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Application for Financial Hardship

Application for Financial Hardship

If you have an outstanding debt with City of Clarence, you may be eligible for hardship assistance where payment would cause you genuine financial hardship. Applicants are encouraged to apply for assistance as soon as possible by completing this form. Please note that individual applications need to be completed for each titled owner for a rates debt, where applicable.

Name(Required)
Address of property applying for hardship(Required)
Is this your principal place of residence?
Additional Address
Council fee/charge(s) you have outstanding(Required)
Please tick all that apply
Property address for your Rates

Application details

Do you receive any pensions or other government benefits?(Required)
Have you claimed a pension concession on any other property this financial year?(Required)
Property address for your Rates

Financial information

Income (weekly unless otherwise stated)(Required)
Your average income after tax
Government benefits/pension (including family payments etc.)
All other income (eg. self employed income, interest, dividends)
 
Include family payments, self employed income, interest, dividends.
Employment details
Name of your employer
Address of your employer
 
If applicable
Type of employment
Assets: Home
Property address:
Current Value
Amount owed to bank or financial instition for this property
 
Assets: other property
Property address:
Current Value
Amount owed to bank or financial instition for this property
 
Other assets
Funds in banks/financial institutions:
Cars/vehicles
Other personal assets (shares/superannuation)
 

Income

Weekly Expenses

Insurance

Amounts you owe

Home loan – weekly amount
Home loan/s
Amount owed
 
Hit the + to add additional lines
Other loans – weekly amount
Loan
Amount owed
 
Hit the + to add additional lines
Other Liabilities – Name of bank or institution
Loan
Amount owed
 
Hit the + to add additional lines
Does anyone contribute to paying these liabilities? (eg. your spouse/partner)

Payment plan

Apply for the following concession(s) on the basis of genuine financial hardship (please tick):
Proposed payment plan frequency (please tick):
A copy of the following documentary evidence is required to assess your hardship application. Please include the following:
  • A copy of all household bank accounts for the past three months
  • Tax return statments and PAYG Summaries from the last two years
  • Centrelink income statement no more than 30 days old (if applicable)
  • Child Support Agency Statement no more than 6 months old (if applicable)
You may also include one or more of the following to further support your application:
  • Statutory Declaration from someone familiar with your circumstance (eg. family doctor, accountant, bank officer, welfare officer, government agency)
  • Medical certificates or other evidence demonstrating the circumstances that have resulted in financial hardship being experienced
  • Evidence of loss of the main source(s) of income (eg. separation certificate)
  • Documented evidence of having sought financial counselling
  • Other documentation demonstrating that you are experiencing financial hardship
  • A copy of the last invoice received from council (not for rates)
  • Council reserves the ability to request further supporting information, at any time, if deemed necessary in order to assess your application.
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      Privacy Statement Your personal information is held by us in accordance with the Personal Information Protection Act 2004. The Personal Information Protection Act 2004 provides that an individual may request access to, or amendment of, information held by a public authority about that individual. Council’s Privacy Policy can be found at: www.ccc.tas.gov.au/your-council/laws-governance/privacy. If you cannot find the information that you are seeking or you wish to access your personal information, please contact us on 03 6217 9500 or email us at clarence@ccc.tas.gov.au.
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      City of Clarence
      38 Bligh Street
      (PO Box 96)
      Rosny Park
      Tasmania 7018
      ABN 35 264 254 198

      Telephone
      03 6217 9500

      Email
      clarence@ccc.tas.gov.au

       

      Acknowledgement

      City of Clarence pays respect to all First Peoples, including the Mumirimina (mu mee ree mee nah) of the Oyster Bay Nation whose unceded lands, skies, and waterways we are privileged to conduct our business on. We pay respect to Elders past and present, and we acknowledge the survival and deep spiritual connection of the Tasmanian Aboriginal People to their Country, and culture; a connection that has endured since the beginning of time.

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