Targeted Hardship Fund - Advance Interim Payment Application form

Targeted Hardship Fund Advance Interim Payment application form Kia ora So we can assess your Advance Interim Payment 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 3.

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

C3Hardship@CityRailLink.govt.nz PO Box 9687, Newmarket, Auckland 1143 Level 2, 25 Teed Street, Newmarket, Auckland 1023

If you have any questions please contact CRL Ltd staff at C3Hardship@CityRailLink.govt.nz or phone 0800 CRL TALK (275 8255) press option 7.

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

PHYSICAL ADDRESS POSTAL ADDRESS (if different from your physical address)

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

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

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Eligibility criteria To be eligible for the Fund’s Advance Interim Payments your business must be immediately adjacent to ongoing 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.

Small business The Ministry of Business, Innovation and Employment defines a small business as having less than 20 full-time equivalent employees. That same definition applies for the purposes of the Targeted Hardship Fund.

How many full-time equivalent employees does your business employ (prior to Level 4 lockdown)?

Lease details What date did you begin operating this business at the premises?* *To be eligible, your business must have been operating at this location prior to 01 October 2019.

What date did you sign a lease for the premises?* * Evidence required: Please provide a signed lease agreement, any other applicable documents (such as rent reviews) and evidence of rent paid such as invoices or receipts.

Who is your current landlord?

What are their contact details?

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Financial & legal viability You are required to demonstrate your business was financially and legally viable at the time that C3 construction 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 Declaration I/We do solemnly and sincerely declare that the business in this application has suffered sustained City Rail Link disruption resulting in genuine 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 it deemed to be fraudulent.

DATE

SIGNATURE

Checklist Please include the following supporting documents with your application

n Completed Application Form n Bank statement or letter from bank confirming bank details n Copy of current Lease When your application is submitted you will receive an automatic confirmation email that the application has been received by CRL Ltd. If you do not receive an email confirmation, please check to see if the email has been treated as spam.

If you need assistance please contact CRL Ltd at C3Hardship@CityRailLink.govt.nz or phone 0800 CRL TALK (275 8255) press option 7.

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