fInancial Hardship Assistance Please complete this form and we will contact you with assistance options. Financial Hardship Assistance Personal DetailsFinancial Hardship Assistance We need your details to verify that you are the account holder.Customer Account NumberHave you applied for Financial Hardship with us previously? Yes No, this is my first time for this account.Are you seeking assistance on other accounts with us? Yes NoAccount Holder's NameContact Email Address on Your IGD AccountBest Contact NumberWhat's your preferred contact method? Email PhoneAccount Holder's Date of Birth PreviousNextAre you experiencing Finacial Hardship due to COVD-19? Yes NoWhat's the reason related to COVID-19? Business loss Loss of job or income Illness (diagnosed with COVID-19) OtherWhat's the reason related to COVID-19 (Other Reason)What type of relief are you seeking? Temporary postponement or deferral of payments Payment arrangement for unpaid or future amounts Early Termination without penalty OtherWhat type of relief are you seeking? (Other Reason)What is the reason of your Financial Hardship? Lost of employment of you or a family member Illness, physical incapacity, hospitalisation or mental illness of you or a family member Family breakdown A death in the family Being a victim of domestic or family violence Natural Disaster Business Loss Other (please indicate)What is the reason of your Financial Hardship? (Others, Please Indicate)Please tell us the amount involved, if known. Please attach a document to support your financial Hardship Application. This may be: *– Centrelink documentation (e.g. Jobseeker payment)– Medical record– Bankruptcy notice/insolvency– Reduced working hours payslip or employer’s letter– Business financial or sales records showing reduced turnoverFinancial Hardship Media UploadChoose File Please add any comment you may wish to make regarding your situation. All personal information collected are handled in accordance to our Collection Notice *Collection Notice * I acknowledge that I am providing personal information to IGD solutions and that I have read the Collection Notice Previous Submit
