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Financial Hardship Form


Enter '0' for amounts not relevant to your situation.
* Required information

1

Member details

2

Personal details

3

Financial details

4

Assets and Liabilities

5

Expenditure

Member details

 

Once you’ve submitted your application, please forward documents evidencing current income to This email address is being protected from spambots. You need JavaScript enabled to view it.. These could include:

  • last two payslips
  • last two bank statements
  • confirmation from Centrelink of current benefit paid, or
  • any other documents evidencing income.

Note: we may require further information and will advise you if any of the following is needed:

  • evidence of insurance on the property
  • details of superannuation
  • details of personal insurance
  • statements of loans and credit cards, and/or
  • medical certificate/letter from your doctor.

 

Reason for hardship request

Agent's information

Complete this information if you would like us to contact your agent to discuss your application.

Personal details

Primary Member

Residential address

Mailing address

Employment details

$
.00

Current employment

Previous employment (if current less than 12 months)

Add secondary member Remove secondary member

Secondary Member

Residential address

Mailing address

Employment details

$
.00

Current employment

Previous employment (if current less than 12 months)

Financial details

If self employed: you will be asked to provide financial statements for the last 2 years.

Income

$
.00
$
.00
$
.00
$
.00
Other income
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00

Calculate total income

Financial Position - Assets and Liabilities

$
.00
$
.00
$
.00
$
.00
$
.00
$
.00

Motor vehicles

$
.00
$
.00
$
.00
$
.00

$
.00
$
.00
$
.00
$
.00
$
.00

Savings accounts / Investments / Superannuation

$
.00
$
.00

Superannuation

$
.00
$
.00

Calculate total assets

Financial position - Liabilities (cont.)

$
.00
Please include any others loans below

(Enter N/a and $0 if not appropriate)

$
.00
$
.00
$
.00
Credit/Store cards

(Enter N/a and $0 if not appropriate)

$
.00

+
$
.00

-
$
.00
$
.00

Calculate total liabilities

Expenditure

$
.00
$
.00

Existing loans

$
.00
$
.00
$
.00

Credit/store cards

$
.00

+
$
.00

- +
$
.00

-

Insurance

$
.00
$
.00
$
.00

Other

$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00

Calculate total expenditure

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