Title: Member of the House of Representatives Disclosure Return

Member of the House of Representatives
Disclosure Return
FINANCIAL YEAR 2022-23

Section 314AED(3) of the Commonwealth Electoral Act 1918 (Electoral Act) requires a member of the House of Representatives to furnish a return within 20 weeks after the end of the financial year.
The due date for lodging this return is 17 November 2023.
Completing the return:
•	This return is to be completed by the member of the House of Representatives or their representative.
•	This return is to be completed with reference to the Financial Disclosure Guide for Members of the House of Representatives and Senators.
•	Amounts should be reported on a GST inclusive basis.
•	This return will be available for public inspection from 1 February 2024 at www.aec.gov.au.
•	Any supporting documentation included with this return may be treated as part of a public disclosure and displayed on the AEC website.
•	The information on this return is collected under section 314AED of the Electoral Act.

Member of the House of Representatives details
Name |
Completing person’s details
Name |
Postal address |
| Suburb/town | | State | | Postcode |
Telephone number | (   ) | Fax number | (   )
Email address |

Certification
I certify that the information contained in this return and its attachments is true and complete to the best of my knowledge, information and belief. Where I sign as a representative, I have made due and reasonable inquiries of the member of the House of Representatives on whose behalf I have consented to act as a representative. I understand that submitting an incomplete, false or misleading return is an offence under Division 137.1 of the Criminal Code Act 1995.

Signature | | | |
| | | Date |

Part 1: Total of donations received for financial year 1 July 2022 to 30 June 2023
This is the total value of all donations received for federal purposes^, both above and below the disclosure threshold during the 2022‑23 financial year. | $
Part 2: Total number of donors
This is the total number of donors who made the donations included in the calculation of ‘total of donations received’ at Part 1. |

Part 3: Details of donations received

Details of any person or organisation from whom donations of more than $15,200 were received for federal purposes during the 2022-23 financial year.
For each donation received that was more than the disclosure threshold, the following details must be disclosed:
•	full name and address* of the person or organisation from whom the donation was received; and 
•	date each donation was received; and 
•	value or amount of each donation.

Received from | Date of donation | Value of donation**
Name | | | $
Postal address | | |
Suburb/town | | State | | Postcode | | |
Name | | | $
Postal address | | |
Suburb/town | | State | | Postcode | | |
Name | | | $
Postal address | | |
Suburb/town | | State | | Postcode | | |
Name | | | $
Postal address | | |
Suburb/town | | State | | Postcode | | |
Name | | | $
Postal address | | |
Suburb/town | | State | | Postcode | | |
Name | | | $
Postal address | | |
Suburb/town | | State | | Postcode | | |
If insufficient space, please attach additional sheets. | Total | $
* Name and address details
•	If the donation was from an unincorporated association (other than a registered industrial organisation), the name of the association along with the name and address of each member of the executive committee are required.
•	If the donation was from a trust or foundation, the name or description of the trust or foundation along with the names and addresses of the trustees are required.
** In this form donation is a gift within the meaning in section 287(1) of the Electoral Act.
^ Federal purpose is defined in section 287(1) of the Electoral Act.

HOR Return (06/23) – Page  of

Enquiries and returns 
should be addressed to:

Funding and Disclosure
Australian Electoral Commission
Locked Bag 4007
Canberra ACT 2601

Phone:	02 6271 4552
Email:	fad@aec.gov.au

Office use only
Date received

HOR Return (06/23) – Page  of |