Hardship Application - Rates

This form is to be completed by Ratepayers who are presently suffering hardship and wish to receive consideration in this regard. The information provided by completing this form will enable Council to determine eligibility for hardship support. Please refer to the lodgement details section for further information.

Rates Period

NOTE: Hardship applications are to be completed annually, and are reviewed by Council regularly.  Hardship arrangements are a temporary arrangement with Council, as often peoples circumstances improve over time, and they may no longer require hardship.

Applicants Details
Pension Details

If yes, please provide type of pension and amount received per fortnight.

Declaration
Clearly state the reason why you wish to apply for assistance with your Council Rates and Charges.
Please state gross weekly amount received in dollars from the following sources of income
Please provide the name of the financial institution and current balance for each of your accounts

Please provide the current balance for each of your accounts:

Please state details of weekly outgoings
Going to
Amount
Going to
Amount
Going to
Amount
Going to
Amount
Going to
Amount
Going to
Amount
Attachments
Browse
Declaration
Payment Arrangement Agreement

  • Please indicate preferred payment amount and frequency below. This amount will be reviewed and is subject to council approval.

  • If Council becomes aware of any ratepayer or individual providing false or misleading information in order to gain assistance for which he or she would otherwise not be eligible, the agreement with Council will become null and void.

  • Legal action to recover a debt may be taken upon non adherence of the agreed paymentarrangement.

  • Hardship Applications are reviewed annually and will require you to provide up to date information each financial year on a hardship application form.

Private information provided from you is required to assess your application for hardship. Council respects all personal and confidential information we receive and will do everything possible to protect information from unauthorised access, loss or misuse. 

Draw signature|Type signatureClear

Please complete the following for the payments to be debited via Direct Debit.

Rates Direct Debit Request

I/we request you, Hornsby Shire Council, User ID number 185532, to arrange for my/our rates to be debited from my/our nominated account at the financial institution shown below according to the schedule specified below, until further notice in writing.

Details of the person who is going to have their bank account debited
Details of the account to be debited. (Note: Direct debiting is not available from any credit card)
Payment Schedule Preference
Scheduled Direct Debits will only be processed on Fridays.
Declaration
Draw signature|Type signatureClear
Draw signature|Type signatureClear

You will still receive your Annual Rate Notice every year. If you elect to pay by instalment quarterly, a notice will be issued showing the amount being deducted.

Please return the Direct Debit Request Form at least 2 weeks prior to the scheduled due date. 

Upon submitting, you will be emailed a copy of this form, please keep a copy for your records.


Save and Complete Later