Iwi/Hapu Management Plan Application Form He Pepa Tono whakakī Mahere Rautaki ā Hapū ā Iwi

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Iwi/Hapu Management Plan He Pepa Tono whakakī Mahere Rautaki ā Hapū ā Iwi 1. This is an application for (tick the option that best applies) The development of a new hapu/iwi resource management planning document Updating or reviewing an existing document (Name existing document below) Name of Existing Document: 2. Name and Contact Details of Hapū/iwi: Address: Email: 3. Contact Details of two key people involved in this project Contact 1 Address: Email: Iwi/Hapū Management Plan Page 1 of 7

Contact 2 Address: Email: 4. Brief details of key contact people (please include their role in the project, skills, qualifications and previous experience) 5. Verification that the document will be recognised by the relevant Iwi Authority: Name of Iwi Authority: Details of Authorised Iwi Representative: Address: Email: Signature: Date: Designation: Iwi/Hapū Management Plan Page 2 of 7

6. Evidence to show the plan being developed has the approval from a wide representation of the Hapū/Iwi. Please provide the following: Copy of minutes of meeting in which the plan development was mandated Letter of confirmation from the chairperson of the Hapū/Iwi Other form of confirmation (please provide detail below). 7. Project Description: (Describe the purpose of the plan, proposed content, goals, objectives and desired outcomes) a) What will be the name of the Hapū/Iwi planning document? Iwi/Hapū Management Plan Page 3 of 7

b) What is the proposed life of the plan? c) Description of Hapū/Iwi areas of interest/boundaries and statutory acknowledgement areas (if applicable). (Please include map if possible) d) Will the plan be developed in stages? Yes / No (please circle) (If yes, please outline stages and proposed timeframes) Iwi/Hapū Management Plan Page 4 of 7

e) Plan Development methods and estimated costs: (This information may be provided as a separate attachment, however, please include the headings identified below and any additional ones you may have). Please provide details beneath the headings below Consultation Hui: $ Estimated Costs Research: $ Administration: $ Site Visit/Field Trip: $ Workshops: $ Consultants/Contractor Fee: $ Other: $ Estimated Total Cost $ f) How much funding are you seeking from Western Bay of Plenty District Council? $ g) Have you obtained funding from any other sources? eg Bay of Plenty Regional Council. (Please include the name of the organisation and the amount received). Iwi/Hapū Management Plan Page 5 of 7

h) How will the Hapū/Iwi contribute to the development of the plan? (Include details about any financial or in-kind assistance) i) How would you like to work with Western Bay of Plenty District Council in developing your plan? 8. Bank Account Details (Please provide a pre-printed bank deposit slip to the application. GST will only be paid if the organisation is GST registered) Bank Name: Branch: Account Name: Account Number: GST Number: Iwi/Hapū Management Plan Page 6 of 7

9. Official lodgement of the final plan Please note that successful applications will be required to officially lodge their plan with the Western Bay of Plenty District Council (see guidelines). The plan will become a public document, and may be placed on Council s website. 10. Authorised signature(s) for application: Role: Signature: Date: Role: Signature: Date: 11. Please send applications to: Māori Relationships and Engagement Advisor Western Bay of Plenty District Council Private Bag 12803 TAURANGA 3143 Phone: 07 571 8008 Email: kaitakawaenga.maori@westernbay.govt.nz Iwi/Hapū Management Plan Page 7 of 7