Please complete all questions carefully as the information provided will assist to process your application.
The information contained in this form is confidential and will not be used for any purpose other than consideration for assistance.
All applicable questions must be answered.
This application is hereby made for consideration by Baw Baw Shire Council for rate assistance in respect of the property below in which I/we reside:
Please fill in the section below to record your fortnightly household income and dependents contribution.
Please list all outstanding debts and outstanding amounts. If you have current payment plans please list them here.
Council may require you to attend financial counselling as a condition of hardship assistance, if you are already participating in counselling please enter the information below.
The Consumer Action Law Centre is a not for profit provider of phone based financial counselling services.
The financial counselling hotline can be reached on free call 1800 007 007. The free hotline is open from 9.30am to 4pm, Monday to Friday. The centre can also direct callers to their closest local in-person service.
A very useful resource is the Victorian Government Money Help website at www.moneyhelp.org.au
Financial Counselling Australia has developed a self-help website which provides letter templates, fact sheets, information on financial counselling services and a debt management self-help tool at www.debtselfhelp.org.au
If making weekly, fortnightly or monthly payments, please enter your payment amount and date of first payment below.
If Council becomes aware of any ratepayer or individual providing false or misleading information in order to gain assistance for which he or she would otherwise not be eligible, the agreement with Council will become null and void. Interest not charged that would otherwise been
payable will be restored to full amount and legal action to recover debt may be taken.
The personal information on this form is being collected by Council to enable assessment of your application. Council will use the information for this primary purpose only. You may apply to Council to gain access to, or for the amendment of personal information held by Council. Information on Council's Privacy Policies can be obtained from Council's Privacy Officer during business hours on 5624 2411.