Financial Hardship Application Form 2021

At LPE, we understand that life can take unexpected turns. If you're facing financial hardship, we're here to help. By completing this application form, it will allow us to assess your situation and determine if you're eligible for our hardship program. Closed accounts are not eligible for our Hardship program.

If you need assistance completing this form or would like to speak to someone you can call us on 1800 040 168. We're available from 8:30am-5:00pm Monday to Friday. You can also read more about our Customer Hardship Program here

Full Name*

Home Address*

Preferred Contact Number *

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

LPE Account Number*

Dependants (including age)

Circumstance for Hardship - Please explain your reason for your application.*

Employment Details

Type of Employment*

Name of Employer (1)

Occupation

Name of Contact Person

Contact Details

Salary per fortnight

Name of Employer (2)

Occupation

Name of Contact Person

Contact Details

Salary per fortnight

Further Employment Detail (eg. Spouse)

Financial Information

Income the household receives per fortnight

Houseshold Salary (wages, child support, centrelink benefits)*

Other (such as rent, investments)

Income the household pays per fortnight

Rent and/or Mortgage*

Council Rates

Other Loan Repayments

Credit Card Payments

Utilities (gas/water/electricity/phone/internet)*

Child Support

Motor Vehicle (petrol/insurance/registration)

Childcare / School Fees

Education

Living Costs (food, public transport)*

Medical Expenses

Insurance (private health)

Please provide any additional information that you would like to add for consideration of your application.
Please ensure you include all relevant information that you wish the decision maker to consider. The decision will be based on the information you have provided in this application.

Please note bank statements may be required to complete this Hardship Application so please ensure you have this information ready before submitting your form.

Additional Information

Declaration

First NameLast Name

By listing your name above you declare that the information provided is true and accurate at the time of completion. You also acknowledge that the information provided will be used and stored in accordance with the Australian Privacy Act 2009.

LPE have a formal complaints policy and welcome the opportunity to resolve any disputes. Please call us on 1800 040 168 or email complaints@localityenergy.com.au. If we are unable to resolve your dispute you can contact the Energy and Water Ombudsman Queensland EWOQ online https://www.ewoq.com.au/ or free call 1800 662 837 or Energy and Water Ombudsman NSW EWON https://www.ewon.com.au/ or free call 1800 246 545.

Customer Hardship Application