Financial Hardship Application

We have a policy in place that enables assistance to be provided to customers who are facing extreme financial or personal hardship.

Under our Hardship Policy, assistance can be provided by way of one or more of the following:

waiver of penalty interest
waiver of legal costs
acceptance of a payment arrangement
defer part of the rates

but does not include the waste charge.

If you are applying for a waiver of rates you are required to meet with a financial counsellor and provide authority to the financial counsellor to speak us on your behalf.

Each application is reviewed on its individual merits. We may not approve all applications.

Please complete each part of the application and submit at your earliest convenience.

It is strongly recommended that any person facing serious hardship seek assistance as soon as possible. Community services are available within the Geelong area to assist and provide support to residents on a wide range of issues, including financial counselling.

Should you disagree with any determination made on your application for hardship consideration, please submit a written dispute and request that we review your application.

Your details

Property (rates) number

Please provide Property (rates) number

Your full name as the owner of the property

Please provide Your full name as the owner of the property

Property address (as stated on your rates notice)

Start typing in your street address, then select it from the list.

Please provide Property address (as stated on your rates notice)Please check the Property address (as stated on your rates notice), be sure to start typing in your street address, then select it from the dropdown list.

Is your postal address the same?

Please provide Is your postal address the same?

Please provide your postal address

Please provide Please provide your postal address

Is the property your principle place of residence?

Please provide Is the property your principle place of residence?

Select contact phone number options

Home
Work
Mobile

Please provide Select contact phone number options

Home phone

Please provide Home phone

Work phone

Please provide Work phone

Mobile phone

Please provide Mobile phone

Please check the Email addressPlease provide Email

Number and age of dependents

Please provide Number and age of dependents

Are you receiving State or Federal assistance?

You may be entitled to an annual rebate off your rates and charges.

Please note that a Health Care Card does not grant this entitlement.

Please provide Are you receiving State or Federal assistance?

Have you received or are you receiving any sort of support or financial counselling?

Please provide Have you received or are you receiving any sort of support or financial counselling?

Please provide details of the support or financial counselling you are receiving/have received

Please provide Please provide details of the support or financial counselling you are receiving/have received

Have you previously made an application for financial hardship?

Please provide Have you previously made an application for financial hardship?

Have your circumstances changed?

Please provide Have your circumstances changed?

Your circumstances

Please detail the change to your situation and explain why you are requesting assistance through our Hardship policy

Please provide Please detail the change to your situation and explain why you are requesting assistance through our Hardship policy

Select your ownership category

individual
business

Please provide Select your ownership category

Select all assets you havePlease provide Select all assets you have

Details of property you own

Please provide Details of property you own

Estimated value of property you own

Please provide Estimated value of property you own

Details of motor vehicles you own

Please provide Details of motor vehicles you own

Estimated value of motor vehicles you own

Please provide Estimated value of motor vehicles you own

Details of your investments

Please provide Details of your investments

Estimated value of your investments

Please provide Estimated value of your investments

Details of your business investments

Please provide Details of your business investments

Estimated value of your business investments

Please provide Estimated value of your business investments

Details of your other assets

Please provide Details of your other assets

Estimated value of your other assets

Please provide Estimated value of your other assets

You own the property

by yourself
with a spouse, another person or persons

Please provide You own the property

Your employment status

Please provide Your employment status

Please advise other employment status

Please provide Please advise other employment status

Your employer's name

Please provide Your employer's name

Your employer's address

Please provide Your employer's address

After tax wages amount

Please provide After tax wages amount

Frequency of payment

Please provide Frequency of payment

Employment status of second owner

Please provide Employment status of second owner

Please advise other employment status of second owner

Please provide Please advise other employment status of second owner

Name of second owner's employer

Please provide Name of second owner's employer

Address of second owner's employer

Please provide Address of second owner's employer

After tax wages amount for second owner

Please provide After tax wages amount for second owner

Frequency of payment for second owner

Please provide Frequency of payment for second owner

Other sources of income - select all that applyPlease provide Other sources of income - select all that apply

Pension amount

Please provide Pension amount

Frequency of pension payment

Please provide Frequency of pension payment

Government benefit amount

Please provide Government benefit amount

Frequency of goverment benefit payment

Please provide Frequency of goverment benefit payment

Superannuation amount

Please provide Superannuation amount

Frequency of superannuation payment

Please provide Frequency of superannuation payment

Investment income amount

Please provide Investment income amount

Frequency of investment income payment

Please provide Frequency of investment income payment

Family allowance amount

Please provide Family allowance amount

Frequency of family allowance payment

Please provide Frequency of family allowance payment

Family maintenance amount

Please provide Family maintenance amount

Frequency of family maintenace payment

Please provide Frequency of family maintenace payment

Amount of interest from banks etc

Please provide Amount of interest from banks etc

Frequency of interest payments

Please provide Frequency of interest payments

Specify other income

Please provide Specify other income

Other income amount

Please provide Other income amount

Frequency of other income payment

Please provide Frequency of other income payment

Total fortnightly income

Please provide Total fortnightly income

Select all ongoing expenses that apply

You will need to provide a fortnightly amount for each expense selected.

