how will their security be maintained?   *2.4 What is the anticipated timing of your project (commencement and completion) and your timing of your requirement for funds? Tip Sheet   Section 3 - Project Funding Please complete this section on a GST exclusive basis: *3.1 How much money is your organisation requesting from SKYCITY Queenstown Casino Community Trust? $   *3.2 How much money has your organisation set aside / already raised for the project? Please fill out table in Question 3.7 $   *3.3 Assuming this application is successful how much more does your organisation need to raise to complete this project? $   How does your organisation intend to raise the balance of the funds needed?     *3.4 Total cost of proposed project. (please add 3.1, 3.2 and 3.3 - GST exclusive) $ *3.5 If your application is successful, how would you spend the amount received from us? Detail separately the elements of expenditure, identifying the $ amounts of the separate components of the project. (If you have actual or quoted costs, please include these and provide a copy of the quote).   $ $ $ $ $ $ $ $ $ $ Total (equal to value in 3.1) $ *3.6 If your organisation already has funds available, why are they not being used for this project? 3.7 Where did the money in Question 3.2 come from? Source of Funds   Amount User fees/subscriptions $ Funds on Hand $ Fundraising $ Funds already spent $ Voluntary effort $ Donated materials $ Sponsorship (specify source) $ Grants (specify source) $ Other (specify source) $ Total of your contribution (to agree to your answer in Question 3.2) $ *3.8 Is your organisation entitled to receive funding assistance towards this project from any other source? Yes   No   If yes please supply details.   *3.9 Has your organisation applied (currently or previously) or do you intend to apply to any other funding agencies for this project? Yes   No   If yes please supply details.   *3.10 Please provide details of any other funding assistance your organisation has received in the last two years (including funds from local authorities, Government Department, Lotteries Board, etc). Source Project Year Amount Tip Sheet   Section 4 - Your Organisations Finances *4.1 To help us assess this application and your possible requirements, we need to have some financial information about your organisation. Please complete in respect of your most recently completed financial year as well as current period to date. Please complete to the nearest $. (Some of these items may not be applicable to your organisation).   Revenue   Current Period (Received to date)   Last Completed Financial Year Donations & legacies $ $ Fundraising & memberships $ $ Investment, interest & dividends $ $ Government subsidies or grants $ $ NET trading income $ $ Other $ $ (A) Total Revenue: $ $ Expenses Salaries & wages $ $ Rent $ $ Interest paid $ $ Non-cash (eg:depreciation) $ $ Other $ $ (B) Total Expenses: $ $ Net Surplus: If (A) is greater than (B) $ $ or Net Deficit: If (B) is greater than (A) $ $ Net Assests Cash at bank $ $ Bank overdraft $ $ Investments $ $ Amount owed to your organisation by other people. $ $ Amount your organisation owes to other people. $ $ Sub Total: $ $ Loans or mortgages $ $ Furniture/Equipment?Building/Land and Motor vehicles $ $ Other $ $ Total Net Assests: $ $ To support this, please enclose copies of all the relevant financial statements used for completing the questions above.   *4.2 Are there likely to be any significant changes to your organisations financial situations in the next 12 months? Yes   No   If yes please explain.   *4.3 Has your organisation received Inland Revenue Department (IRD) approval as a charitable organisation under section 61(25) of the Income Tax Act? Yes   No   If yes, please provide us with a copy of that approval by IRD.   *4.4 How will your organisation continue to fund the project once the funds requested have been committed?   *4.5 Does your organisation sell any products or services? Yes   No   If yes, is there any planned expansion of these activities? Yes   No   If yes, what would be the extent of that expansion? *4.6 How many people are working for your organisation? Paid (full time equivalent) Voluntary   4.7 Please provide us with copies of those items listed below in the following order: If for some reason you can't please let us know why.   Photocopy of your organisation's IRD charitable status approval (If appropriate) Annual Accounts from which the summary of Question 4.2 came from Copy of your organisation's Constitution / Rules / Deed of Trust / Charter Annual Report Photocopy of the latest Bank statement for each account held   Finally is there anything else you think we should know about your organisation or this project? Tip Sheet