Ngāti Rehua Ngātiwai ki Aotea Trust MEMBERSHIP REGISTRATION FORM 1. YOUR PERSONAL DETAILSYour Name* First Name Family Name Your Maiden Name (if applicable) Your Gender Male Female Postal Address Street Address Suburb City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date Of Birth* DD slash MM slash YYYY Relationship status Single Married De Facto Civil Union Phone Number Mobile Number Your Email Your Preferred Contact Method Phone Email Postal None 2. TUPUNATo be eligible to register with the Ngāti Rehua Ngātiwai ki Aotea Trust, you must be able to whakapapa or tatai to the founding tupuna by virtue of being descended from one or more of the following: a. Ranginui, the son of Hikihiki: and/or b. Rehua, the son of Mataahu and Te Kura: and/or c. Te Awe, son of Te Whaiti.TupunaPlease select your Tupuna (if known): Ranginui Rehua Te Awe 3. YOUR SPOUSE/PARTNER'S DETAILSName First name Family name Maiden name (if applicable) Gender Male Female Date of birth DD slash MM slash YYYY Iwi (if applicable) 4. YOUR WHAKAPAPATo be eligible to register with the Ngāti Rehua Ngātiwai ki Aotea Trust, you must be able to whakapapa or tatai to the founding tupuna by virtue of being descended from one or more of the following: a. Ranginui, the son of Hikihiki: and/or b. Rehua, the son of Mataahu and Te Kura: and/or c. Te Awe, son of Te Whaiti. The Combined Kaumatua Validation Committee will make a decision to either accept your registration, ask you for more information or decline your application. Please complete the relevant whakapapa that validates your link to Ngāti Rehua Ngātiwai ki Aotea Trust. Please note that additional fields will become available as you start filling out your whakapapaMy Father's familyStart entering your whakapapa to see more generationsMy Father My Grandfather is My Grandmother is My Great GrandparentsMy Grandfather's Father is My Grandfather's Mother is My Grandmother's Father is My Grandmother's Mother is My Great Great GrandparentsMy Grandfather's Paternal Grandfather is My Grandfather's Paternal Grandmother is My Grandfather's Maternal Grandfather is My Grandfather's Maternal Grandmother is My Grandmother's Paternal Grandfather is My Grandmother's Paternal Grandmother is My Grandmother's Maternal Grandfather is My Grandmother's Maternal Grandmother is My Mother's familyStart entering your whakapapa to see more generationsMy Mother My Grandfather is My Grandmother is My Great GrandparentsMy Grandfather's Father is My Grandfather's Mother is My Grandmother's Father is My Grandmother's Mother is My Great Great GrandparentsMy Grandfather's Paternal Grandfather is My Grandfather's Paternal Grandmother is My Grandfather's Maternal Grandfather is My Grandfather's Maternal Grandmother is My Grandmother's Paternal Grandfather is My Grandmother's Paternal Grandmother is My Grandmother's Maternal Grandfather is My Grandmother's Maternal Grandmother is 5. YOUR CHILDREN/DEPENDANTS (under the age of 18 years)Number of children/dependents 0 1 2 3 4 5 6 7 8 9 First dependentName First names Surname Date of birth DD slash MM slash YYYY Gender Male Female Relationship to me Second dependentName First names Surname Date of birth DD slash MM slash YYYY Gender Male Female Relationship to me Third dependentName First names Surname Date of birth DD slash MM slash YYYY Gender Male Female Relationship to me Fourth dependentName First names Surname Date of birth DD slash MM slash YYYY Gender Male Female Relationship to me Fifth dependentName First names Surname Date of birth DD slash MM slash YYYY Gender Male Female Relationship to me Sixth dependentName First names Surname Date of birth DD slash MM slash YYYY Gender Male Female Relationship to me Seventh dependentName First names Surname Date of birth DD slash MM slash YYYY Gender Male Female Relationship to me Eighth dependentName First names Surname Date of birth DD slash MM slash YYYY Gender Male Female Relationship to me Ninth dependentName First names Surname Date of birth DD slash MM slash YYYY Gender Male Female Relationship to me NOTESPlease add any notes or additional dependents that you would like submitted with your registrationAdditional info6. IDENTIFICATION REQUIREMENTSPlease provide official identification such as a birth certificate, a passport, a driver’s licence, or any other acceptable form that reflect Name, Surname and Date of Birth.IDAccepted file types: jpg, gif, png, pdf, tiff, Max. file size: 256 MB.7. PRIVACY ACTIn accordance with the provisions of the Privacy Act 1993, any information received herein, will be held by Ngāti Rehua Ngātiwai ki Aotea Trust or their respective successors, and will not be made available to any other parties without your consent. As a registered charity, it will be required to retain documents, including the application forms and ID for 7 years.8. DECLARATIONI do solemnly declare that to the best of my knowledge and belief, that the information that I have provided about me is true.Signature* Hidden5. DECLARATION*In accordance with the provisions of the Privacy Act 1993, I consent that any information received herein will be held by Ngati Rehua Ngatiwai ki Aotea Trust or their respective successors, and will not be made available to any other parties without your consent. YES - I give my consent NO - I do not give my consent NameThis field is for validation purposes and should be left unchanged. Δ
