BSB 806 015

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BSB 806 015

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Helping &nds
Nominate an individual

Nominate an individual

Thanks for deciding to nominate someone you know for a Helping &nd.

3 ways to improve your nomination

Here are some hints & tips to give your nomination the best chance of being considered by our team:

Tell us how a Helping &nd will make a difference
Tell us how you know the nominee
Familiarise yourself with the Terms and Conditions

By completing this form, you confirm that:

The individual I am nominating is a permanent resident of Western Australia.
The contribution for which I am nominating the nominee will not benefit myself or my family.
The contribution for which I am nominating the nominee will not be used for fundraising or a donation to a charitable organisation.
The contribution for which I am nominating the nominee will not be used for hazardous, dangerous or illegal activities, or cause harm to the community or any people or animals.
The contribution for which I am nominating the nominee will not be used for gambling.

P&N Bank will not seek to publish names or identifying details of your nomination without prior consent.

* required information

Your details

Your full name

Your postcode

Your email address Please enter a valid email address

Your phone number

Your P&N Bank member number

Nominee's details

Please provide as much information as possible about the individual or family you are nominating. Only share information that the nominee would consent to you providing to us. Please don't provide any confidential or sensitive information.

Name of individual / family

Individual's address

Individual's suburb

Individual's postcode

Individual's phone number (we will not contact them without letting you know first)

Age group of the individual

What is your relationship to the nominee? (e.g. neighbour)

Has the individual/family you are nominating been impacted by coronavirus (COVID-19) in some way (e.g. illness, job loss or reduced income)?

Yes

Not sure

Tell us about the individual or family you are nominating and explain the difficult situation they are currently facing.

Please specify what a P&N Bank Helping &nds contribution could assist with (Assistance with: expenses due to illness/accident; paying a bill; groceries; child related expenses; purchasing basic household items (furniture, fridge etc.))

How would a Helping &nds contribution assist the individual or family at this time? What would this mean to them?

How urgent is this need for the individual or family?

Within the next two weeks

Within one month

Within three months

No specific urgency

Have you made the individual aware of the nomination?

Helping &nds Terms and Conditions I agree to the terms and conditions