Criteria for enrolment 1. You must complete all sections of this form and sign it. Incomplete forms will not be accepted. 2. Return completed form to Raukawa Settlement Trust, Private Bag 8, Tokoroa 3444. 3. Your application must be validated by the representative of your nominated Marae which the Tribal Registrations staff will organise. Therefore you may be contacted for more details to assist with verification. Why Register? The purpose of registration is to collect in a centralised place the contact details of all those who affiliate to Raukawa Settlement Trust so that:

• You are able to participate in Raukawa Settlement Trust board elections or special resolution voting.

• You are able to be advised of any possible benefits and grants that you may be entitled to.

*First Names:

Preferred Name:

*Surname:

Maiden name: Gender: Male: o Female: o *Birth Date:

Email Address:

*Postal Address:

Suburb: *City:

Post Code: Home Phone:

Mobile Number: Work Phone:

Correspondence: Please indicate your preferred form of communication from the Raukawa Settlement Trust: E-Mail: o Postal mailings: o

Private Notice:

Persons registering on the iwi register are able to state whether they wish to receive a private notice for general meetings of the Trust and postal ballot papers for MIO elections, changes to the constitutional documents of the MIO, the disposal of income shares by the MIO and the disposal or conversion of settlement quota by the MIO. Yes: o No: o

WHAKAPAPA DETAILS COMPULSORY: Complete the section for RAUKAWA SETTLEMENT TRUST AFFILIATION only:

Please indicate your PRIMARY MARAE from the list below of Raukawa Settlement Trust Marae

*Primary Marae: Mōkai (Pakaketaiari) Ukaipō Tapapa Owairaka (Rawhitiroa) Rengarenga Aotearoa Whakaaratamaiti Pikitu Tangata Ngatira Mangakaretu Ruapeka Whakamārama Pārāwera (Te Taumata) Ongaroto Paparaamu

APPLICATION FOR REGISTRATION

WHAKAPAPA Please complete just your Raukawa Settlement Trust Lineage. It is only necessary to complete your line of descent back to your marae.

It is accepted your whakapapa is your personal taonga however, it is a requirement for you to prove your entitlement. Therefore you may be required to provide evidence verifying your affiliation through descent from a primary ancestor of Raukawa Settlement Trust. The Trustees may determine the Tikanga of Raukawa Settlement Trust by which whāngai (persons who may not affiliate to Raukawa Settlement Trust by descent from Raukawa Settlement Trust but who are adopted by a Member of the Raukawa Settlement Trust in accordance with Tikanga or with the Adoption Act 1955) or other persons who do not descend from the primary ancestor of Raukawa Settlement Trust are able to affiliate to Raukawa Settlement Trust.

The Board reserves the right to disallow any application because of insufficient or incorrect information. The onus for inclusion onto the Raukawa Settlement Trust register of beneficiaries is on the applicant and not the Board.

GreatGrandfather

Grandfather

GreatGrandmother

Father

()

Fullname GreatGrandfather

Grandmother

GreatGrandmother

Applicant

GreatGrandfather

Grandfather

GreatGrandmother

Mother

()

Fullname GreatGrandfather

Grandmother

GreatGrandmother

NOTES TO APPLICATION Entitlement to register Subject to the rules set out in the Raukawa Settlement Trust Deed, the Trustees must enter in the Tribal Register any person:

a) By or on behalf of whom a valid application has been made; and b) Who in the reasonable opinion of the Trustees affiliates to Raukawa Settlement Trust through

descent from a primary ancestor of Raukawa Settlement Trust and affiliates to the Marae recorded on his or her Registration Form in accordance with the Deed.

Affiliation to Marae It is recognised that many are able to whakapapa to more than one Raukawa Settlement Trust marae, you must designate one primary marae for voting purposes. Spouse/Partner If your spouse/partner can whakapapa back to a Raukawa Settlement Trust marae, then he/she will need to complete an application form. A spouse/partner who is unable to whakapapa back to one of the 16 mandated Raukawa Settlement Trust marae can NOT be entered on the register. Issue (Nga Tamariki) A separate form must be completed for all applicants including minors. Parents or Guardians may complete and sign an application on behalf of minors. Those who are 18 years or older MUST complete their own enrolment form and sign it themselves. Beneficiaries under the age of 18 will be registered but not for voting purposes. DECLARATION/DISCLAIMER: I declare that the information given in this application is true and correct. Pursuant to the Privacy Act 1993, I understand this information will be collected, held, and used by the Raukawa Settlement Trust, and Raukawa Settlement Trust Entities, to further the purposes of the Raukawa Settlement Trust Deed and keep me informed of opportunities to participate. I understand that I have the right to view and correct my information at any time.

*SIGNATURE:

….......................................……………….......………....….… DATE: ………/………/………

*PRINT NAME:

………….......................................……….......………....….…

FOR OFFICE USE ONLY: As the Raukawa Settlement Trust trustee representing the Marae of the applicant, I confirm that the above named is a beneficiary of the Marae and endorse inclusion on to the Raukawa Settlement Trust register of beneficiaries.

SIGNATURE:

………………………………………………………………

DATE:

………..…/….....……/…….….…

PRINT NAME: ……………………………………………………………… MARAE: …………………………………….

*Compulsory Fields

(Parents or Guardians may sign this application on behalf of minors. A separate form must be completed for all applicants including minors)