Tenant name:
Address:
Number of adults in household:
How many household members have been affected by financial hardship?
Total household income (per week) prior to Covid-19 impact:
Number of dependents:
How many household members have been unaffected by financial hardship?
Income/Week:
Supporting Documentation:
I have attached copy of payslip
I have attached a copy of my bank statement/s
I receive Centrelink benefits (if yes,Centrelink Statement attached)
My employment has been terminated
Last day of employment:
Role:
Company:
Company contact details for confirmation of the above:
Name:
Phone:
I have attached an Employment Separation Certificate or a Letter from my employer
I have applied for Centrelink benefits including Rent Assistance
Application Number:
Expected start date:
Rate of pay:
I am ineligible for Centrelink payments
Why:
I am in forced isolation
Reason for isolation:
First day of isolation:
I will be returning to work on:
Expected last day of isolation:
I have had my hours or income significantly reduced
My hours have reduced by:
Income loss per week:
I have attached a Letter from my employer
OR I am a Sole Trader
I am a Business Owner and have had my income significantly reduced
Name of business:
Nature of business:
Accountant’s name and contact details:
Business expected to recommence trading once crisis has subsided?
Yes
No
I have attached a copy of my business bank statement
I have attached a copy of my personal bank statement
I have attached a copy of my ABN
I have attached a copy of my last company Tax Return
Current rent:
Proposed reduced rent:
Period of reduction:
Comments:
I/We confirm that we are in true financial hardship.I/We have exhausted all options for financial aid and make a declaration that my/our financial position has been adequately portrayed within this application
I/We understand that until such a time that a financial request is negotiated and/or agreed upon, that the rent will remain the same as current, and standard procedures will apply for collection of rent.
Signed:
Date of submission:
Please Attach supporting documents ticked above: