HAPŪ REGISTER: NGĀI TAMAWHARIUA KI TE REREATUKAHIA PART 1: PERSONAL INFORMATION Question Title * 1. What is your name? (Required.) Question Title * 2. What is your date of birth? (Required.) Date / Time Date Question Title * 3. Where do you currently reside? (Required.) Question Title * 4. What is your email address? (Required.) Question Title * 5. What is your contact number? (Required.) PART 2: CHILDREN OR DEPENDENTS (under the age of 18 years) Question Title * 6. Child/Dependent 1 Name Question Title * 7. What is the child/dependent 1's date of birth? Date / Time Date Question Title * 8. Child/Dependent 2 Name Question Title * 9. What is the child/dependent 2's date of birth? Date / Time Date Question Title * 10. Child/Dependent 3 Name Question Title * 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. Question Title * 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. (Required.) YES I am a Whāngai NO I am not Whāngai Question Title * 13. What is your whakapapa? 3 On your Mothers side Question Title * 14. Name of your Mother (Required.) Question Title * 15. Name of your Grandmother (Mothers mum) Question Title * 16. Name of Great-Grandmother (your grandmothers mum) Question Title * 17. Name of your Great-Grandfather (your grandmothers dad) Question Title * 18. Name of your Grandfather (Mothers father) Question Title * 19. Name of your Great-Grandmother (your grandfathers mum) Question Title * 20. Name of the Great-Grandfather (your grandfathers dad) On your Fathers side Question Title * 21. Name of your Father (Required.) Question Title * 22. Name of your Grandmother (your Dads mother) Question Title * 23. Name of your Great-Grandmother (your Grandmothers mum) Question Title * 24. Name of your Great-Grandfather (your grandmothers dad) Question Title * 25. Name of your Grandfather (your Dads father) Question Title * 26. Name of the Great-Grandfather (your grandfathers dad) Question Title * 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. Question Title * 28. You declare and agree . . . . (Required.) 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. Question Title * 29. Completed this form (Required.) Date / Time Date Time AM/PM - AM PM Done