City of Wanneroo

Instructions

For enquiries that are of an urgent-nature that require immediate assistance or that relate to animals, parking, ranger assistance or other community safety matters, please call us on (08) 9405 5000

To ensure a timely and professional response, please complete this form with as much detail as possible.

Your personal information collected in this form will help us to complete your request or to improve our services, in accordance with the City's Personal Information Privacy Policy.

Hardship Assistance Application

Terms & Conditions / General Information / Policy Documents

I confirm that I have read and agree to the declaration (on previous page and linked above) (Required)

OWNERS DETAILS

Title

First name (Required)

Last name (Required)

Date of birth (Required)

Business name (if applicable) (Required)

Daytime Contact Number: (Required)

Email address (Required)

Property address (Required)

ADDITIONAL OWNER DETAILS

Title

First name.

Last name.

Date of birth.

Business name. (if applicable)

Daytime contact number.

Email address.

Property address.

...

Please provide a detailed explanation of your financial hardship situation (Required) *

Please provide details

How often would you like to make payments? (Required)

What is the maximum amount you can afford to pay at this frequency? (Required)

When can you make your first payment? (Required)

A letter from a medical practitioner if the financial hardship is a result of illness or injury

Please click below to upload files relating to this submission.

Please upload an Income/Expenditure Statement showing your weekly/fortnightly income and expenses (Required) *

Please click below to upload files relating to this submission.

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