Hardship Application
LOAN REFERENCE
Enter Loan Number
CUSTOMERS PERSONAL INFORMATION
Surname:
Given Name/s:
Residential Address:
Mobile Number/s:
Email:
EMPLOYER
Enter Company Name:
Essential Service:
Yes
No
Industry (Eg: Travel/Retail/Beneficiary/ACC etc):
INCOME from 01 April 2020
Enter Frequency Paid:
Select...
Weekly
Fortnightly
Monthly
(Weekly/ Fortnightly/ Monthly)
Amount after Tax Paid:
Other Income (boarder, part time employment, ACC): $
Comments:
EXPENSES
Frequency
Select...
Weekly
Fortnightly
Monthly
(Weekly/ Fortnightly/ Monthly)
Living Food and Household expenses:
Type
Payment Amount
Additional Details
OTHER EXPENSES
Frequency
Select...
Weekly
Fortnightly
Monthly
(Weekly/ Fortnightly/ Monthly)
Provide details of any debts you are already paying:
Debt Type: E.g. Vehicle, Lender Name: E.g- Geneva Finance, Payment Amount, Balance Remaining.
Lender/ Type
Type
Payment Amount
Balance Remaining
