Claim Form

Reimbursement claim form for agreed Meet Your Street funding.

It is essential that we receive this form with all receipts attached to enable reimbursement. (If you have more scanned files than we have upload buttons for below you will need to combine some of them).

As part of the Selwyn District Council’s evaluation of Meet Your Street, all small subsidy recipients are required to complete this form. Reimbursement is capped at $75 per gathering.

If preferred, you may download a printable copy [PDF, 476 KB] of the form.

Contact Details

Name of Street
Contact Name
Address
Email
Phone Number

Activity Details

Activity
Location of activity
Number of participants
Date of activity
Weather conditions
Summary of event
Please give details of how the money was spent and attach copies of your receipts
Bank account details

Bank slip:

Receipts:

Please include at least one file, you may include up to five. Files must be PDF or JPG format, and under 5mb in size.

Photos:

Files must be PDF or JPG format, and under 5mb in size.

Photo agreement:

By checking this box the applicant agrees to Selwyn District Council using their photos for marketing purposes.

Please complete this form after your event, attach receipts and photos or scan and email within 30 days of your event.

Send your claim by submitting this form or sending your printable/scanned form to meetyourstreet@selwyn.govt.nz or post to:

Community Development
Meet Your Street
Selwyn District Council
PO Box 90
Rolleston 7643

Claim Form

Contact Details

Activity Details

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