Business Funding Application Form

The City of Kalamunda has established a $1 million COVID-19 Crisis Relief Fund to support households, community groups and small businesses that employ staff and have been subject to closure or highly impacted by the shutdown restrictions announced by the Government as a result of the corona virus (COVID-19).

Eligible small businesses will be provided with a one-off grant of up to $1000 which can be used to pay local government rates, fees or charges.

Opening Date: Applications open 1 July 2020.

Closing Date: Applications close 31 August 2020.

Further Information
Frequently Asked Questions
Terms & Conditions
How to Apply


Applicants can submit their details online below or alternatively an application form can be downloaded and submitted via email or in person at 2 Railway Road, Kalamunda during business hours.

Note: This application is subject to approval and funding available.
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Business Company Details

Tenure Arrangements

If known - can be found on rates notice

The business is subject to closure
The business has been assessed as eligible for the Commonwealth JobKeeper payment:
Operates the primary activity from premises in the City of Kalamunda or a registered owner of a business located in the City of Kalamunda
The business employs staff in the City of Kalamunda (Generally, to be considered an “employee”, staff must be under the control of the business, and have income tax and superannuation paid by the employer.)
The business had turnover greater than $75,000 in 2018-19
The business has, or was expected to have, turnover greater than $75,000 in 2019-20 before being adversely impacted by COVID 19 restrictions
The business has, or is expected to have, total payroll of less than $1,500,000 in 2019-20
The business has an Australian Business Number (ABN) and it held that ABN on 1 March 2020
At the time of lodgement of this application form, the business is a going concern, and was still operating in the City of Kalamunda on 1 March 2020
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Contact Details

e.g. Mr, Mrs, Ms, Other

For future correspondence, please ensure it is correct.

Reason for Application

Full time equivalent (FTE) is based on a 35 hour or more work hours per week (e.g. 2 full time staff working more than 35 hours and 2 part time staff working 18 hours is 3 FTE)

I am applying for:
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Payment Arrangements

If your application is found as eligible, payment will be made as a credit to your rate notice.
You should not create an invoice in relation to this transaction.

Located on your City of Kalamunda Rates Notice

as it appears on the business bank statement

as shown in your BAS statement (monthly/quarterly)

(Pre-March 2020) Business Activity Statement (BAS)

as shown in adjacent field

as shown on BAS statement (monthly/quarterly) being submitted

Most recent Business Activity Statement (BAS):
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Additional Documentation:

Such as: Evidence of JobKeeper eligibility

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Evidence of eligibility for JobKeeper - documentation such as a screen shot of your eligibility confirmation from the ATO or a bank statement demonstrating receipt of JobKeeper payments
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Declaration & Agreement

Acknowledgement and Lodgement

  1. Privacy Consent

    I acknowledge that the City of Kalamunda administering the Grant program, is subject to certain legislative and administrative
    accountability and transparency requirements of the Australian Government and Government of Western Australia, including public disclosure in accordance with Premier and Cabinet policy.

    I acknowledge that the City of Kalamunda will treat all information provided by applicants sensitively.

    I agree that any information contained in, or relating to, an application, including information identified by an applicant as confidential, may be disclosed by the City of Kalamunda:
    • to its employees, advisers or third-parties in order to assess and process an application;
    • where information is authorised or permitted by law to be disclosed; and/or
    • where the information is already in the public domain.

    I acknowledge that information collected will be used and held for the purposes of assessing the application, administering and handling the grant in accordance with the Grant Guidelines.

  2. Consent and Declaration

    I declare that:
    I am authorised for and on behalf of the entity nominated in this application to provide this declaration and to submit this application.

    My business is a going concern, and I have not, to the best of my knowledge having made all reasonable inquiries, omitted any information that:

    1. Would have a bearing on the consideration of my application, and I acknowledge that I may be required to provide evidence of statements made in this application.
    2. The statements set out in this application are true and correct in every particular.
    3. I understand this grant is for a small business that is subject to closure or highly impacted by the restrictions announced by the Commonwealth Government and the Government of Western Australia as a result of COVID-19.
    4. Neither I, nor any other person associated with this business, has previously applied for this grant for this business.
    5. I acknowledge that failing to provide some or all of the information which the City of Kalamunda requests about me may result in this application not being processed or approved.
    6. The details provided in this application are true, complete and accurate. I acknowledge and accept that the provision of incorrect details will delay the processing of my application and/or not receiving payment.
    7. I understand that if any information provided in this application is found to be untrue or misleading, the grant will be repayable on demand, and the matter may be referred to law enforcement and penalties may apply.
I am making the above declarations; and I agree that if our organisation receives a grant we will be legally bound by the Grant Terms and Conditions set out above.
I have read and understood the COVID-19 Crisis Relief Fund Guidelines.
Please indicate all areas that you have addressed / supplied:
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Please do not close this window until you receive a confirmation message. This may vary depending on your internet connection as well as how many attachments and how large they are. All successful applications will receive a confirmation email to the supplied email address - please ensure your email is correct prior to submission.
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© City of Kalamunda 2020