For application with more than 2 members, please contact us on 13 25 77.
For application with more than 2 members, please contact us on 13 25 77.
Reason for hardship request
Reason for hardship request
Explain your current financial circumstances and provide any other reason why you are submitting this application for hardship assistance
Agent's information
Complete this information if you would like us to contact your agent to discuss your application.
Agent's information
Complete this information if you would like us to contact your agent to discuss your application.
Agent's Name
Agent's Address
Personal details - Primary member
Personal details - Primary member
Member number
Full name
Phone number
Email address
Please enter your date of birth
Please enter your date of birth
Day
-- Select an option --
1
2
3
4
5
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7
8
9
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11
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13
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16
17
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19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
Number of dependants
-- Select an option --
0
1
2
3
4
5
6
7
8
9
10
Residential address
Suburb
State
-- Select an option --
WA
NSW
VIC
QLD
SA
ACT
TAS
NT
Postcode
Residential status
Select your residential status
Owner
Owner - with mortgage
Renting
Boarding
Living with relatives
Time at residential address (years)
Select the number of years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Greater than 20
Months
Select the number of months
0
1
2
3
4
5
6
7
8
9
10
11
Postal address
Suburb
State
-- Select an option --
WA
NSW
VIC
QLD
SA
ACT
TAS
NT
Postcode
Employment details - Primary member
Employment details - Primary member
Employment type
Select your employment type
Full time
Part time
Casual
Retired
Unemployed
Other
Other employment type
Employer's name
Employer's address
Suburb
State
-- Select an option --
WA
NSW
VIC
QLD
SA
ACT
TAS
NT
Postcode
Phone number
Occupation / Position
Employment time with employer (years)
-- Select an option --
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Greater than 20
Months
Select the number of months
0
1
2
3
4
5
6
7
9
10
11
Previous employment - Primary member
Previous employment - Primary member
Previous employer's name
Previous employer's address
Previous employer's suburb
Previous employer's state
Enter your previous employer's state
WA
NSW
VIC
QLD
SA
ACT
TAS
NT
Previous employer postcode
Previous employer's phone number
Previous employer occupation / position
Previous employer's service period (years)
Select the number of years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Greater than 20
Months
Select the number of months
0
1
2
3
4
5
6
7
8
9
10
11
Personal details - Secondary member
Personal details - Secondary member
Member number
Full name
Phone number
Please enter your date of birth
Please enter your date of birth
Day
-- Select an option --
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
Number of dependants
Select the number of dependants
0
1
2
3
4
5
6
7
8
9
10
Residential address
Suburb
State
-- Select an option --
WA
NSW
VIC
QLD
SA
ACT
TAS
NT
Postcode
Residential status
Select your residential status
Owner
Owner - with mortgage
Renting
Boarding
Living with relatives
Time at residential address (years)
Select the number of years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Greater than 20
Months
-- Select an option --
0
1
2
3
4
5
6
7
8
9
10
11
Postal address
Suburb
State
-- Select an option --
WA
NSW
VIC
QLD
SA
ACT
TAS
NT
Postcode
Employment details - Secondary member
Employment details - Secondary member
Employment type
Select your employment type
Full time
Part time
Casual
Retired
Unemployed
Other
Other employment type
Employer's name
Employer's address
Suburb
State
-- Select an option --
ACT
NSW
QLD
SA
TAS
VIC
WA
NT
Postcode
Phone number
Employment time with employer (years)
Select the number of years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Greater than 20
Months
Select the number of months
0
1
2
3
4
5
6
7
8
9
10
11
Previous employment - Secondary member
Previous employment - Secondary member
Previous employer's name
Previous employer's address
Previous employer's suburb
Previous employer's state
Enter your previous employer's state
WA
NSW
VIC
QLD
SA
ACT
TAS
NT
Previous employer postcode
Previous employer's phone number
Previous employer occupation / position
Employment time with employer (years)
Select the number of years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Greater than 20
Months
Select the number of months
0
1
2
3
4
5
6
7
8
9
10
11
Financial details
Financial details
Please provide more information
Income
Please list your income amounts per month (gross less tax):
If self employed: please provide financial statements for the last 2 years.
Enter '0' if not applicable.
Income
Please list your income amounts per month (gross less tax):
If self employed: please provide financial statements for the last 2 years.
Enter '0' if not applicable.
Primary wages/salary income per month
Secondary wages/salary income per month
Pension/Superannuation income per month
Family allowance income per month
Rental income per month
Interest income per month
Dividend income per month
Family maintenance income per month
Other income per month
Expenses
Please list your expense amounts per month:
Enter '0' if not applicable.
Expenses
Please list your expense amounts per month:
Enter '0' if not applicable.
