Clermont Aboriginal Community Development
Fund (ACDF)
Funeral Fund Application Form
Approval Date
Approved by
Signature
Jacqueline Broderick
Karen Johnson
Mayleah Bemrose
Morne VanZyl
Petulia Stokes
Sarel Grobler
Revision Date
Revision Reason
18/11/16
ACDF Committee Recommendations – clarity
around Clermont Agreement requirements
Approved by
Background
The death of a loved one is a sad and stressful time and on top of grief and loss there can be the
financial pressure of paying for a funeral.
The Clermont Aboriginal Community Development Fund (ACDF) has made provision to
support eligible people who require assistance in meeting the costs of funerals due to financial
hardship.
Eligibility
An application for funding from the ACDF may be made to the ACDFC in respect of the funeral
of, and by any member (or entity where applicable), of the Aboriginal Community of Interest.
The Aboriginal Community of Interest is comprised of every person who is either;
a) A member of the Wangan & Jagalingou Native Title Claim Group; or
b) Able to provide evidence that he or she is an Aboriginal person who has resided
within the area of the Wangan & Jagalingou Native Title Claim for more than one
year.
Funding Support
The Funeral Fund provides a one-off payment for costs associated with funeral expenses. They
include:
1. Up to $3,000 toward direct costs of a registered Funeral Director
 Paid directly to the Funeral Director on receipt of a tax invoice
2. Up to $2,500 for individual payment for funeral expenses.
Funds will be paid:
 Directly to a family member organising the funeral or directly to an
Aboriginal organisation organising the funeral upon the provision of a
satisfactory explanation of the arrangements.
 As a one-off payment and no receipts required.
AND, if applicable
3. The ACDF will also consider additional funds required for incarcerated family members
to attend i.e. family members detained in or other compulsory detention.
 Supporting documentation from Corrective Services providing approval
& detailing transport and travel costs
How to apply
Each application for funeral funding should:
a) Be made in accordance with the Application Form that is available from the
Executive Officer;
b) Application forms may be emailed or posted to:
Executive Officer
Clermont Aboriginal Community Development Fund
PO Box 491
Clermont Queensland 4721
Email: [email protected]
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Payment
Wherever possible, funds will be made available in advance of the funeral and within 3 days of
an application. However this provision is subject to approval by the ACDF Committee in
accordance with an assessment process designed to expedite the consideration of funeral fund
applications.
In some circumstances, it may not be possible to consider applications in this manner and those
applications will be assessed at the next ACDF Committee meeting. In these circumstances,
further information may need to be sought.
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Aboriginal Community
Development Fund (ACDF)
Funeral Fund Application Form
1.
APPLICANT DETAILS
Applicant name:
Applicant postal address:
Applicant phone / mobile No.:
Applicant email address:
Are you a member of the Wangan & Jagalingou Traditional Owner
group?
Yes / No (please circle)
If yes, which apical ancestor do you identify with?
If no, please attach evidence proving association with/to the Aboriginal Community of Interest.
Are you a member of any other Native Title Claim Groups?
Yes / No (please circle)
If yes, which other groups do you identify with?
2.
DECEASED PERSON DETAILS (as appropriate)
Name:
Date of Birth:
Age:
Additional family information:

Deceased’s Mother’s Name:

Deceased’s Grandparents’ Names (Mother’s side):

Deceased’s Father’s Name

Deceased’s Grandparents’ Names (Father’s side):
Is the deceased member of the Wangan & Jagalingou Traditional
Owner group?
Yes / No (please circle)
If yes, which apical ancestor does the deceased identify with?
If no, please attach evidence proving association with/to the Aboriginal Community of Interest.
Is the deceased a member of any other Native Title Claim Groups?
Yes / No (please circle)
If yes, which other groups does the deceased identify with?
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3.
FUNERAL ARRANGEMENTS (please attach a copy of the Funeral Notice)
Date and Time of Funeral Service:
4.
FINANCIAL ASSISTANCE REQUIRED
In what way will you use the financial assistance? Please give details as to which Wangan and
Jagalingou members or Aboriginal Community of Interest members will receive assistance from the
funds (eg transport) or, if the funds are to be used for goods and services associated with the funeral
or the wake, explain what these are:
5.
REGISTERED FUNERAL DIRECTOR AND ORGANISER DETAILS
Are you the family member
organising the funeral with the
Funeral Director?
Yes / No (please circle)
If you are not the organising family
member, who is?
Funeral Director name:
Funeral Director postal address:
Funeral Director phone/ mobile No. :
Funeral Director email:
Please provide a copy of the account/ invoice containing bank details for direct payment to the
Funeral Director Company.
If payment has already been made and reimbursement of costs is sought, please provide a copy
of the paid Funeral Director account as well as the individual account detail (below) for
reimbursement.
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6.
ACCOUNT DETAILS (if requesting individual payment for funeral expenses)
Name:
BSB No.:
Account No.:
Bank:
Amount (funding assistance requested):
Name:
BSB No.:
Account No.:
Bank:
Amount (funding assistance requested):
7.
DECLARATION
I declare the information contained in this application is true and correct, and I am not receiving any
other bursary from another party.
I consent the disclosure of information from my application:
 to the immediate family of the deceased, the organiser of the funeral and the Funeral
Director for the purposes of confirming the logistics and arrangements outlined in my
application; and
 in the Annual Summary Report which is provided to the Wangan & Jagalingou Applicants,
the Agreement Implementation Group, the Aboriginal Community Development Fund
Committee and the Proponent.
I understand the ACDFC is not required to provide any person reasons for its rejection of any
application.
Applicant name
Applicant signature
Date
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