He rārangi ingoa tēnei mā ngā uri a Paerangi-i-te-Whare-Toka, arā, ko Paerangi-o-te-moungaroa. Heoi anō, e hāngai ana tēnei rārangi ingoa mā ngā uri e hono ana ki ngā papatairite o maunga Ruapehu i puta mai ai a Rangituhia, Rangiteauria me Uenuku-Manawawiri tupua, otira me ngā uri o Taiwiri, Ururangi me Tāmuringa. The information from this form will be used by Te Kāhui o Paerangi and Te Tōtarahoe o Paerangi (Ngāti Rangi Rūnanga and Ngāti Rangi Trust) to develop its tribal database. If you prefer to complete online please visit: ngatirangi.com/register.aspx

Te Kahui o Paerangi Ngati Rangi Registration Form——

Title: ______________________ Surname: _________________________________________

First Name: (s) ___________________________________________________________________

Maiden Name: __________________________ Also known as: __________________________

Date of Birth: dd / mm / yyyy Gender: male female

Spouse/Partner’s Full Name: _______________________________________________________

Address: ________________________________________________________________________ ________________________________________________________________________ Postcode: ______________ Country: _______________________________________________

Home Phone: ( ) ______________ Mobile Phone: ( ) ______________

Email: _______________________________________________________________________

Please Circle which way you prefer to be informed about iwi pānui: (you can circle more than one)

Post Email Txt/SMS

How did you find out about us? _____________________________________________________

Name: _________________________________________ M / F Date of Birth: dd / mm / yyyy

Name: _________________________________________ M / F Date of Birth: dd / mm / yyyy

Name: _________________________________________ M / F Date of Birth: dd / mm / yyyy

Name: _________________________________________ M / F Date of Birth: dd / mm / yyyy

Name: _________________________________________ M / F Date of Birth: dd / mm / yyyy

Section Three: CHILDREN’S DETAILS (Children over 18 must complete their own form)

Section Two: CONTACT DETAILS

Section One: PERSONAL DETAILS

Circle Gender

(where applicable)

Section Four (A): CONNECTION TO NGĀTI RANGI - Marae Details

In addition to the whakapapa information sought in Section Seven, the following information regarding marae and connections to land within the Ngāti Rangi rohe is requested to assist the Trust to confirm your affiliation to Ngāti Rangi. Please circle the Ngāti Rangi marae you affiliate to*. For voting purposes choose the two marae you have closest affiliation to and rank them ‘A’ and ‘B’.

HAUTAPURaketapaumaNgāti Rangituhia

KuratahiNgāti RangituhiaNgāti Parenga

Te Ao HouNgāti TupohoNgāti Rangi-ki-tai

WHANGAEHUTirorangiNgāti TongaitiNgāti Rangiteauria

TirohiaNgāti Hioi

Ngā MōkaiNgāti Tongaiti

MANGAWHEROMaungārongoNgāti Tui-o-Nuku

MangamingiNgāti TamakanaNgāti Uenuku

Tuhi ArikiNgāi Tuhi Ariki

TE WAIMARINORaetihi (Te Puke)Ngāti UenukumanawawiriNgāti Uenuku

MarangaiNgāti Uenukumanawawiri

Mote KatoaNgāti UenukuNgāti Patutokotoko

WaitahuparaeNgāti UenukumanawawiriNgāti Patutokotoko

Section Four (B): CONNECTION TO NGĀTI RANGI - Land Block Details

If you do not know your marae, then please identify at least one (1) land block in our rohe that you connect to. Please include the full land block names (and numbers if relevant).

Land block details: (eg Murimotu 3B2B3) ________________________________________________

________________________________________________________________________________

Future tribal development will require key skills, knowledge and experience. By providing your current employment and qualification details we will be able to identify uri who could participate in our development.

Occupation: ___________________________ Industry: ________________________________ Qualifications & Skills: ______________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Section Five: OCCUPATION AND QUALIFICATIONS

* Listing of marae in this form is not an assertion of Ngati Rangi Trust’s mandate to negotiate on behalf of or represent that marae (or the hapu that affiliate to that marae) for the purposes of settling Treaty of Waitangi historical claims.

Section Six: TE REO MĀORI

Native Speaker

Basic

Fluent

None

Section Seven: WHAKAPAPA TO NGĀTI RANGI

Ingoa (Your Name)

Matua (Father)

Tupuna (Grandfather)Kuia (Grandmother)

Matua Tupuna (Great Grandfather)

Tupuna Kuia (Great Grandmother)

Whaea (Mother)

Kuia (Grandmother) Tupuna (Grandfather)

Matua Tupuna (Great Grandfather)

Tupuna Kuia (Great Grandmother)

Matua Tupuna (Great Grandfather)

Tupuna Kuia (Great Grandmother)

Matua Tupuna (Great Grandfather)

Tupuna Kuia (Great Grandmother)

Please complete this whakapapa chart to the best of your ability to assist us to confirm your registration as an uri of Ngāti Rangi. Please only include your Ngāti Rangi line.

FreePost

FreePost Ngati RangiNgāti Rangi TrustPO Box 195Ohakune 4660New Zealand

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Kia ū ai ki ngā TIKANGATo be DUTY BOUND

We collect personal information from you, including information such as your name, contact information and other information as set out in this form. Any personal information you provide to us is subject to the Privacy Act 1993. We collect your personal information in connection with the Trust’s purposes, including to keep you informed about the activities of the Ngāti Rangi Trust, maintain our iwi register, ensure we have up to date information about our beneficiaries, and to ensure you are able to vote on important Ngāti Rangi issues. We will not disclose your personal information to third parties without your permission. You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong. If you would like to ask for a copy of your

information, or to have it corrected, please contact us at office@ngatirangi.com, or 0800 N RANGI, or PO Box 195, Ohakune.

I understand that the information I provide is subject to the Privacy Act 1993

I agree to my information being passed on to my respective marae indicated above

I confirm that the information provided in this form is true and correct

Signed: ___________________________________________ Date: dd / mm / yyyy

Section Eight: DECLARATION & PRIVACY

Yes No

Yes No

Yes No

Kia MANA ai ngā mahiTo act with INTEGRITY and HONESTY

Kia rapu ai i te MEA NGAROTo unleash POTENTIAL

Kia tika ai tōu TŪRANGAWAEWAETo be ACCOUNTABLE

Kia mau ai ki te MANAAKITANGATo CARE WHOLEHEARTEDLY

Kia ū ai ki ngā TIKANGATo be DUTY BOUND