Residential Customer Hardship Application

At LPE, we understand that life can take unexpected turns. If you are facing financial hardship, we are here to help. By completing this application form, you will allow us to assess your situation and determine if you are eligible for our hardship program.

If you need assistance completing this form or would like to speak to someone you can call us on 1800 040 168. We are available from 8:30am to 5:30pm Monday to Friday. You can also read more about our Customer Hardship Program here

Name*

First NameLast Name

LPE Account Number (if known)

Email*

example@example.com

Phone Number*

Format: (000) 000-0000.

Please tell us primary reason why you are in financial hardship:*

Tick your employment type or the source of income you currently receive *

Tick the frequency of your income *

How much income do you receive after tax?

WeeklyFortnightlyYearly

Based on the above frequency what are your total living & household expenses (mortgage/rent, loans, bills, transport, insurance, food)

How much are you able to pay towards your bill? *

Select how often you are able to pay this amount: *

When can you commence making payments? *

Date

How will you make the payments? *

Please tick if you hold one of the following concession cards:

Healthcare CardPensioners CardVeterans Card

Please confirm, if you have applied for a Home Energy Emergency Assistance grant within the last 2 years?

Please provide any other information you would like us to take into consideration when assessing your financial hardship application:

By listing your name below, you declare that the information provided is true and accurate at the time of completion. You also acknowledge that the information provided will be used and stored in accordance with the Australian Privacy Act 2009.

Residential Customer Hardship Application

Consent