Financial Hardship Application

Please complete the below form, and email any other required documents to support@sky5g.com.au

Once assessed, we will be in contact to discuss your claim.

Refer to our Financial Hardship Policy here.

Name

Contact Phone

Date of Birth

Brief Description of why you are claiming hardship

Have you sought the advice of a financial counsellor in relation to this matter?

Yes - (If yes, please supply information from counsellor including forms, authority forms, written proposals, etc) No – (If no, you can find information about contacting financial counsellors in the policy section)

How long do you predict hardship to last:

Short Term (Less than 3 months) Long Term (More than 3 months)

Are you currently receiving any income?

What are your estimated expenses (this does not include expenses paid by another member of the household)?

What is the amount you are able to pay?

Frequency of the amount above:

Week Fortnight Monthly

Commencing Date of above payments

Are you willing to reduce spend where possible by lowering plans, and temporarily disconnecting services?

Yes No

To assist with our assessment have you or are you willing to provide us any supporting evidence such as income statements?

Yes No

I declare the information provided is true and accurate at the time of completion. Please type full name and today's date.

info@sky5g.com.au

1300 413 798

PO Box 21
Richmond, QLD, 4822

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