Hardship Concession Application

                                                Hardship Concession Application


If you have been severely impacted by hardship circumstances and are experiencing financial difficulties, please fill out
this application form. For more information please see Council’s Rates and Charges Financial Hardship policy, available
our website – www.noosa.qld.gov.au.
1. Property Details
Rate Property Number
Address of Property

Suburb                                                   State QLD                       Postcode


2. Applicant details
Name/s of owner/s who reside at the property



Current residential address



Suburb                                               State                        Postcode
Current postal address                Write “As Above” if the same as your residential address



Suburb                                               State                        Postcode
Are the above address details the same for each                 Yes               No
owner?                                                                                  Please provide details in
Tick the relevant box                                                                   section 4.
Do you own any other properties in the Noosa area?  Yes                           No
Tick the relevant box

Home phone                            Work phone                                  Mobile

Email address                                                                     Fax

Council will update your record with the contact details you provide on this form



3. Application details
Please provide details of applicants holding any of the following current pension card/s:
Pension Concession card issued by Centrelink?
Department of Veteran Affairs or Repatriation Health (Gold) Card issued by Department of Veteran Affairs?
Queensland Seniors Card issued by the Queensland State Government?
Name of Applicant/s                  Pension Card Numbers                  Card Start Date    Full or Partial Type




 NOOSA COUNCIL                 PO Box 141              P. (07) 5329 6500         [email protected]
 ABN 97 969 214 121            TEWANTIN QLD 4565       F. (07) 5329 6501         www.noosa.qld.gov.au