Title: Senator Disclosure Return Amendment
Author: AEC
Last saved by: Karen Wilson
Company: Australian Electoral Commission

Request for Amendment
Senator Disclosure Return
FINANCIAL YEAR 2022-23

Completing the Return:
•	This request for amendment should be used to amend a 2022-23 Senator Disclosure Return lodged with the AEC.
•	This request for amendment is to be completed with reference to the Financial Disclosure Guide for Members of the House of Representatives and Senators.
•	This request for amendment will be available for public inspection from 1 February 2024 at www.aec.gov.au.
•	Any supporting documentation included with this request for amendment may be treated as part of a public disclosure and displayed on the AEC website.
•	The information on this request for amendment is collected under s 319A of the Commonwealth Electoral 
Act 1918.
Senator details
Name |

2022-23 Return details |
Is this the first amendment to the return? | Yes | ☐☐ | | No | ☐ | | How many other Requests for Amendment have been lodged? | |
Completing person’s details
Name |
Postal address |
| Suburb/town | State | | Postcode
Telephone number | (   ) | Fax number | (   )
Email address |

Request and Certification

I request the Electoral Commission amend the Senator Disclosure Return as detailed in this request for amendment. 
I certify that the information contained in this request for amendment 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 Senator on whose behalf I have consented to act as a representative.
I understand that submitting a false or misleading return is an offence under Division 137.1 of the Criminal Code Act 1995.

Signature | | |
| | Date |

How to complete this form:
•	If you are amending an existing entry, complete the ‘Original Entry’ item as it appeared on the original return and then write the amendment in full at the ‘Amended Entry’ item.
•	If adding a completely new entry, write N/A in the ‘Original Entry’ item and complete the ‘Amended Entry’ item in full.
•	Amounts should be reported on a GST inclusive basis.
Part 1: Total of donations received
No change to previous information | ☐   OR
Previous total donations | $ | .00 | Amended total donations | $ | .00
Part 2: Total number of donors
No change to previous information | ☐   OR
Previous total donors | | Amended total donors |
Part 3: Details of donations received
No change to previous information | ☐   OR
Received from | Date of donation** | Value of donation
Original Entry | Name | | | $ | .00
| Postal address | |
| Suburb/Town | | State | Postcode |
Amended Entry | Name | | .00 | $ | .00
| Postal address | |
| Suburb/Town | | State | Postcode |
Original Entry | Name | | | $ | .00
| Postal address | |
| Suburb/Town | | State | Postcode |
Amended Entry | Name | | .00 | $ | .00
| Postal address | |
| Suburb/Town | | State | Postcode |
If insufficient space, please attach additional sheets.
*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.

DAR_1 (06/20) – 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

SRA (06/23) – Page  of

SRA (06/23) – Page  of