APANA^® DONATION OF EQUIPMENT FORM

I,................................................................................(insert full name)

of ..........................................................................(insert full address)

hereby donate to the Australian Public Access Network Association Incorporated (APANA^®) the following item(s) of equipment:

Description                              Brand/Model                      Serial No.
-------------                                ---------------                        -----------
 
 
 

for the following purpose(s):
 
 
 
 

(above only to be filled in if donor so wishes.)

The above equipment becomes the outright property of APANA and I relinquish all rights, both legal and moral, to the  aforementioned equipment.

Further, I hereby certify that I am the legal owner of this equipment at the time of donation. Copy of proof of purchase is attached/not attached.*
 
 

Signed    ...........................................................     (donor)

Dated at  .................................. on .........................................

Witnessed ............................................
 

*cross out that which does not apply.