Please complete this application so we can assess your situation.

You can save your application at any time and submit later; simply click on the Save and Complete Later button at the bottom of the form and take note of the link generated.


Applicant Details

Registered Ratepayer

Telephone

Registered Ratepayer (2)

Telephone

Property Details

Account Number is located on the top right hand side of your rate notice.

Please indicate below the circumstances for your financial hardship.

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You must select at least one financial hardship reason from above.



Please list other persons residing at the premises

Please enter the proposed payment plan

If you wish to defer your payments please explain how and when you intend to pay.

Please note that deferral date cannot be more than 12 months from today.

Your deferral date is greater than 12 months, please enter a deferral date less than 12 months.


In order to assess your application, please complete the following in relation to your Income, Expenses and Assets.


Income and Expenses

INCOME

Ratepayer (1)
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Have you applied for a Pension Concession on your Council Rates?

If not, please refer to the following link where you can apply:

https://www.warrnambool.vic.gov.au/pension-concession


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Ratepayer (2)
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Have you applied for a Pension Concession on your Council Rates?

If not, please refer to the following link where you can apply:

https://www.warrnambool.vic.gov.au/pension-concession



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Household Income

Please enter the income details below as combined rate payers if applicable .

EXPENSES

Please enter the household expense details below as combined rate payers if applicable 

Weekly Household Expenses

Fortnightly Household Expenses

Monthly Household Expenses

Annual Household Expenses

Loans and Credit Cards
Living Expenses
(Medical/Entertainment/)
Total Living Expenses
Total Loans & Credit Card Expenses
Total Expenses
Balance (Income - Expenses)

You may wish to consider seeking assistance from a qualified financial advisor or counsellor.You can access free advice through the National Debt Helpline:   https://ndh.org.au/
Another useful resource is the Victorian Government Money Help website:  https://moneysmart.gov.au/managing-debt/financial-counselling

ASSETS AND SAVINGS

Please enter the asset and savings details below as combined rate payers if applicable 

Please provide details of any savings or assets you own (Bank accounts, term deposits, house, rental property, car, boat, caravan etc)


(Transaction\Savings\Investment)
(Cars\Boats\Caravans\Motorbikes\etc.)
(Shares\Cryptocurrency)

FINANCIAL ASSISTANCE

You may wish to consider seeking assistance from a qualified financial advisor or counsellor.You can access free advice through the National Debt Helpline:   https://ndh.org.au/
Another useful resource is the Victorian Government Money Help website:  https://moneysmart.gov.au/managing-debt/financial-counselling


Council is collecting the information on this form so that it may consider your application. The information is only used by Council for this purpose and will not be disclosed unless required under law.

Acknowledgement 

I declare that the information contained in this application is true and correct and:

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Unable to submit your application as the deferral date entered  is greater than 12 months from today's date.
Please go back to the Deferral Section of this form and enter a valid date.

Unable  to submit your application as you have not entered at least one reason for financial hardship. Please go to the reason for financial hardship section and select a reason