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Hardship Assistance Payment Arrangement Online Form

RATES / DEBTOR ACCOUNTS

 

Please complete the online form below. Else, if you wish to print the form to complete, please use this link: Hardship Assistance Request Form - Printable.

 

Advisory Notes

  • This form must only be completed and signed by the property/land owner/authorised representative (rates accounts) or person responsible to pay the account or authorised representative (debtor accounts).

Fields marked * are mandatory.

 
1. PAYMENT ARRANGEMENT DETAILS
Details of the balance for this application*

 
Please tick your preferred arrangement and complete the relevant details below:*
Tick Your Preferred Arrangement

 
2. REASON FOR HARDSHIP REQUEST
Indicate why you are seeking assistance and provide details below:*





 
*
 
*
 
*
 
3. APPLICANT AND ACCOUNT DETAILS
*
 
*
 
Customer Type:*

 
*
Ensure your details are accurately entered so Council can contact you following submission of this form.
 
*
Ensure your details are accurately entered so Council can contact you following submission of this form.
 
*
 
*
 
*
 
 
 
4. FINANCIAL SUPPORT AND DEPENDENTS
Current employment status:*


 
Do you have a current Pensioner Concession Card (PCC) or receive any pension/government benefits?:*

 
Have you claimed a Pensioner Concession on any other property this financial year?:*

 
Is your postal address your principle place of living?:*

 
Indicate all categories of people living at the property:



 
*
 
5. OWNERSHIP / RESIDENCY DETAILS
Is the property you listed in this application your:*



 
Is the property you listed in this application:*

 
6. INTEREST IN OTHER PROPERTIES
Do you own an interest (either whole or partial) in any other property?:*

 
7. SUPPORTING DOCUMENTS CHECKLIST

The information below is recommended (if in possession) to be attached to an application to assist Council in granting financial hardship assistance.

NOTE - The total attachment file size limit for this form is 10MB. You have currently selected 0 MB

Bank Statements

Copies of recent bank statements confirming the balances and transactions in the last 6 months, held in all bank, credit union or building society accounts. This should include your main transaction account

Confirm how many documents you will upload.
 
 
Pensioner Concession Cards

Copy of Pensioner Concession Card (PCC) where applicable

Confirm how many documents you will upload.
 
Letters from other utilities or mortgage provider

Copies of letters from other utilities or mortgage provider confirming your financial hardship assistance agreement with them

Confirm how many documents you will upload.
 
Support organisation

Copies of letters from support organisation confirming your financial hardship

Confirm how many documents you will upload.
 
Ownership of business

Proof of ownership of business where applicable

Confirm how many documents you will upload.
 
Lease agreements

Copies of lease agreements where applicable

Confirm how many documents you will upload.
 
Letter from Financial Advisor

Letter from Financial Advisor confirming your financial situation

Confirm how many documents you will upload.
 
Severance letters

Copy of severance letter or letter confirming you have been stood down without pay

Confirm how many documents you will upload.
 
Other relevant information

Other relevant information you feel may assist in your application

Confirm how many documents you will upload.
 

NOTE - The total attachment file size limit for this form is 10MB. You have currently selected 0 MB

8. PRIVACY NOTICE
 

Georges River Council is required under the Privacy and Personal Information Protection Act 1998 to collect, maintain and use your personal information in accordance with the Information Privacy Principles. Your personal information is being collected to process your application. Council may use your personal information for the purposes of processing your application. Council is regarded as the agency that holds the information and will not disclose your personal information without your consent unless authorised or required by law. You may apply to access or amend your information by contacting Council on 9330 6400 or at mail@georgesriver.nsw.gov.au.

 
9. PAYMENT ARRANGEMENT DECLARATION
Authorisation*
I declare that I am authorised to apply for payment arrangement and I understand the conditions below:
 
  • Council can accept or renegotiate the terms of hardship assistance as per the Debt Management and Hardship Policy.
  • Further communications and/or documentation may be required to finalise this arrangement.
  • A formal response will be provided by Council detailing the outcome of the hardship application and/or payment arrangement.
  • If the payment arrangement is not maintained and the applicant does not notify Council, the total amount outstanding becomes due and payable and will be subject to Council’s debt recovery process. Interest charges or late fees will apply. The cost of legal recovery will be charged to the rates or debtor account.
  • I consent to Council conducting any necessary checks to verify the information I have provided.
 
Signature
*
 

If applicant is company:

 
 
 
Signature:*
 
 
 

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