Financial Hardship Application Form
v1.4
Purpose. Ratepayers use this form to apply for deferral of rates, waiver of interest or other hardship relief under the Rates and Revenue Policy.
1.Who can apply
The ratepayer named on the rate notice, or a person authorised in writing to act for them, can apply. The property must be the applicant's principal place of residence or, for farm properties, the farm the applicant lives on and works.
2.What to include
Attach evidence of income and essential expenses for the last three months. A statement from a financial counsellor will be accepted in place of detailed evidence. Applications without evidence will be returned.
- Recent payslips, pension statements or business accounts
- Bank statements for the last three months
- Details of other debts and repayments
- Any financial counsellor report
3.Privacy
The information on this form is collected to assess your application under the Rates and Revenue Policy. It will be stored in the restricted hardship folder and will only be seen by rates staff and the Manager Finance and Rates.
4.What happens next
A rates officer will assess the application within ten business days and write to you with the decision. Recovery action stops while the application is being assessed. If you disagree with the decision you can ask the Chief Executive Officer for a review.
5.Declaration
By signing, the applicant declares that the information is true and complete and agrees to tell the shire if their circumstances change.