Payment Arrangement Application

About this Form

Council recognises there are cases of genuine financial hardship requiring respect and compassion in special circumstances. If you are unable to pay your rates by the due date, Council may approve a payment arrangement by accepting a regular periodical payment. Alternatively, Council may approve an extension to pay with an agreed date for a lump sum payment. The ratepayer must consider their personal financial circumstances, any future obligations and the overdue rates balance in order to meet the ongoing payment amount.

NOTES TO RATEPAYER

Submit one application for each rates account.
Choose at least one option;
- Payment Arrangement – defined as a regular periodical payment, relevant to the ratepayer’s personal financial circumstances.
- Extension to Pay in Full – defined as a period to delay the payment of rates whereby the rates are paid in full on an agreed date that does not exceed a period of 4 weeks from the date of application. If the extension exceeds 4 weeks, a regular periodical payment is required.
The ratepayer must calculate the amount of the arrangement in adherence with the conditions below whereby Council will accept all reasonable arrangements and will only contact the ratepayer if an adjustment to the amount is required in order to align with Council’s policy and guidelines.
The ratepayer must consider that new rates and charges will be issued by the end of July of each financial year.

CONDITIONS OF AGREEMENT

All future correspondence from Council will be sent to the postal address provided on this form.
Any arrangement made before the due date of the 3rd instalment, should be made such that all amounts are paid in full by 30th June of that financial year.
Arrangements made after the 3rd instalment due date may extend into the following year however, must be reviewed once the subsequent year’s levy also becomes payable.
Payment arrangements are subject to Council’s Rates and Charges, Debt Recovery and Hardship Assistance Policy.
If the application for the payment arrangement is approved, any existing direct debit authority will be cancelled. A new Direct Debit Authority Request will be required if you wish to have your direct debit arrangement re-instated following the agreed arrangement period.
Overdue Rates and Charges are subject to daily interest pursuant to Section 566 of the LocalGovernment Act, 1993.
If financial circumstances should cause the delay of any payment or the inability to maintain this arrangement you must notify Council immediately.
Failure to adhere to the agreed payment arrangement may result in the commencement of legal action without further notice.

PROPERTY DETAILS

Rates Account Number *

Address *

Suburb *

Post Code *

RATEPAYER DETAILS

Is the property Owner Company/Business? *

YesNo

Company/Business Name *

First Name *

Surname *

Email Address *

Phone (mobile preferred) *

POSTAL ADDRESS DETAILS

Postal Address *

Suburb: *

Postcode *

DETAILS OF CIRCUMSTANCES *

ARRANGEMENT OPTION *

Extension to Pay in Full (Must not exceed a period of 4 weeks from the date of application)Arrangement to Pay

EXTENSION TO PAY IN FULL

Payment in Full Date *

DETAILS OF ARRANGEMENT

Arrangement Commencement Date *

Arrangement Amount *

Payment Frequency : (Please tick one option) *

WeeklyFortnightlyMonthly

DECLARATION

I agree to the terms and conditions as outlined in the Conditions of Agreement *

Full Name *

Applicant 1 Signature *

Draw signature|Type signatureClear

Date *

Privacy Statement:

In submitting this form, you consent to Council:

1. collecting your personal information as contained in the form; and

2. using the information for the purposes outlined in the form and for any other Council function.

Providing your information is voluntary. Should you choose not to provide the information, Council is unable to process your application/request.

You may access any of your personal information that Council holds upon request.