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Application for personal financial hardship assistance

Use this form to make an application for personal financial hardship. You will need to meet the eligibility criteria outlined below to be considered. This process is consistent with the General Financial Hardship Policy.

Definition of financial hardship

For the purpose of the General Financial Hardship Policy, financial hardship means:

For a Person: Severe suffering or privation which could be brought on by unemployment, sickness, family breakdown, lower income or loss of income.

Refunds: We can only offer a partial refund where a service cannot be provided in the future. Refunds are not available for services completed or for prior periods.

Interpreter services
We cater for people of all backgrounds. Please ask your English-speaking support person to call 03 9280 0726.
Applicant details
Name (required) *
First field is required.
Last field is required.
Address (required) *
Street address field is required.
Suburb field is required.
State field is required.
Postcode field is required.
Country field is required.
Is this your main place of residence?
Preferred day time contact number field is required.
Personal details
Date of birth field is required.
Status
Time at above address (years / months) field is required.
How do you own the property?
Name of spouse/de facto
Name of other person
Address of other person (if different from your address)
Employment details (if applicable)
Address of employer
Other supporting questions
Are you a carer for any member of your family?
Has their illness or injury caused financial difficulties?
Have you sought financial counselling?
Have you sought any other support services or funding opportunities?
What fees and charges have you already paid to, or owe to City of Melbourne?
Details of earnings and expenses

Please complete all questions.

What are your current monthly earnings? (Excluding any pension, benefit or superannuation.) field is required.
Are you in receipt of any Centrelink benefits?
One file only.
3 MB limit.
Allowed types: gif, jpg, jpeg, png.
Do you have any other source of income not previously mentioned?
Total monthly expenses field is required.
Net total (total income less expenses) per month field is required.
Do you own, or part-own any other property?
Please include:
•    address
•    type of property
•    percentage of property ownership
•    monthly income received from property
•    estimated value of property
Payment arrangements
What arrangements do you plan on making to repay any outstanding fees and charges to the City of Melbourne? field is required.
What would be your preferred repayment option?
Declaration

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

I consent to the handling of my personal information provided with this application form.

Ticking this box is acceptance that all the information you have supplied is accurate, and that you have read and understood the declaration above. (required) *
I have read and agree to the declaration above field is required.
Privacy

The City of Melbourne is committed to protecting your privacy. The personal and financial information in the claim form and supporting documentation is being collected by City of Melbourne for the purpose of assessing your application for financial hardship assistance resulting from a Force Majeure Event, or any other directly related purpose. The information provided will not be disclosed to any other external party without your consent, unless required or authorised by law. If this information is not collected, we will not be able to fully assess your application or contact you to discuss your application. If you wish to alter any information you have supplied to City of Melbourne, please contact Council via the City of Melbourne website – contact us.

Financial hardship assistance

our acknowledgement

  • Torres Strait Islander Flag
  • Aboriginal People Flag

The City of Melbourne respectfully acknowledges the Traditional Owners of the land we govern, the Wurundjeri Woi-wurrung and Bunurong / Boon Wurrung peoples of the Kulin and pays respect to their Elders past and present. 

 

We acknowledge and honour the unbroken spiritual, cultural and political connection they have maintained to this unique place for more than 2000 generations.

We accept the invitation in the Uluru Statement from the Heart and are committed to walking together to build a better future.