Wai 312 Registration

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INSTRUCTIONS

For the purposes of this form a ‘claimant' is a person claiming beneficial status in respect of the WAI 312 Claim and Settlement.
Every claimant age 18 years and over must complete their own registration form.
Every form must be filled out in pen.
Te Komiti Whakahaere o Ngati Whatua o Kaipara ki te Tonga or their successors as may be established may determine whether a person is or is not to be recognised, for the purposes of registration as a claimant.
The form can be filled out by parents regardless of whether they are a claimant in their own right on behalf of children under the age of 18.
Every person claiming an interest solely on the basis that they are a spouse of a claimant will not be recognised as a claimant in their own right and shall not have the right to make any decisions in relation to the operation and management of matters relating to the WAI 312 Claim and Settlement, but at the discretion of the body set up to administer the settlement may be eligible to receive benefits from the settlement.
A whangai (being a person adopted in accordance with tikanga Maori) shall be entitled to a beneficial interest to the same extent as that person would have been entitled if that person had been a child of the claimant.
Each application for registration must be witnessed by another person who has known the claimant for at least 1 year.

Once completed, please send this form to: WAI 312

P.O.Box 41

Helensville

Wai 312 Registration Form

Ingoa Matua/Surname:

Ingoa Iriiri/Given Name(s)

Also known as:

Maiden Name:

Tangata/Male:

Wahine/Female:

Kainga/Address:

Iwi/Hapu (for this registration):

Other Iwi/Hapu Affiliations:

Waea Kainga/Phone (H):

Waea Mahi/Phone (W):

Email:

Ra Whanau/Birthdate:

Ingoa Hoa Aroha/Spouse's Name:

Nga Ingoa o Nga Tamariki/ Children's Names	Tama/Kotiro Male/Female	Ra Whanau/ Children's Birthdates	Relationship

(Please use a separate sheet if you need more space)

What are your interests or your children's interests or your spouse's interests (tick as many boxes as apply) within the WAI 312 claim area ? Please fill out relevant details.
	Land interests within claim area:
	__________________________________________________________________________
	__________________________________________________________________________
	__________________________________________________________________________

	Tupuna from claim area:
	___________________________________________________________________________
	___________________________________________________________________________
	___________________________________________________________________________

	Affiliation to any of the five marae:
	___________________________________________________________________________
	___________________________________________________________________________
	___________________________________________________________________________
	___________________________________________________________________________
	___________________________________________________________________________

	Whangai of Claimant: (see note on instruction sheet)
	___________________________________________________________________________
	___________________________________________________________________________
	___________________________________________________________________________
	___________________________________________________________________________

Whakapuakitanga/Declaration and Statement to comply with the provisions of the Privacy Act 1993: I sincerely declare that:
All the information on this registration form is true and correct;
I understand that the information I provide will be held by Te Komiti Whakahaere o Ngati Whatua o Kaipara ki te Tonga or their successors as may be established to process this registration;
Te Komiti Whakahaere o Ngati Whatua o Kaipara ki te Tonga or their successors as may be established may use this information to keep me informed of activities that may be of interest to me;
I have the right of access and correction to the information held by Te Komiti Whakahaere o Ngati Whatua o Kaipara ki te Tonga or their successors as may be established concerning me, provided under the Privacy Act 1993.
I authorise Te Komiti Whakahaere o Ngati Whatua o Kaipara ki te Tonga or their successors as may be established to make such inquiries about me that may be relevant to processing this application from any third party including any person named in this whakapapa. I acknowledge that the information supplied in this application may be made available to other parties in the course of enquiries regarding registration details.


Signature:	______________________	Date:_____________


Witness Details
Full Name:	______________________	Full Address:____________________ ____________________________________________

Signature:	_______________	Date:_________________

Page last updated 7 Dec 2008

Wai 312 Registration

INSTRUCTIONS

For the purposes of this form a ‘claimant' is a person claiming beneficial status in respect of the WAI 312 Claim and Settlement.

Every claimant age 18 years and over must complete their own registration form.

Every form must be filled out in pen.

Te Komiti Whakahaere o Ngati Whatua o Kaipara ki te Tonga or their successors as may be established may determine whether a person is or is not to be recognised, for the purposes of registration as a claimant.

The form can be filled out by parents regardless of whether they are a claimant in their own right on behalf of children under the age of 18.

A whangai (being a person adopted in accordance with tikanga Maori) shall be entitled to a beneficial interest to the same extent as that person would have been entitled if that person had been a child of the claimant.

Each application for registration must be witnessed by another person who has known the claimant for at least 1 year.

Once completed, please send this form to: WAI 312

P.O.Box 41

Helensville

Wai 312 Registration Form

Ingoa Matua/Surname:

Ingoa Iriiri/Given Name(s)

Also known as:

Maiden Name:

Tangata/Male:

Wahine/Female:

Kainga/Address:

Iwi/Hapu (for this registration):

Other Iwi/Hapu Affiliations:

Ra Whanau/Birthdate:

Ingoa Hoa Aroha/Spouse's Name:

What are your interests or your children's interests or your spouse's interests (tick as many boxes as apply) within the WAI 312 claim area ? Please fill out relevant details.

Land interests within claim area:

Tupuna from claim area:

Affiliation to any of the five marae:

Whangai of Claimant: (see note on instruction sheet)

Whakapuakitanga/Declaration and Statement to comply with the provisions of the Privacy Act 1993:

I sincerely declare that:

All the information on this registration form is true and correct;

I understand that the information I provide will be held by Te Komiti Whakahaere o Ngati Whatua o Kaipara ki te Tonga or their successors as may be established to process this registration;

Te Komiti Whakahaere o Ngati Whatua o Kaipara ki te Tonga or their successors as may be established may use this information to keep me informed of activities that may be of interest to me;

I have the right of access and correction to the information held by Te Komiti Whakahaere o Ngati Whatua o Kaipara ki te Tonga or their successors as may be established concerning me, provided under the Privacy Act 1993.

Signature:

______________________

Date:_____________

Witness Details

Full Name:

______________________

Full Address:____________________

Signature:

_______________

Date:_________________