Please provide Select all ongoing expenses that apply

Fortnightly mortgage repayment amount

Please provide Fortnightly mortgage repayment amount

Fortnightly car repayment amount

Please provide Fortnightly car repayment amount

Fortnight car running expenses amount

Please provide Fortnight car running expenses amount

Fortnightly personal loan amount

Please provide Fortnightly personal loan amount

Fortnightly credit/store care repayment amount

Please provide Fortnightly credit/store care repayment amount

Fortnightly food expenses amount

Please provide Fortnightly food expenses amount

Fortnightly clothing expenses amount

Please provide Fortnightly clothing expenses amount

Fortnightly utilities amount

Please provide Fortnightly utilities amount

Fortnightly insurance/s amount

Please provide Fortnightly insurance/s amount

Fortnightly mobile phone/internet amount

Please provide Fortnightly mobile phone/internet amount

Fortnightly medical expenses amount

Please provide Fortnightly medical expenses amount

Fortnightly child care and/or school fees amount

Please provide Fortnightly child care and/or school fees amount

Fortnightly entertainment expenses amount

Please provide Fortnightly entertainment expenses amount

Please specify other fortnightly expenses

Please provide Please specify other fortnightly expenses

Fortnightly other expenses amount

Please provide Fortnightly other expenses amount

Total fortnightly expenses

Please provide Total fortnightly expenses

Select all arrears that applyPlease provide Select all arrears that apply

Mortgage arrears total

Please provide Mortgage arrears total

Credit cards or personal loan arrears total

Please provide Credit cards or personal loan arrears total

Water rates arrears total

Please provide Water rates arrears total

Electricity arrears total

Please provide Electricity arrears total

Gas arrears total

Please provide Gas arrears total

Telecommunications and internet arrears total

Please provide Telecommunications and internet arrears total

Please specify other arrears

Please provide Please specify other arrears

Other arrears total

Please provide Other arrears total

Overall position

Take your total fortnightly income (part 4) and subtract your total fortnightly expenses (part 5) and provide your total remaining income minus your total expenses.

For example: Total fortnightly income of $5000 MINUS total fortnightly expenses of $3000 = overall position of $2000

Please provide Overall position

Amount

Please provide Amount

Frequency of payment

Please provide Frequency of payment

Starting date for first payment

Open the calendar popup.

Please provide Starting date for first payment

Are there any other factors you believe should be taken into consideration by the City when assessing this application?

Please provide Are there any other factors you believe should be taken into consideration by the City when assessing this application?

Declaration

You make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of an Act of Parliament of Victoria rendering persons making a false declaration punishable for wilful and corrupt perjury:

You agree to the terms and conditions established for the repayment of the outstanding debt.
You agree to commit fully to making repayments as required.
You understand that interest will continue to accrue on any outstanding rate balance (subject to the provisions of the Financial Hardship Policy).
You acknowledge that if in default of this agreement, the City has the right to proceed with the full recovery of the debt without further notice.
You understand that additional recovery costs may be incurred by me/us if in default of this agreement.

By ticking this box you agree to, acknowledge and understand all statements in this declaration.

Please provide By ticking this box you agree to, acknowledge and understand all statements in this declaration.

Privacy statement

The personal information requested on this form is being collected by City of Greater Geelong for the purpose of assessing hardship.

If the personal information is not collected, we will be unable to make an assessment of financial hardship.

We will not disclose your personal information without your consent, except where required or authorised to do so by law.

Our privacy policy is available on our website and at our Customer Service Centres.

If you wish to alter any of the personal information you have supplied to City of Greater Geelong, please contact us by sending an email to [email protected] or by contacting us on 03 5272 5272

We Acknowledge the Wadawurrung People as the Traditional Owners of the Land, Waterways and Skies. We pay our respects to their Elders, past and present. We Acknowledge all Aboriginal and Torres Strait Islander people who are part of our Greater Geelong community today.

Our council

Our services

What’s happening

Financial Hardship Application

Your details

Your circumstances

Your assets

Your income

Your ongoing expenses

Your outstanding bills

Proposed payment arrangement

Declaration

Privacy statement

Our council

Our services

What’s happening

Financial Hardship Application

Your details

Your circumstances

Your assets

Your income

Your ongoing expenses

Your outstanding bills

Proposed payment arrangement

Declaration

Privacy statement

Privacy policy