Dealer Name:

Dealer Code Tag/Gmon #

Registration No. Holden Invoice No.

Date of Delivery Model Name

Telephone No:

Amount Claimed (Inc GST) $ GST Amount $

Bank Details:

Account name:

BSB: Account Number:

Trade In Details:

Make: Model:

Customer Signature:

Dealer Signature: Date of this Claim:

Holden Use Only:

TAX CODE: I2 Cost Centre:

Finance Dept Approval:

GL: 8011153018

Profit Centre: 45011OVS10 Bulletin No. 1 2 / 1 8

Member Cashback Claim FormEmail this completed form to jessicap@collingwoodfc.com.au

GM Holden Ltd is offering a personal benefit to members of Collingwood. Refer to Terms and Conditions on following page.

To claim the cashback Collingwood Australian members must give the Dealer their Membership Number and Name

Member’s Name:

Membership # (AFL/AFLW/Netball):

Address:

Postcode:

Telephone No:

Email Address:

Collingwood Member Details:Following purchase of your new Holden (no later than 31 December 2018) complete the details and sign this form with your Holden Dealer. The completed form can be mailed to the address below or emailed to jessicap@collingwoodfc.com.au

Terms and conditions relating to this offer appear on the back of this form.

Details of Parent (or Legal Guardian) if Member under the legal age to hold a drivers licence

Parent / Legal Guardian’s name:

Address:

Postcode:

Telephone No:

Email Address:

For information on Holden’s privacy policy please visit www.holden.com.au or call Holden Customer Assistance on 1800 033 349.

Vehicle Purchase DetailsGM Holden Ltd. ABN 84 006 893 232

Cashback Postal Address: GM Holden LtdPricing DepartmentVSSM Finance GPO Box 1714Melbourne 3001 VIC

Cashback Facsimile: (03) 9647 2500

e.g. Commodore, Colorado

Collingwood Football Club Cashback Terms And Conditions

1. The Collingwood (“Cashback”) is only redeemable by private buyers who are Collingwood members (either Collingwood FC members, Collingwood AFLW members or Collingwood Magpies Netball members). It is only available on the purchase of a brand-new Holden vehicles which is ordered and invoiced through an authorised Holden Dealer between 1st January 2018 – 31st December 2018 (Eligible Vehicle). A copy of the Cashback offer and proof of an Eligible Vehicle purchase will be required to claim this offer. The name in the Cashback offer must correspond to the name on the proof of purchase for the Eligible Vehicle. 2. The sole purpose of the Cashback is to assist in reducing the agreed selling price of an eligible Holden by the amount designated for the specific carline (see Clause 4). The Cashback claim remains valid during the stated program period and must be endorsed by an authorised Holden Dealer. The dealer or the purchaser can forward the completed claim form to the Holden Collingwood team at the email address provided and a Cashback EFT for the amount as determined by the carline (amounts include GST) will be made payable to the purchaser listed on the vehicle registration. This offer is not negotiable and the any Cashback amounts will only be paid through EFT. 3. To claim this Cashback please complete this Member Cashback Claim Form and send it to the email provided. All Cashback claims for purchases of Eligible Holden Vehicles must be received by Collingwood no later than 31st March 2019. 4. Carline and Factory Cashback amount: Spark Cashback $ 250 (incl GST); Barina Cashback $250 (incl GST); Trax Cashback $500 (incl GST); Astra Cashback $1000 (incl GST); Equinox Cashback $1000 (incl GST); Captiva (incl. Active) Cashback $1000 (incl GST); ZB Commodore (LT,RS) Cashback $1000, ZB Commodore (RS-V, Calais, Calais-V, VXR) Cashback $2000; ZB Commodore Tourer (Calais, Calais-V) Cashback $2000; VF Commodore (Sedan, Ute or Wagon) (excl all V8s) Cashback $2000 (incl GST); Colorado (incl Storm Pack 4 x 4) Cashback $2000 (incl GST); Trailblazer (incl Z71) Cashback $2000 (incl GST). 5. This Cashback is not available for any Holden purchased as part of a fleet transaction. 6. The Cashback cannot be used in conjunction with other Holden cashback offers (e.g. Partner program, Red Bull Holden Racing Team, Holden in the Driveway, PGA Holden Scramble). 7. Only one claim may be applied to each purchase of an eligible new Holden vehicle under this program 1st January 2018 – 31st December 2018. Cumulative claims are invalid on any single new Holden purchase. 8. Cashback applications for the prior Cashback, which expired on 31/12/17, are not cumulative and cannot be used with this current program. 9. This offer is not transferable, other than to members of the immediate family of the member named, namely husband, wife, son, daughter, son-in-law or daughter-in-law, mother, father, brother, sister or defacto partner (the offer does not include father-in law or mother-in-law). Proof of relationship to the Subscriber will be required. Holden reserves the right to reasonably reject any claims where proof is insufficient or unsatisfactory. A Subscriber may also register the vehicle in a registered company name, where the Subscriber is a director or partner of that business and proof has been provided. “By completing this registration form and providing it to Holden and the Collingwood team you consent to the use of your personal information in this form by Holden for purposes relating to the operation of the Collingwood Cashback and the related rebate offer. Further, you consent to Holden using your personal information for marketing and promotional purposes. Holden’s privacy policy (available at www.holden.com.au/privacypolicy) explains how Holden may use and disclose your personal information, how you can access or correct any personal information Holden holds about you, how you can complain about a privacy breach by Holden, how Holden will deal with a privacy complaint, and how you can opt out of receiving marketing materials from Holden. You can contact Holden on 1800 033 349 or at holdencustomercare@gm.com.