Titi Islands

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APPLICATION

FOR

REGISTRATION

TE RUNANGANUI O WAITAHA

MAATA WAKA INC. 1991

TRIBAL

DATABASE:

Please return this form to:

TE RUNANGANUI O WAITAHA

me MAATA WAKA

IWI AUTHORITY INCORPORATED 1991

Kokirihapuku

Awahuri R.D.9

Palmerston North

NEW Zealand

or Email:

uruao@yahoo.co.uk

HE WHAKAMARAMA

It is estimated that of the 39,000 who identified as Ngai Tahu Whanui in the 2001 census the tribe's membership database contains the names of only 34,500 Ngai Tahu. Many of the 5,000 unregistered beneficiaries refuse to be included on the tribal database predominately due to the lack of real acknowledgment of the protocols of both Mamoe and Waitaha. This number does not include those who chose Waitaha as their Iwi to the census affiliation. This form and register will be used for a number of purposes, including—gathering information.

to compile a Data Base of all Nga Uri O Waitaha

Show the Regional displacement of all Whanau/hapu Nga Uri O Waitaha.

To design a proper governance structure for Nga Uri O Waitaha

Form a better network of Communications for Nga Uri O Waitaha.

Identify Social, Educational and Manaakitanga needs of Nga Uri O Waitaha

Distribute benefits to nga Marae or Individuals of Nga Uri O Waitaha that may arise

About those who wish to confirm their Waitaha affiliation and/or for inclusion in the Te Runanganui O Waitaha me Maata Waka Iwi Authority Inc. 1991 tribal register.

Please ensure that you fill out the form fully, including the names of your principal hapu (if known) and principal marae. When you have completed the form, you may either have it validated by one or two Waitaha Kaumätua in the spaces provided, or you may send it back to the Te Runanganui O Waitaha me Maata Waka Iwi Authority Inc. 1991 Working Committee, who will arrange for its validation.

WAITAHA TRUST BOARDS. INCORPORATED SOCIETIES. WHANAU TRUST.

We encourage all other Waitaha Trust’s, Incorporated Societies and Whanau Trust’s to use the form provided to register Their Trust and or Society within the Tribal Database where your membership detail are protected,

P R I V A C Y & C ON F I D E N T I A L I T Y

Please be assured that the information gathered by this form will only be used for tribal purposes—it will not be sold, made available to any other agency, or misused in any way. This form, and the electronic database in which the information will be stored, will be kept secure and will only be made available to authorised persons for purposes associated with the governance of Te Runanganui O Waitaha me Maata Waka Iwi Authority Inc. 1991.

Te Runanganui O Waitaha me Maata Waka Iwi Authority Inc. 1991.is committed not just to observing the principles of the Privacy Act 1993 but also to protecting the mana of individuals, hapu of Waitaha as a whole.

P E R S O N A L I N F O RMA T I O N

LAST NAME: _____________________________________ MR/MRS/MS/DR/OTHER:

FIRST NAME(S): _______________________________________________________________

MAIDEN NAME (IF APPLICABLE): _____________________________________________________

PRINCIPAL HAPU (IF KNOWN): _______________________________________________________

OTHER HAPU: (IF KNOWN): __________________________________________________________________

PRINCIPAL MARAE: _____________________________________________________________

DATE OF BIRTH: ___________________________________ GENDER: M / F

POSTAL ADDRESS: __________________________________________________________

TELEPHONE (HOME): __________________________ (WORK):

E-MAIL: ___________________________________ (MOBILE):

WHAT IS THE BEST WAY TO CONTACT YOU IF WE NEED MORE INFORMATION ABOUT THIS FORM?

________________________________________________________________________

PRIVACY ACT

The information gathered by this form will be used by Te Runanganui O Waitaha me Maata Waka Iwi Authority Inc. 1991 solely for the purpose of establishing and operating a tribal database.

D E C L A R A T I O N

I DECLARE THAT, TO THE BEST OF MY KNOWLEDGE, THE INFORMATION CONTAINED IN THIS

FORM IS TRUE AND CORRECT:

YOUR SIGNATURE: _________________________________ DATE: _______________

V A L I D A T I O N

WE, THE UNDERSIGNED KAUMATUA, DECLARE THAT, TO THE BEST OF OUR KNOWLEDGE, THE APPLICANT IS A MEMBER OF WAITAHA AND IS ENTITLED TO BE INCLUDED IN THE TE RUNANGANUI O WAITAHA me MAATA WAKA INC. 1991TRIBAL REGISTER:

SIGNATURE OF KAUMATUA: ____________________________ DATE: _______________

FULL NAME OF KAUMATUA: ______________________________________________________

SIGNATURE OF KAUMATUA: ____________________________ DATE: _______________

FULL NAME OF KAUMATUA: _______________________________________________________

(PARENTS MAY SIGN FOR CHILDREN UNDER 16)

WH A K A P A P A

Please ensure that your full name and the full names of your parents are included in the information provided below. For the generations prior to your parents, enough information must be provided to establish a line of descent back to the principal hapu named on the previous page. Every space in the ‘family tree’ does not need to be filled in, as long as the line of descent is established.

Your Full Name

Your Fathers Full Name	Your Mothers Full Name

Paternal Grandfather Name	Paternal Grandmother Name

ARE YOU A MEMBER OF ANY OTHER WAITAHA TRIBALGROUP OR TRUST YES/NO

REGISTRATION FOR:

WAITAHA TRUST BOARD’S, INCORPORATED SOCIETY’S. WHANAU TRUST’S

NAME OF TRUST/BOARD/SOCIETY

REGISTED OFFICE ADDRESS

PHONE:

FAX:

Email.

Under the Rules of our Constitution I am duly Authorised to Register our Trust, Board or Society and our members to be included onto the Waitaha Tribal Database being complied by Te Runanganui O Waitaha me Maata Waka Inc 1991. Our Total Membership Number as of this day; ________________is __________. In registering our Trust, Board or Society with Te Runanganui O Waitaha me Maata Waka Inc 1991 Waitaha Tribal Database we will keep Te Runanganui O Waitaha me Maata Waka Inc 1991, informed of any membership changes. If any of our members wish to register as an Individual or as a Whanau of Te Runanganui O Waitaha me Maata Waka Inc 1991, Te Runanganui O Waitaha me Maata Waka Inc 1991 will notify us accordingly from their Individual Registration Form List, once authorised by the applicant.

Signed by:

Position Held

Date:

Please Forward a Copy of Your Certification with this Application:

F U R T H E R I N F O RMA T I O N

If you have any comments, questions or concerns about this form or the registration process in general, please contact :

TE RUNANGANUI O WAITAHA me MAATA WAKA IWI AUTHORITY INCORPORATED 1991

Kokirihapuku

Awahuri R.D.9

Palmerston North

NEW Zealand

or Email: uruao@yahoo.co.uk

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October 02, 2005