Desexing Voucher Application + Means Test
All information shared here is treated in accordance with the Privacy Act 2020.
We require proof of your financial hardship to support your application. This can be in the form of a bank statement or proof of beneficiary or a community services card.
Your rabbit is required to be currently vaccinated with Filavac prior to surgery. Proof is required.
We reserve the right to decline any application. Vouchers expire 2 months from issue date.
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Occupation
*
Rabbit Name
*
Age
*
Sex
*
Male
Female
Weight
*
Please explain why you need financial assistance with desexing.
*
Means Test - Income
*
Monthly Total
Pay checks
Other Income
Total
Means Test - Household Expenses
*
Monthly Total
Rent / Mortgage
Insurance
Utilities (electricity, gas)
Internet, phone, pay to view
Other household expenses
Means Test - Food Expenses
*
Monthly Total
Groceries
Eating Out
Other
Means Test - Transportation Expenses
*
Monthly Total
Fuel
Public transportion
Car Maintenance
Car Insurance
Car Loan
Other
Means Test - Other Expenses
*
Monthly Total
Child Support
Childcare expenses
Health expenses
Entertainment (movies, events out)
Tobacco
Alcohol
Other expenses
Attach Supporting Proof
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
By submitting this form, you are declaring that all information presented is true and accurate to the best of your knowledge.
Please verify that you are human
*
Submit
Should be Empty: