Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Australian Credit Licence Number 234527.
ANZ CUSTOMER CONNECT
APPLICATION FOR HARDSHIP ASSISTANCE
Page 1
Date
SECTION 1: PERSONAL DETAILS SECTION 1B: PERSONAL DETAILS
Customer 1 Customer 2
Full name Full name
Date of birth Preferred contact number Date of birth Preferred contact number
Preferred contact email Preferred contact email
Marital Status No. of dependants Marital Status No. of dependants
Is the account you’re requiring assistance on in joint names?
If so please complete section 1B.
Employment Status
Contract Full time Part time Casual
Pensioner Self employed Unemployed Temporary
Studying Seasonal Stood down without payment
Employment Industry
Accommodation Administrative and support services Agriculture, forestry and fishing Construction
Arts and recreation services Education and training Electricity, gas, water and waste services
Food services Health care and social assistance Information, media and telecommunications
Manufacturing Mining Professional, scientific and technical services
Public administration and safety Rental, hiring and real estate services Retail trade
Transport, postal and warehousing Wholesale trade Other services
SECTION 2: REASON FOR APPLYING FOR FINANCIAL ASSISTANCE
Main reason for seeking financial assistance
Unemployment
Medical Illness
Reduced Income
Over-Commitment
Parental Leave
Separation/Divorce
Death/Bereavement
Domestic Violence
Unexpected/One-off expense
Permanent Disability
Covid-19
Natural Disaster
Other
When did your financial circumstances change?
Less than 3 months ago Between 3 and 6 months Between 6 and 12 months More than 12 months ago
When do you think you will be able to resume your full regular repayments?
Up to 3 months Between 3-12 months Permanent financial difficulty,
unlikely to afford full repayments again
Please let us know briefly about your situation and reasons for seeking financial assistance
You can send us your completed application form by:
Email
Credit Cards, Personal Loans and Overdraft
facilities: [email protected]
ANZ Asset Finance: [email protected]
Small Business: [email protected]
Home Loans: [email protected]
Mail
Locked Bag 10,
Collins Street West
Melbourne VIC 8007
Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Australian Credit Licence Number 234527. Page 2
SECTION 3. ANZ ACCOUNT DETAILS
Enter an ANZ account number or your customer registration number available to you
Select the accounts you may need assistance for
Home Loan(s)
Personal Loan
Consumer Credit Card
Consumer Overdraft
Business Overdraft
Small Business Loan
ANZ Asset Finance
Business Credit Card
For the account/s you have selected above, can you maintain your current minimum contractual repayments?
Yes
No
For the account/s you have selected above can you maintain a partial repayment?
Yes
No
SECTION 4: OTHER FINANCIAL INSTITUTIONS
Do you have any loans or credit cards with other lenders?
Yes
No
If you answered yes, please list them below
Name of credit providers Sole or joint names? Credit limit Current account balance Minimum repayment
Mortgage
$
$
$
Mortgage
$
$
$
Personal loans
$
$
$
Personal Loan
$
$
$
Personal Loan
$
$
$
Personal Loan
$
$
$
Car loans
$
$
$
Car loans
$
$
$
Credit card
$
$
$
Credit card
$
$
$
Credit card
$
$
$
Credit Card
$
$
$
Credit Card
$
$
$
Credit Card
$
$
$
Business Overdraft
$
$
$
Business Overdraft
$
$
$
Investment mortgage
$
$
$
Investment mortgage
$
$
$
Other mortgages
$
$
$
Other mortgages
$
$
$
Personal Overdraft
$
$
$
Personal Overdraft
$
$
$
Business Overdraft
$
$
$
Business Loan
$
$
$
Business loan
$
$
$
BNPL facilities*
$
$
$
BNPL facilities*
$
$
$
BNPL facilities*
$
$
$
BNPL facilities*
$
$
$
Other
$
$
$
Other
$
$
$
Other
$
$
$
Other
$
$
$
*For eg: Zip pay Total balance owed
$
0
Page 3Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Australian Credit Licence Number 234527. Item No. 86286 03.2023 WZ129509
SECTION 5. YOUR INCOME
Please insert the monthly amount for each expense.
Customer 1 Amount Customer 2 Amount
Income after tax including
salary/self-employed income,
Bonus, Overtime, Dividends/
Interest Income
$
Income after tax including
salary/self-employed income,
Bonus, Overtime, Dividends/
Interest Income
$
Centrelink income
$
Centrelink income
$
Other income
$
Other income
$
Residential or
Commercial Rental Income
$
Residential or Commercial
Rental Income
$
Monthly Total income
$
SECTION 6: YOUR EXPENSES
Please insert the monthly amount for each expense. Amount
Rent
$
Utilities
(Water, gas, electricity bills for your home)
$
Groceries
(Supermarket shop – including food, cleaning products and toiletries, fresh food from butchers, markets and greengrocers).
$
Public transport and vehicle expenses
(Public transport tickets, registration, vehicle insurance, servicing, petrol, parking fees, road tolls)
$
TV and communications
(Mobile phone, landline, internet, pay TV and streaming subscriptions)
$
Health
(Health insurance, fitness, dental, optical, pharmaceuticals, physiotherapy, chiropractic fees, doctor visits, ongoing hospital fees)
$
Personal insurance
(Life and income replacement insurance)
$
Lifestyle
(Entertainment, hobbies and recreation – e.g. eating out, takeaways, alcohol, tobacco, pets, movies, electronics, books, sport/camping
equipment, holidays and travel).
$
Household
(Rates, home and content insurance, repairs and maintenance, furniture and appliances, gardener, housekeeping, cleaning services)
$
Personal
(Clothing and shoes, haircuts, cosmetics, personal care for yourself and your dependents)
$
Property Investment
(Rates, water, building insurance, landlord insurance, state revenue/land tax, repairs and maintenance, appliances, gardener, housekeeping,
cleaning services, agent letting costs)
$
Professional cost and service
(Financial management/legal costs – e.g. accountant, financial planning and solicitors, union fees and professional association
membership/costs).
$
Private education
(Tuition fees, uniforms, books, excursions and camps for independent schools).
$
Childcare and public education
(Childcare and preschool costs; public primary, secondary and tertiary education costs e.g. tuition, fees, uniforms, books, excursions and
camps as well as tertiary education costs including textbooks).
$
Child spousal maintenance
(Regular child/spousal maintenance payments)
$
Other
(Any other regular expenses e.g. Superannuation voluntary contribution, voluntary HECS payments, gifts and donations, Land Tax, Body
Corporate fees)
$
Monthly Total living
expenses
$
SECTION 8: YOUR ASSETS
Assets Value
House property Address:
$
Other assets Details:
$
$
$
$
(Superannuation, car, rental property etc)
Total assets
$
SECTION 9. CUSTOMER DECLARATION
Please tick the following box to confirm that the information completed above is true and correct.
0
0
0
