Test Registration

I do solemnly and sincerely declare:

That I have provided my correct and true date of birth
(A copy of the applicant’s full birth certificate can be attached to this application below(Optional))

• That I am Ngai Tahu in terms of the “Te Runanga o Ngai Tahu Act 1996”
• That I am a blood descendant of the 1848 Kaumatua of Te Runanga o Waihao iwi as listed on this form.
• That the Whakapapa on this form indicating my blood descent from the said “1848 Kaumatua” is true and correct.

I acknowledge that the information contained in this form provided by me to Te Runanga o Waihao Inc is subject to the Privacy Act 1993; and that by submitting this form, I agree that Te Runanga o Waihao Inc may use this information to maintain its Papatipu Runanga voting rolls, contact databases and any other purpose which Te Runanga o Waihao considers reasonable, whilst performing its statutory role.