Please submit to City of Darwin approximately four (4) weeks before the start date of the event/activity/service. Required fields are denoted by * Please read through City of Darwin’s annual fee and charges, and advise what Council services/equipment is relevant to your proposed event/program you are requesting as In-Kind support: Applicant Details Name of group/organisation Contact person Contact email Contact phone Provide a brief description of your group/organisation: Eligibility Check Are you a non-profit group or a non-profit organisation? Yes No Is the event or service being delivered generating revenue/profit for the organisation? Yes No Will your program interrupt or adversely impact City of Darwin's operations and provision of business-as-usual services? Yes No Do you have the current public liability insurance of $20 million? Yes No If yes, please upload the P/L certificate. One file only.64 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Program details Program details Name of event/initiative/program/service Location Dates Expected participants number Low scale 0-500 people Minor 500-1,000 people Medium 1,000-7,000 people Major over 7,000 people Please supply a short description of your event/initiative/program the In-Kind Support is required for. Please advise why the activity or event will not occur without in-kind support. Have you applied for any other subsidies, grants, sponsorship, or in-kind support for this event/initiative/program from City of Darwin? Yes No If yes, please provide the details including the amount and time of receiving the support. Please demonstrate that the initiative/program/event/project will provide greater social, environmental and economic benefits to the Darwin community as a result of in-kind support provided. In particular, which outcome for Darwin 2030 does your event/initiative/program/event/project contribute. A capital city with best practice and sustainable infrastructure A safe, liveable and healty city A cool, clean and green city A smart and prospectus city A vibrant and creative city Please provide details. How will you acknowledge Council’s contribution to your event/initiative/program/project/service? Upload any supporting documents. One file only.64 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. In-Kind Support Assistance Support assistance In-kind support description Dates required Total amount Acknowledgment I agree to Collect and return equipment to City of Darwin in good order and condition. Pay for any damages that occur as a result of its use of in-kind items/equipment. Acknowledge the City of Darwin’s support in relevant public forums, speeches, or openings, or in promotional or program material for the activity or event for which the in-kind support has been received. Lodgement details I certify that I have been authorised to submit this request on behalf of the above-mentioned group/organisation and the information contained herein is a true and correct record. Yes, I am authorised and confirm the provided information is true and correct.
