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Am I eligible to apply for assistance?

Applicant's Details
Mr Mrs Ms Miss
First name:
Last name:
Occupation:
Age:

Spouse/Partner
Mr Mrs Ms Miss
First name:
Last name:
Occupation:
Age:

Other Information
Post Address:
Postcode:
Home Phone:
Email:
Cell Phone:
Work Phone:
Name/s on Watercare Account:
Watercare Account No:
Oustanding amount owed to Watercare: $
As at (date of last account):
Are you the property owner?
Yes No
If you are not the property owner, please provide the property owner's/manager's details below (if known):
Property owner's /
manager's name:
Post Address:
Phone:
Email:
Do you authorise the Trust and/or Watercare to contact the property owner/manager regarding your application?
Yes No