• Application for Financial Hardship Relief

  • This application should be used to apply for financial relief through changes to payment arrangements for Council rates and annual charges where it can be demonstrated that the person(s) or organisation is suffering financial hardship and cannot meet their obligations in the short to medium term. 

    Please refer to the Financial Hardship Policy for further information.

    • Applicant Details 
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    • Company Details 
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    • Fees and Charges 
    • Fee Reimbursement 
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    • Information to Support Application 
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    • Attach Documents 

    • Note: Please attach your last financial years income, and expenditure statement. A copy of your most current income, and expenditure statement.

    • Note: Please attach any relevant documentation, you feel may assist your application.

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    • Privacy and Personal Information Protection Notice 
    • Purpose of Collection: For assessment of Financial Hardship applications.
      Intended recipients: Council staff and approved contractors of Council.
      Supply: Voluntary. The information supplied in this application will enable an application to be assessed Council. If the information is not provided, the application may not be accepted.
      Access / Correction: Contact Council Customer Service Team on (02)6226 1477 to access or correct this information.
      Storage: Yass Valley Council, 209 Comur Street Yass, NSW 2582

      Privacy and Personal Information Protection Act 1998

      Compliance with Section 10

      The information contained in this application form and any information requested for the purpose of assessing eligibility for Financial Hardship support is required under the Local Government Act 1993 and the Local Government (General) Regulation 2005.

      This information is required before your application for Financial Hardship support can be processed. The information is private and confidential and Council must not disclose the information to any person or body if it is not directly related to the purpose for which the information was collected.

      If you have a complaint about the use of your personal information, contact the Yass Valley Council Public Officer. The information contained or referred to in this application form may be corrected and updated by you, by contacting the Council.

      Privacy Statement

      You will need to provide personal information to Yass Valley Council in respect of this application. Council is required under the Privacy & Personal Information Protection Act 1998 (PPIPA) to collect, maintain & use your personal Information in accordance with the Privacy Principles & other relevant Requirements of the PPIPA. For further clarification please contact the Privacy Contact Officer at Yass Valley Council

    • Applicant Consent 
      • Pension Number
      • Name
      • Address
      • Postcode, and
      • that I am a valid concessional card holder

      For the sole purpose of authorising Yass Valley Council to confirm with Centrelink whether or not the details I have provided to Council match Centrelink or other Commonwealth portfolio department or agency in relation to the current status of my Commonwealth Benefit.

      I agree that, unless I revoke my consent, this Customer Consent record is a permanent consent and may be relied on by Council until such time as I revoke it.

      I may revoke this Customer Consent record at any time by giving Council written notice that my consent is revoked. I understand if I revoke this consent, I may not be eligible for the concession given by Council.

      I acknowledge that I have read and understood this Customer Consent record.

    • Note: If you make a false statement in an application, you may be guilty of an offence and fined up to $2,200.

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