I, of elect to donate an amount of $ to the Victoria Campaign of Pauline Hanson's One Nation Party (State of Victoria) to be used for a State electoral purpose. I acknowledge that the gift has been accepted as a political donation.

Donations to One Nation Victorian State Campaign:

1. Make a donation in your capacity either as: a. Australian citizen or Australian resident (residing in Australia holding a permanent visa or a special category visa); or b. Australian organisation or business as indicated by a registered ABN (if donating in the name of a business or entity).

2. Provide the following details to One Nation Victoria on request (and provide supporting evidence where requested): a. If making a donation in your personal capacity: i. Your full name; ii. Your residential address; iii. Your telephone number; and iv. Your email address b. If making a donation on behalf of a business or entity: i. The full name of the business or entity; ii. The registered ABN of the business or entity; iii. The full name of the representative of the business or entity; iv. The telephone number of the representative of the business or entity; and v. The email address of the representative of the business or entity.

3. Acknowledge that: a. The Electoral Act 2002 (Vic) prohibits non-citizens from making political donations unless they are permanent residents. By attending this event and/or making any donation, you confirm and declare that you are an Australian citizen or permanent resident; b. A receipt will be issued to you/your organisation to identify the donation amount; c. For any donation of $1,210 or greater, you understand that you/your organisation must disclose the donation to VEC Disclosures within 21 days of making the donation; d. There is a $4,850 general cap on political donations from any one donor to One Nation Victoria in an election period (typically the four years between regular State elections); e. You or your organisation may be fined if you do not comply with the disclosure requirement; f. If you or your organisation make a political donation that is prohibited by the Electoral Act 2002 (Vic) and the recipient accepts the donation, it must be forfeited to the State; g. If you knowingly make a foreign donation, an anonymous donation of $1,210 or more, or a donation above the $4,850 general cap, you or your organisation may be fined up to 300 penalty units, imprisoned for up to two years, or (as an individual) both; and h. It is an offence to enter into or carry out a scheme with the aim of circumventing a law regarding political donations or disclosures under the Electoral Act 2002. The penalty for this offence is up to 10 years imprisonment.

4. Ensure that donations can be reconciled by the VEC by: a. Providing receipting details that exactly match those supplied to the VEC during registration.