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Caznet Pty Ltd ACN 143 897 303  ·  ABN 47 143 897 303
GPO Box 2409, Adelaide SA 5001
1300 229 638  ·  caznet@caznet.com.au

Financial Hardship
Application Form

Payment Assistance Policy  ·  caznet.com.au

Customer Details
Full nameMust match the name on your account
Account numberFound on your invoice
Contact phone number
Contact email address
Postal address
Preferred contact method
Date of birth
Details of Financial Hardship
Period of assistance required
Reason for hardshipSelect all that apply
Illness (personal or household)
Unemployment
Low or reduced income
Domestic or family violence
Death in the family
Natural disaster
Change in personal circumstances
Other unexpected change
Brief description of your situationPlease explain what has changed and why you are having difficulty paying
Assistance being requestedOptional — describe what arrangement would help
Supporting Documentation
Short-term assistance (up to 3 billing cycles) or domestic/family violence: You do not need to provide documentation unless the amount owed exceeds $1,000, you have been a customer for less than 2 months, or we have reasonable grounds to suspect fraud.

Long-term assistance: We may ask you to provide documentation such as a medical certificate, a statement of your financial position, income confirmation, or evidence of engagement with a financial counsellor. We will only request what is strictly necessary.
Documents attachedList any documents included with this form
Customer Declaration

By signing below, I declare that:

Full name (print)
Signature
Date
How to Submit
Return this completed form to Caznet by any of the following methods:
Email: caznet@caznet.com.au  ·  Post: GPO Box 2409, Adelaide SA 5001  ·  Phone: 1300 229 638 (9:00am–5:00pm ACST, Mon–Fri)

We will assess your application within 5 business days of receiving your completed form and advise you of the outcome within 2 business days of completing the assessment. There is no charge for an assessment. For our full Payment Assistance Policy, visit caznet.com.au/about/legal/financial-hardship