Tenant Financial Hardship Form

COVID-19 Tenant Financial Hardship Application

Please enter all required information so we can process your request
TENANCY INFORMATION
Tenant Name/s:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
Phone Number

Area CodePhone Number
Family / Living Situation
Number of adults in household?*
Number of dependents in household?*
How many members have been affected by hardship?*
What is the gross current total household income per month?*
WORKING SITUATION

PLEASE NOTE: ONE APPLICATION TO BE COMPLETED PER JOB LOSS / CHANGE OF JOB CIRCUMSTANCES
My employement has been terminated
Last day of employment

MonthDayYear
Date
Job Role & Company you worked for
I have attached a letter of seperation from my employerI have attached copies of my 3 most recent pay slipsI have attached copies of my bank statement/sI have applied for Centrelink benefits including Rent Assistance
If Applicable - Centrelink Application Number
Expected start date for Centrelink payments

MonthDayYear
Date
Rate of pay expected from Centrelink per month
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I am forced into Isolation
Reason for Isolation
First day of isolation

MonthDayYear
Date
Expected last day of isolation

MonthDayYear
Date
I will be returning to work on

MonthDayYear
Date
I have attached copies of my 3 most recent pay slipsI have attached copies of my bank statement/s
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I have had my hours or income significantly reduced
My hours have been reduced by %
Income loss of $ per month
Role & Company details
Company Contact for confirmation
I have attached a confirmation letter from my employerI am a sole traderI have attached copies of my 3 most recent pay slipsI have attached copies of my bank statement/sI have applied for Centrelink benefits including Rent Assistance
If Applicable - Centrelink Application Number
Expected start date for Centrelink payments

MonthDayYear
Date
Rate of pay expected from Centrelink
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I am a Business Owner and have had my income significantly reduced
Nature of Business
Accountant name and contact details
YESNO
I have attached a copy of my business bank statementI have attached a copy of my personal bank statementI have attached a copy of my ABNI have attached a copy of my last years tax returnI have applied for Centrelink benefits including Rent Assistance
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FINANCIAL REQUEST
YES
Current Rent per month
Proposed reduced rent per month
Periond of reduction
YES
Proposed payment amount per month
Frequency of payments
Difference in rent total
I will pay difference back by:
Paying an extra $
WeeklyMonthly
Proposed period to pay back rent
DISCLOSURE
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.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Time*

:HourMinutesAM/PM Option
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COVID-19 Tenant Financial Hardship Application

TENANCY INFORMATION

Family / Living Situation

WORKING SITUATION

My employement has been terminated

I am forced into Isolation

I have had my hours or income significantly reduced

I am a Business Owner and have had my income significantly reduced

FINANCIAL REQUEST

DISCLOSURE