BCU - Financial Hardship Form

Member details

Member number

Full name

Credit account type/s

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
Please remove or mask any TFN or Account numbers in the documents before sending.

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

Explain your current financial circumstances and provide any other reason why you are submitting this application for hardship assistance:

Agent's information

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

Name

Address

Post code

Relationship

Phone

If you own real property, are the rates (Council/Shire/Water) currently paid up to date?

Personal details

Primary Member

Title

Given name/s

Surname

Date of birth

Number of dependants

Email address

Telephone

Drivers licence number

Drivers licence state:

Residential address

Suburb

State:

Postcode

Residential status:

Time there (years)

Time there (months)

Mailing address

Tick if mailing address is the same as residential address

Mail address

Suburb

State:

Postcode

Employment details

Employment status:

Add secondary member Remove secondary member

Secondary Member

Title

Given name/s

Surname

Date of birth

Number of dependants

Email address

Telephone

Drivers licence number

Drivers licence state:

Residential address

Suburb

State:

Postcode

Residential status:

Time there (years)

Time there (months)

Mailing address

Tick if mailing address is the same as residential address

Mail address

Suburb

State:

Postcode

Employment details

Employment status:

Financial details

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

Have you ever been bankrupt or insolvent or assigned your estate for the benefit of your creditors or been connected with a company which has been wound up under the provisions of the Companies Act?

Are you a Guarantor for any other liabilities or subject to any contingent liabilities whatsoever?

Income

Income frequency

Net wages/salary (gross less tax)

$

.00

Spouse's net income (gross less tax)

$

.00

Pension/superannuation

$

.00

Family allowance

$

.00

Other income

Rent

$

.00

Interest

$

.00

Dividends

$

.00

Other

$

.00

Family maintenance

$

.00

Total income

$

.00

Calculate total income

Financial Position - Assets and Liabilities

House at

Estimated value

$

.00

Balance owing

$

.00

Other dwelling at

Estimated value

$

.00

Balance owing

$

.00

Vacant land at

Estimated value

$

.00

Balance owing

$

.00

Motor vehicles

Primary member Make & Model

Estimated value

$

.00

Balance owning

$

.00

Caravan

Estimated value

$

.00

Balance owning

$

.00

Boat

Estimated value

$

.00

Balance owning

$

.00

Home contents value

$

.00

Savings accounts / Investments / Superannuation

Primary member savings balance

$

.00

Superannuation

$

.00

Total assets

$

.00

Calculate total assets

Financial position - Liabilities (cont.)

Overdraft with

Amount outstanding

$

.00

Please include any others loans below

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

Loan 1

Amount outstanding

$

.00

Loan 2

Amount outstanding

$

.00

Loan 3

Amount outstanding

$

.00

Credit/Store cards

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

Credit/Store card 1 with

Limit

$

.00

Add another card?
+

Guarantor for

Amount outstanding

$

.00

Total liabilities

$

.00

Calculate total liabilities

Expenditure

Expenditure frequency

Mortgage repayments

$

.00

Rent board

$

.00

Existing loans

Motor vehicle

$

.00

Furniture

$

.00

Other

$

.00

Credit/store cards

Credit/Store card 1

Monthly payment

$

.00

Add another card?
+

Insurance

House

$

.00

Motor vehicle

$

.00

Superannuation/Life

$

.00

Other

Rates/taxes

$

.00

Housekeeping

$

.00

Motor vehicle (e.g. fuel/rego)

$

.00

Family maintenance payments

$

.00

Education

$

.00

Other expenditure 1

Amount

$

.00

Other expenditure 2

Amount

$

.00

Other expenditure 3

Amount

$

.00

Total expenditure

$

.00

Calculate total expenditure

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Financial Hardship Form

Member details

Reason for hardship request

Agent's information

Personal details

Primary Member

Residential address

Mailing address

Employment details

Current employment

Previous employment (if current less than 12 months)

Secondary Member

Residential address

Mailing address

Employment details

Current employment

Previous employment (if current less than 12 months)

Financial details

Income

Other income

Total income

Financial Position - Assets and Liabilities

Motor vehicles

Savings accounts / Investments / Superannuation

Superannuation

Total assets

Financial position - Liabilities (cont.)

Please include any others loans below

Credit/Store cards

Total liabilities

Expenditure

Existing loans

Credit/store cards

Insurance

Other

Total expenditure

Because you

Because you