Statement of financial hardship

We understand that debt can be overwhelming, and we are committed to assisting our clients in paying off their debts. If you are experiencing financial hardship, we encourage you to submit a statement of financial hardship. This will enable us to gain a deeper understanding of your financial situation and provide you with personalized solutions that cater to your unique needs.

To help us understand your current financial situation, we will require you to complete the below Statement of Financial Position Form and include all relevant supporting documentation.
Income:

3 most recent pay slips or Centrelink statements
90 days Bank statements showing day to day transactions
Rental or Mortgage statements
Utility bills
Living expenses
Loan or Credit statements

Please provide any documentation relating to other income, expenses or medical conditions which you believe may impact your ability to action your debt.

If you are experiencing any difficulties or concerns, please do not hesitate to contact us on 1300 793 187 to speak with one of our agents.

Financial hardship form

Contact Details

ANR Case Number

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment

Employment (Full time/Part time/Casual)

Employer

Employer Address

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If unemployed, please detail type of benefit you recieve

Type of Benefit

Primary Income ( We will require payslips or statements to substantiate)

Amount earned after tax

Frequency

Other Income

Amount earned after tax

Frequency

Property and Assets

Property or Asset

Value

Property or Asset

Value

Cash at bank

Financial Institution

Value

Liabilities (Write "NA" If not applied to your living circumstances)

Rent/Board $ Amount Each Fortnight

Mortgage Repayments Each Fortnight

Car Repayments Each Fortnight

Electricity Each Fortnight

Gas Each Fortnight

Travel & Motor Vehicle Each Fortnight

Other Liabilities

Debts owed to:

Amount owed:

Repayment amount

Frequency

How much would you like to pay?

$ Amount

Frequency

Date

Please ensure you attach all relevant documentation as outlined above(Required)

Drop files here or

Max. file size: 100 MB.

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