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  1. Home
  2. Financial Hardship Application

Financial Hardship Application

This form requires multiple supporting documents to be uploaded for lodgement

Please ensure you have these forms available to upload before commencing:

  • Bank Statement/s
  • Medical Certificate
  • Centrelink
  • Letter from employer
  • Letter from a Provider who has deemed you to be experiencing financial hardship (e.g. bank, super fund, utilities)
  • Letter from an authorised financial counsellor or planner confirming financial hardship
  • Documentation such as a statutory declaration from a person familiar with your financial circumstances (e.g. family doctor, accountant).

1Owner/ratepayer Information
2Property Information
3Financial Hardship
4Income and Expenditure
5Dependents
6Payment Proposal
7Supporting Documentation
8Declaration
This field is for validation purposes and should be left unchanged.

Owner/ratepayer Information

Are you the sole owner/co-owner/ratepayer of the property?(Required)
Residential Address(Required)
Postal Address(Required)

Property Information

Property Address(Required)
Is the property owner/occupied or is it a rental?(Required)

Financial Hardship

Is your request for assistance caused by the impact of a declared emergency?(Required)
How have you been paying your most recent rates account?(Required)

Is your payment plan active or cancelled?(Required)
Please tell us about your financial position by selecting the reason/s below(Required)
Have you or your employer applied for any of the Federal or State Government’s assistance or other financial assistance measures?(Required)
Please indicate financial assistance measures you or your employer have applied for(Required)
How long do you expect you will be experiencing financial difficulty?(Required)

Income and Expenditure

Have you received any other income?

Outgoing Expenditure

Mortgage / Home loan *

Other mortgages / business loans

Other loans

Credit Cards

Power *

Water *

Rates

Phone

Insurances *

Living Expenses *

Do you have any other outgoing expenditure?

Dependents

Please indicate any dependents you are supporting

Payment Proposal

What is the payment amount and frequency you can afford to commit to?

Supporting Documentation

To assist us with your application, please provide on lodgment the relevant documentation to support your financial hardship application.
Maximum number of uploads: 10,
Allowed file extensions: pdf, jpg, jpeg, png
Maximum file size: 1MB.
Drop files here or
Accepted file types: pdf, jpg, jpeg, png, Max. file size: 1 MB, Max. files: 10.
    Confirm Uploaded Documents(Required)

    Declaration

    Consent(Required)
    Consent(Required)
    Please click on the box below to draw your signature
    Clear Signature

    Office Hours

    Monday to Friday
    8:30am – 4:30pm

    Contact Us

    • P (08) 9928 1102
    • E enquiries@mingenew.wa.gov.au
    • Shire of Mingenew
    • Submit Feedback

    Postal Address

    PO Box 120,
    21 Victoria Road
    Mingenew WA 6522

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    Acknowledgment of Country

    The Shire of Mingenew acknowledges the traditional custodians of country throughout Australia and their connections to land, sky, waters and community, including the Wattandee people of these lands. We pay our respect to their Elders past, present and emerging, and extend that respect to all First Nations people today.

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