longTermFinancialHardship | Everyday Mobile from Woolworths

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Long Term Payment Assistance (Financial Hardship)

Fill in the below details to submit a request for long term Payment Assistance (Financial Hardship) if you require payment assistance for a period of more than three months.

* Mandatory Fields

Full Name*required

Email Address*required

Your Everyday Mobile phone number*required

Please outline the reasons for requesting financial difficulties assistance*required

Please advise of the most relevant change in your circumstances*required

Have you consulted a Financial Counselor regarding your financial circumstances? *required

Employment Status*required

Statement Of Position

Income Type - Monthly Net Amount

Net Wages/Salary*required

Commission/Overtime

Pension and/or Superannuation*required

Family Allowance/Centrelink*required

Investment Income*required

Spouse Income*required

Other Income*required

Total Net Income

Expense Type - Amount Owing Monthly

Mortgage/Rent/Board*required

Estimated Living Expenses*required

Medical/Prescription Expenses*required

Credit Card Payments

Financial Institution*required

Payment*required

Total Credit Card Payments

Personal Loan Repayments

Financial Institution *required

Payment *required

Total Personal Loan Payments

Total Monthly Expenses

Balance

Please provide the following documentation with your application: Centrelink Income statement, Bank statements, Separation Certificate and other relative documents.

You must attach at least 2 files.

Attach all files at once if you have multiple files to upload. Max file size is 5MB*required

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