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Home
What To Do
FAQs
Payment
Corporate
PRIVACY
Contact Us
Financial Hardship Application Form
Step - 01
Applicant Details
Step - 02
Assets
Step - 03
Living Expenses
Step - 04
Current Debts
Step - 01
Applicant Details
Full Name *
Account reference *
Date of Birth *
Email *
Contact Number *
Alternative Number
Street Address *
Suburb *
State *
Please Select
ACT
NT
NSW
QLD
SA
TAS
VIC
WA
Postcode *
What was/is the cause of your financial hardship? *
Please Select
Illness, injury or death
Natural Disaster
Incarceration
Unemployment / reduced income
Failure of Business
Other
When and how did your financial difficulties begin as a result of the above?
Do you expect the period of your financial difficulties to be long term or short term?
How do you propose that your account should be treated on account of your financial hardship?
Please indicate what amount, if any, you are able to contribute to your account?
Is there any other information that you consider relevant to your request for a financial hardship variation?
Next
Step - 02
Assets
What is the estimated value of the property (e.g. car or house) that is the security for the loan?
Type of Asset
Value of Asset
Type of Asset
Value of Asset
Type of Asset
Value of Asset
What is your current monthly household income after tax?
Salary
Business Income
Rental Income
Centrelink Benefits
Child Support
What are the values of your other assets?
Properties
Vehicles
Superannuation
Bank Balance
Shares
What are the values of your other assets?
Source Type
Amount
Source Type
Amount
Source Type
Amount
Source Type
Amount
Source Type
Amount
Source Type
Amount
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Next
Step - 03
Living Expenses
Rent
Council Rates
Water Bill
Gas or Electricity bill
Telephone bill
Insurance
Food
Clothing
Medical Expenses
School Fees
Car Costs
Other Travel Expenses
Other Living Expenses (indicate type)
Living Expenses Type
Amount
Living Expenses Type
Amount
Living Expenses Type
Amount
Living Expenses Type
Amount
Living Expenses Type
Amount
Living Expenses Type
Amount
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Next
Step - 04
Current Debts
What are your current debts and minimum repayments? Please include the name/s of the lender.
Your Home loans
Home loan name
Balance
Required Monthly Payment
Monthly Payment Made
Arrears Amount
Home loan name
Balance
Required Monthly Payment
Monthly Payment Made
Arrears Amount
Home loan name
Balance
Required Monthly Payment
Monthly Payment Made
Arrears Amount
Personal loans/Credit Cards
loans/Credit Cards name
Balance
Required Monthly Payment
Monthly Payment Made
Arrears Amount
loans/Credit Cards name
Balance
Required Monthly Payment
Monthly Payment Made
Arrears Amount
loans/Credit Cards name
Balance
Required Monthly Payment
Monthly Payment Made
Arrears Amount
Other Debts
Debt name
Balance
Required Monthly Payment
Monthly Payment Made
Arrears Amount
Debt name
Balance
Required Monthly Payment
Monthly Payment Made
Arrears Amount
Debt name
Balance
Required Monthly Payment
Monthly Payment Made
Arrears Amount
Please email all supporting documents to
assist@accessmercantile.com.au
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* Required fields
