Arrangement

Please complete the form below to enter into an arrangement to repay your debt. We are required to verify your identity so please ensure you complete as many personal details as possible.

We recommend that this form be completed at a desktop computer using Internet Explorer, Google Chrome or Mozilla Firefox.

Once you submit this form you will receive an automated email notification that you request has been received.

We will be in contact by your preferred contact method if we require any additional information or to discuss your proposal further.

If you would like to update your details please click here or for details on how to make a payment towards your debt click here.

* Mandatory Field

YOUR PERSONAL DETAILS
Your Full Name *		Drivers Licence Number
Number of Dependants * -- Please select -- 1 2 3 4 5+		Age of Dependants
Phone Number - Home		Phone Number - Mobile
Phone Number - Work		Your Email Address *
Residential Status * -- Please select -- Owner Renting Boarding Paying Mortgage Living With Parents		Unit Number and / or Street Number
Street Name		Suburb, State and Postcode
YOUR EMPLOYMENT DETAILS
Your Employment Status * -- Please select -- Full-Time Employed Part-Time Employed Self-Employed Unemployed Retired		Name of Current Employer
Occupation		Date Commenced Employment
YOUR HOUSEHOLD INCOME
I Receive My Income: -- Please select -- Weekly Fortnightly Monthly
After Tax Salary		Centrelink Payments
Family Tax Benefit		Child Support Received
Rental Income or Board Income		Other Income
Total Household Income *
YOUR REGULAR EXPENDITURE
My Expenditures Are: -- Please select -- Weekly Fortnightly Monthly
Mortgage or Rental Payments		Mortgage Interest and Charges
Body Corporate Fees		Council Rates
Electricity		Gas
Water		Internet
Pay-TV		Home Phone
Mobile		Car Insurance
Home and Contents Insurance		Health Insurance
Groceries		Clothing and Shoes
Health (Insurance and Medical)		Entertainment
Personal Care		Life Insurance
Pet Expenditure		Other (Subscriptions, Sports, Hobbies)
Vehicle Costs (Fuel)		Vehicle Costs (Registration)
Vehicle Costs (Insurance)		Public Transport (Train, Taxi, Ferry)
Other Transport Expenses		Child Education and / or Childcare
Self-Education (University, TAFE)		Other (Child Support Payments)
Total Living Expenditure *
DETAILS OF YOUR ASSETS
Your Assets -- Please select -- Motor Vehicle Investment Property Residential Property Savings Superannuation Household Furniture Tools of Trade Other		Provide Details
Your Assets -- Please select -- Motor Vehicle Investment Property Residential Property Savings Superannuation Household Furniture Tools of Trade Other		Provide Details
Your Assets -- Please select -- Motor Vehicle Investment Property Residential Property Savings Superannuation Household Furniture Tools of Trade Other		Provide Details
Your Assets -- Please select -- Motor Vehicle Investment Property Residential Property Savings Superannuation Household Furniture Tools of Trade Other		Provide Details
Your Assets -- Please select -- Motor Vehicle Investment Property Residential Property Savings Superannuation Household Furniture Tools of Trade Other		Provide Details
Your Assets -- Please select -- Motor Vehicle Investment Property Residential Property Savings Superannuation Household Furniture Tools of Trade Other		Provide Details
Your Assets -- Please select -- Motor Vehicle Investment Property Residential Property Savings Superannuation Household Furniture Tools of Trade Other		Provide Details
Your Assets -- Please select -- Motor Vehicle Investment Property Residential Property Savings Superannuation Household Furniture Tools of Trade Other		Provide Details
DETAILS OF YOUR OUTSTANDING DEBTS
Your Outstanding Debts -- Please select -- Investment Property Loan Home Mortgage Personal Loan(s) Credit Card(s) Other		Provide Details
Your Outstanding Debts -- Please select -- Investment Property Loan Home Mortgage Personal Loan(s) Credit Card(s) Other		Provide Details
Your Outstanding Debts -- Please select -- Investment Property Loan Home Mortgage Personal Loan(s) Credit Card(s) Other		Provide Details
Your Outstanding Debts -- Please select -- Investment Property Loan Home Mortgage Personal Loan(s) Credit Card(s) Other		Provide Details
Your Outstanding Debts -- Please select -- Investment Property Loan Home Mortgage Personal Loan(s) Credit Card(s) Other		Provide Details
YOUR REPAYMENT OFFER
How Much Will You Pay? *		Frequency of Payments *                   -- Please select --                   Weekly                   Fortnightly                   Monthly
1st Payment Date *		Preferred Payment Method *                   -- Please select --                   Online Direct Debit                   Telephone Direct Debit                   BPAY                   Electronic Funds Transfer                   Bank Deposit                   Online Debit Card
Other Comments or Questions
ATTACH SUPPORTING DOCUMENTATION
Attach File (250Mb Limit)
VERIFICATION STATEMENT
The Information I Have Supplied Is True and Correct -- Please select -- Yes No
Prove you're not a robot *