Membership – Protect & Prosper New Zealand

Application form to join Protect & Prosper New Zealand.

First Name *

Last Name *

Date of Birth

Residential street address Suburb, town, city or locality [not a PO Box address] *

Phone *

Email *

Enrolment details

I am a registered electorSelect an option *YesNo

Which electorate do you reside in? Unsure? Find my electorater

Enrolled in

Complete only if you are NOT a registered elector

I am not a registered elector but I am eligible to enroll.Select an optionYesNo

You are eligible to enrol if you are a New Zealand citizen or permanent resident of New Zealand, 18 years old or older and have resided in New Zealand continuously for one year or more and are not disqualified from enrolling. Contact the Electoral Commission if you are unsure whether you are eligible to enrol.

I am eligible to enrol as a New Zealand parliamentary elector as I am a *Please select one *New Zealand citizenPermanent resident of New ZealandOther

Please Specify

I have lived continuously in New Zealand for

Year

Months

If you live overseas provide the date last in New Zealand

Membership details (membership fee $1 per person)

Membership fee payment

How would you like to pay your membership fee. *Pay cash to our representative (Please contact our team for more details)Pay online ( Account name K BHARGAVA, Account number 01-0505-0219040-46 Please put your last name and initial of your first name in the reference )

I authorise Protect & Prosper New Zealand to record my name as a financial member of Protect & Prosper New Zealand.

I authorise the secretary of Protect & Prosper New Zealand to release this application form and subsequent financial membership details to the Electoral Commission for the purposes of Protect & Prosper New Zealand registration under the Electoral Act 1993.

I wish to receive the newsletter from the Protect & Prosper New Zealand.

Please sign below or upload your digital signature

The acceptable form of signature is as follows;

images of signatures that are electronic replications of actual ‘pen-and-paper’ signatures, such as scanned or photographic images, and
images of signatures that are produced and captured electronically using technologies such as signature pads, trackpads/touchpads or the mouse, light pens, or similar devices.

Please upload your digital signature here or sign below

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Today's Date

Please Note: Any New Zealand citizen or legally registered New Zealand voter, company, or organisation can donate an aggregated total of up to and including $5,000 per calendar year to Protect & Prosper New Zealand without having their details publicly disclosed. However, Protect & Prosper New Zealand is required to maintain accurate donor records including your name and address. These details are kept confidential by Protect & Prosper New Zealand and used exclusively to meet our requirements under the Electoral Act. If this donation, by itself or when combined with others made in the current calendar year, exceeds $5,000, your name and the amount you have donated must be publicly disclosed. If you have any questions about these requirements, please contact us at 0210302114. Your donation is not tax deductible.
Authorised by Kush Bhargava,

20 Frances Brown Avenue, Aotea, Porirua- 5024

Ph: 0210302114

Email : greatppnz@gmail.com