Applicant(s) Name |
|
Student(s) Name(s) |
|
General Information |
What type of assistance are you applying for? |
|
Do You Have a spouse? |
|
How many dependent children do you have? |
|
What period does your financial information relate to? |
|
INCOME: Please enter the following with regards to your household income
(supporting documentation required: 2 x payslips, bank statements detailing income)
|
Salary/wages |
|
Spouse's salary/wages |
|
Pensions & allowances |
|
Rents & boarding fees |
|
Interest/dividends |
|
Other |
|
Total Amount of Income |
|
EXPENSES: Please enter the following with regards to your household expenses
(supporting documentation required: bank statements detailing expenses, account statements, invoices, receipts)
|
Mortgage repayments |
|
Rent repayments |
|
Other loan repayments |
|
Housekeeping |
|
Electricity/Gas/Rates/Phone |
|
Vehicle costs |
|
Insurance |
|
School fees |
|
Holiday & entertainment |
|
Other |
|
Total Amount of Expenses |
|
ASSETS: Please enter the following with regards to your personal assets
|
House(s) |
|
Motor vehicle(s) |
|
Furniture and effects |
|
Investments/bank accounts/shares |
|
Other |
|
Total Value of Assets |
|
LIABILITIES: Please enter the following with regards to your personal liabilities (supporting documentation required: bank statements detailing liabilities) |
Home Loan(s) |
|
Credit card(s) |
|
Personal Loan(s) |
|
Other(s) |
|
Other(s) |
|
REASONS FOR APPLICATION: After working through your budget enter the reasons you are applying for hardship assistance
|
Provide an indication of the amount of payments you believe you can afford to pay |
|
Application Declaration |
The applicant declares, understands and agrees:
- The information contained in this application is correct and hereby apply for concession on fees and payments due to Tec-NQ based on the information supplied.
- To notify Tec-NQ of any signification change in our circumstances or the information provided in support of this application
- That any concession granted is only of a short term nature and continuing assistance beyond the current calendar year, or other specified period, would require completion of a new application.
|
Signee:
|
Date:
|
Sign: Clear
|
Signee:
|
Date:
|
Sign: Clear
|