Online Gift Application
Lax Kw'alaams Band Gift December 2022

Registered Lax Kw’alaams Band members are entitled to a one-time gift of $500. To apply on behalf of Lax Kw’alaams Band members under 18 years of age, children must be fully in your care.

This form is only for those residing in Canada or the United States. This form is also for those wishing to receive a cheque only - there is no direct deposit option at this time.

If you require more space for dependents, please complete this form a second time with your additional dependents.

Form submissions will be processed starting in January 2023.

Deadline to apply: February 28, 2023

Applicant information

All fields must be complete, including middle name (if applicable). Use your legal name, as it appears on your status card.

First Name

Middle Name

Last Name

Month of Birth

Select month

Day of Birth

Select day

Year of Birth

Select year

Street Address or PO Box #

Unit number, building number and street name OR post office box #

Example: Unit 123 - 6789 Example Street

OR: PO Box #999

City

Or name of community

Province

Or State

Postal Code

Or Zip Code

Phone

All applications submitted through this form will be processed as a cheque until further notice

I consent to having my gift processed as a cheque (mark with an x)

Applicant Signature

Type the main applicants legal name here.

Date of Application

mm/dd/yyyy

Declaration

I hereby declare that the information provided is true and correct (mark with an x)

Spouse and/or Dependent(s)

Must be Lax Kw’alaams member(s).

Add spouse and/or dependent

Send me a copy of my responses

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Online Gift Application Lax Kw'alaams Band Gift December 2022

Applicant information

Spouse and/or Dependent(s)

Online Gift Application
Lax Kw'alaams Band Gift December 2022