HAPŪ REGISTER: NGĀI TAMAWHARIUA KI TE REREATUKAHIA

PART 1: PERSONAL INFORMATION

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* 1. What is your name?

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* 2. What is your date of birth?

Date / Time

Date

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* 3. Where do you currently reside?

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* 4. What is your email address?

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* 5. What is your contact number?

PART 2: CHILDREN OR DEPENDENTS (under the age of 18 years)

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* 6. Child/Dependent 1 Name

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* 7. What is the child/dependent 1's date of birth?

Date / Time

Date

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* 8. Child/Dependent 2 Name

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* 9. What is the child/dependent 2's date of birth?

Date / Time

Date

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* 10. Child/Dependent 3 Name

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* 11. What is the child/dependent 3's date of birth?

Date / Time

Date

If you have more children or dependents to add please contact the office at admin@tamawhariua.org.nz or 075490760

PART 3: WHAKAPAPA

The purpose of the information requested in this section is to verify actual whakapapa to Ngāi Tamawhariua ki Te Rereatukahia. Whakapapa is verified by kaumātua. You will be advised whether or not your application for registration has been accepted. You will have a right to appeal.

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* 12. Please tick the box if you are Whāngai (do not whakapapa to Ngāi Tamawhariua ki Te Rereatukahia but adopted by a person of Ngāi Tamawhariua ki Te Rereatukahia descent) or not.

YES I am a Whāngai

NO I am not Whāngai

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* 13. What is your whakapapa?

On your Mothers side

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* 14. Name of your Mother

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* 15. Name of your Grandmother (Mothers mum)

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* 16. Name of Great-Grandmother (your grandmothers mum)

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* 17. Name of your Great-Grandfather (your grandmothers dad)

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* 18. Name of your Grandfather (Mothers father)

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* 19. Name of your Great-Grandmother (your grandfathers mum)

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* 20. Name of the Great-Grandfather (your grandfathers dad)

On your Fathers side

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* 21. Name of your Father

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* 22. Name of your Grandmother (your Dads mother)

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* 23. Name of your Great-Grandmother (your Grandmothers mum)

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* 24. Name of your Great-Grandfather (your grandmothers dad)

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* 25. Name of your Grandfather (your Dads father)

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* 26. Name of the Great-Grandfather (your grandfathers dad)

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* 27. Name of the Great-Grandmother (your grandfathers mum)

OUR PRIVACY PROMISE

Te Rūnanga o Ngāi Tamawhariua promise not to disclose your registration information to any other organisation without your consent.

PART 4: DECLARATION

The purpose of this section is to remind you of your Privacy Rights and to obtain your consent to use your information on this form for the stated purposes. Please select all options and by doing so you agree.

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* 28. You declare and agree . . . .

1. That the information provided in this registration form will be held by Te Rūnanga o Ngāi Tamawhariua.

2. That Te Rūnanga o Ngāi Tamawhariua may use the data on the register in a way that does not identify you and other hapū matters.

3. That you have the right to access and correct the information held on the Hapū Register.

4. That at any time you can advise that you wish to delete your register profile.

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* 29. Completed this form

Date / Time

Date

Time

AM/PM