Time Assist application form

Complete this application form to place your account on hold for up to 3 months.

All fields are required unless marked as optional

Your details

First name

Last name

Phone number

Email address

Property details

Account number

Property address

Suburb

Postcode

Current circumstances

A financial care consultant will consider your current circumstances in case there is a different program more suitable to your situation. Information is confidential.

Please tell us about your current financial situation including your current income.

Please tell us about what is impacting your ability to pay your bills.

Please tell us when you think you will be able to make payments?

Your details

Property details

Current circumstances

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