Mortgage payments per month
Investment property payments per month
Rent/Board payments per month
Motor vehicle loan payments per month
Other loan payments per month
Credit/Store card (all cards) payments per month
House insurance payments per month
Motor vehicle insurance payments per month
Superannuation/Life insurance payments per month
Rates expenses per month
Transport (include fuel, vehicle registration, public transport) expenses per month
Food expenses per month
Power expenses per month
Gas expenses per month
Phone expenses per month
Family maintenance payments per month
Education expenses per month (public/private school costs, additional education costs)
Other monthly expenses per month
Assets & Liabilities
Please list your assets, liabilities and their current values:
Enter '0' if not applicable.
Assets & Liabilities
Please list your assets, liabilities and their current values:
Enter '0' if not applicable.
Residential property address
Residence property current value (estimated)
Residence property current amount outstanding
Investment property address
Investment property current value (estimated)
Investment property current amount outstanding
Vacant land address
Vacant land current values (estimated)
Vacant land current amount outstanding
Primary member - Motor vehicle make & model
Primary member - Motor vehicle current value (estimated)
Primary member - Motor vehicle current amount outstanding
Secondary member - Motor vehicle make & model
Secondary member - Motor vehicle current value (estimated)
Secondary member - Motor vehicle current amount outstanding
Caravan make, model, year and registration
Caravan current value (estimated)
Caravan current amount outstanding
Boat make, model, year and registration
Boat current value (estimated)
Boat current amount outstanding
Home contents value (estimated)
Primary member - Savings/Investment balance
Primary member - Superannuation balance
Secondary member - Savings / Investment balance
Secondary member - Superannuation balance
Overdraft details
Overdraft current amount outstanding
1. Other loan - Financial institution
Other loan amount outstanding
2. Other loan - Financial institution
Other loan amount outstanding
Total credit/store card limits
Total credit/store card balance outstanding
Declaration
By selecting Submit , you agree to the terms of our Privacy Statement and Consent and agree to Police & Nurses Limited collecting, using, exchanging and transferring overseas, my personal information as described and set out in our Privacy Statement and Consent and Privacy Policy.
I declare that the answers in the foregoing statements are true and complete in every particular and that I have no financial commitments or obligations other than those stated in this document and that I am aware that it is on the basis of the information that I have provided that P&N will make its decision whether or not to grant a loan. I authorise P&N to make enquiries, which it considers necessary to fully assess this loan enquiry. I acknowledge that this form does not constitute an offer or acceptance of credit in terms of any legislation relating to the provision of credit or any other applicable act or ordinance relating to the provision of credit.
Note: Fees and charges are applicable to this loan. A Schedule of Fees and Charges is available upon request.
Declaration
By selecting Submit , you agree to the terms of our Privacy Statement and Consent and agree to Police & Nurses Limited collecting, using, exchanging and transferring overseas, my personal information as described and set out in our Privacy Statement and Consent and Privacy Policy.
I declare that the answers in the foregoing statements are true and complete in every particular and that I have no financial commitments or obligations other than those stated in this document and that I am aware that it is on the basis of the information that I have provided that P&N will make its decision whether or not to grant a loan. I authorise P&N to make enquiries, which it considers necessary to fully assess this loan enquiry. I acknowledge that this form does not constitute an offer or acceptance of credit in terms of any legislation relating to the provision of credit or any other applicable act or ordinance relating to the provision of credit.
Note: Fees and charges are applicable to this loan. A Schedule of Fees and Charges is available upon request.
Declaration
By selecting Submit , we agree to the terms of our Privacy Statement and Consent and agree to Police & Nurses Limited collecting, using, exchanging and transferring overseas, my personal information as described and set out in our Privacy Statement and Consent and Privacy Policy.
We declare that the answers in the foregoing statements are true and complete in every particular and that I have no financial commitments or obligations other than those stated in this document and that I am aware that it is on the basis of the information that I have provided that P&N will make its decision whether or not to grant a loan. I authorise P&N to make enquiries, which it considers necessary to fully assess this loan enquiry. We acknowledge that this form does not constitute an offer or acceptance of credit in terms of any legislation relating to the provision of credit or any other applicable act or ordinance relating to the provision of credit.
Note: Fees and charges are applicable to this loan. A Schedule of Fees and Charges is available upon request.
Declaration
By selecting Submit , we agree to the terms of our Privacy Statement and Consent and agree to Police & Nurses Limited collecting, using, exchanging and transferring overseas, my personal information as described and set out in our Privacy Statement and Consent and Privacy Policy.
We declare that the answers in the foregoing statements are true and complete in every particular and that I have no financial commitments or obligations other than those stated in this document and that I am aware that it is on the basis of the information that I have provided that P&N will make its decision whether or not to grant a loan. I authorise P&N to make enquiries, which it considers necessary to fully assess this loan enquiry. We acknowledge that this form does not constitute an offer or acceptance of credit in terms of any legislation relating to the provision of credit or any other applicable act or ordinance relating to the provision of credit.
Note: Fees and charges are applicable to this loan. A Schedule of Fees and Charges is available upon request.
Submit
