Targeted Hardship Fund Application Form (New applicants only)

Targeted Hardship Fund Application Form (New applicants only)

Kia ora So we can assess your Targeted Hardship Fund (THF) application as quickly as possible, please carefully read all information, including eligibility criteria, at CityRailLink.co.nz/targetedhardshipfund Please make sure to read this document carefully and answer honestly. All applications must be submitted using this form and include supporting documents as listed on page 4.

Please note that applications under the THF are processed and administered by TSA Management.

You can send your application by: Email: Post: Delivery/courier:

C3Hardship@tsamgt.com PO Box 26433, Epsom, Auckland 1344 Level 2, 88 Broadway, Newmarket, 1023

If you have any questions please contact TSA Management at C3Hardship@tsamgt.com or phone 021 169 4149.

Applicant contact details FIRST NAME LAST NAME BUSINESS NAME OFFICIAL TRADING NAME (if different from above) BENEFICIAL OWNER (if different from legal or registered owner) EMAIL ADDRESS

PHONE NUMBER

BUSINESS PHYSICAL ADDRESS POSTAL ADDRESS (if different from above)

BUSINESS BANK ACCOUNT NUMBER

What is the legal status of your organisation?

n Company n Māori Trust

n Charitable Trust n Incorporated Society n Other eg. community groups with no formal legal structure

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Organisation registration number (eg. NZ Companies Registration/Charities Register number)

1 | Targeted Hardship Fund Application Form (new applicants only)

Application period Tick all that apply.

n Tranche 4 - 01 April 2022 to 30 June 2022 n Tranche 5 - 01 July 2022 to 30 September 2022 Eligibility criteria To be eligible for the THF your business must be immediately adjacent to, and impacted by, major and sustained CRL construction disruption.

What is the address of your leased premises?

To be eligible, your business must be in the C3 Affected Area.

Briefly outline how City Rail Link C3 construction has directly caused your business genuine financial hardship during the application period/s selected.

Small business The Ministry of Business, Innovation and Employment defines a small business as having less than 20 fulltime equivalent employees. That same definition applies to the THF.

How many full-time equivalent employees does your business employ?

Lease details What date did you begin operating this business at the premises?* *To be eligible, you must have been operating this business in this location prior to 01 October 2019. Evidence required: Please provide a signed lease agreement, and any other applicable documents (such as rent reviews or lease renewals) and evidence of rent paid such as invoices or receipts.

What is your annual rental amount payable?

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Include any fixed operating amount/s charged by your landlord.

2 | Targeted Hardship Fund Application Form (new applicants only)

Have you received any assistance, such as a rent decrease, from your landlord since 01 October 2019? *CRL will take into account a business’ financial position. If no such assistance has been offered to date, CRL will seek a meaningful contribution towards the level of financial support offered to a successful applicant from their landlord - in line with CRL Sponsors’ high-level guidelines.

n Yes n No If you answered yes to the above question, please detail the assistance provided from your landlord below. *Please include when such support started, and for how long. Evidence required: Please attach any relevant supporting documentation.

Who is your current landlord?

What are their contact details?

Financial & legal viability You are required to declare whether your business was financially and legally viable at the time that C3 construction officially started (01 October 2019). This includes all required statutory and regulatory approvals under the relevant laws, including planning, licensing, and building approvals.

Was your business financially viable at 01 October 2019?

n Yes n No Is your business currently legally compliant?

n Yes n No Are there any current legal proceedings being brought against your business?

n Yes n No Is your business still operating?

n Yes n No If you answered no to the above, what date did your business stop operating?

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DATE

3 | Targeted Hardship Fund Application Form (new applicants only)

Declaration I/We do solemnly and sincerely declare that the business in this application has suffered sustained City Rail Link disruption resulting in genuine financial hardship, and that the information contained in this application, together with all supporting information, is true and correct.

I/We do understand that my application may be subject to audit, and that action may be taken if deemed to be fraudulent.

DATE

SIGNATURE

Checklist Please include the following supporting documents with your application.

n n n n n n

Completed Targeted Hardship Fund application form Recent bank statement within the last three months, or letter from bank confirming bank details Copy of signed lease covering period from 01 October 2019 Copy of signed current lease Copy of signed rent review (if applicable) Evidence of rent paid e.g. invoices or statements from landlords, bank statements or rent receipts

Annual accounts or tax returns for:

n n n

2019/2020 2020/2021 2021/2022 (a draft format will be accepted)

When your application is submitted you will receive an automatic confirmation email that your correspondence has been received by TSA Management. If you do not receive an email confirmation, please check to see if the email has been treated as spam.

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If you need assistance please contact TSA Management at C3Hardship@tsamgt.com or phone 021 169 4149.

4 | Targeted Hardship Fund Application Form (new applicants only)