Financial Hardship Assistance Application

Application for ratepayers requiring assistance with the payment of rates and charges on the grounds of financial hardship, in line with City of Ballarat's Financial Hardship Policy.

Your details

Is the ratepayer a company or association?

Yes

Full name

Company name

ABN (optional)

Postal address

Address line 1

Address line 2

Post code

Contact number

Email (optional)

Property information

Rates assessment number

Property address

Address line 1

Address line 2

Post code

Financial circumstances

Please outline the circumstances that have led to the need to request financial hardship consideration

Please provide supporting documentation of financial hardship (optional) For example Centrelink documents or employer statements. Further information may be requested by City of Ballarat to consider your application. Limited to 30MB. Only image files, Microsoft Word Documents and PDFs are accepted.

Assistance requested

What type of assistance do you require?

Payment Arrangement

Deferment of Rates and Charges

Waiver of Interest, Rates and Charges

Please refer to the policy for details around the types of assistance available. All assistance requests will be reviewed by the City of Ballarat to make sure they are suitable and in line with the policy.

Applicants please note: You will be required to provide an independent financial counsellor’s recommendation.

Payment arrangement

A payment arrangement is a mutually acceptable agreement between the City of Ballarat and the ratepayer which enables the arrears to be paid off in regular intervals.

Payment frequency

Weekly

Fortnightly

Monthly

Payment amount

Deferment of rates and charges

A deferment is a mutually acceptable agreement between the City of Ballarat and the ratepayer which allows additional time to pay the arrears in full.

What date you would like to defer payment until? Must be no more than 12 months after the date of application.

Declaration

By completing this application you declare that you are the owner or authorised managing agent of the property stated on this application and that all the information provided is true and correct to the best of your knowledge at the time of submission.

Collection statement

Your personal information is being collected by City of Ballarat for considering your request for financial hardship assistance. Your information will be stored in Council’s Customer Database and used to identify you when communicating with Council and for the delivery of services and information. For further information on how your personal information is handled, refer to Council’s Privacy Policy at www.ballarat.vic.gov.au/privacy

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