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Financial assistance
Payment extension request online application

Payment extension request online application

Before you apply

This form is only for payment extensions under 12 months duration.
If you want to make a payment plan over 12 months duration, please contact the Department to discuss your available options on 1300 886 235 select option 2/ option 1/ option 2.
Prepare the supporting documents you have to support your online application form.

Supporting documentation

If your application is in relation to natural disaster, at least one of the following documents need to be uploaded to support your application:-

Notice of Natural Disaster Declaration issued by the NSW Government
Bureau of Meteorology report
A letter from NSW Food Authority (disease) or
A letter from a rural financial at the end of this application.

Important information about this form

By selecting the Submit button, you have read and agreed to the department's Privacy statement.
The fields marked with an asterisk * are mandatory and must be completed in order to submit the form.
After you have submitted your form, a copy of the application can be emailed to the address entered in the form or a copy can be saved or printed.

Payment extension request

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In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

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Payment extension details

Enter your account or notice number(s)

Provide details of the circumstances surrounding this request

Are you requesting for an instalment plan or postponement of the payment?

Instalment planPostponement

Full payment amount to be paid

Payment date

What is your preferred frequency of instalments to pay off the total amount payable over a period of time?

WeeklyFortnightlyMonthlyQuarterly

Proposed start date of the plan

Proposed end date of the plan

Total amount payable

Proposed instalment amounts

Would you like a Direct Debit set up for these payments?

Yes - The Department will contact you to set up a direct debit.No

Does the plan include the payment of rent as it becomes due during the payment plan period?

Yes

No - ongoing rent will be paid as it becomes due

I would like the department’s assistance to incorporate the rent into the plan

The Department will contact you to discuss incorporating your ongoing payments into your payment plan..

I understand that interest will continue to accrue on the unpaid amount. You may be eligible for a waiver of the interest - check your eligibility here.

Do you want to apply for a waiver?

YesNo

On what grounds are you eligible for a waiver on interest.

Is this payment extension in relation to a natural disaster?

YesNo

Supporting documentation is required

Upload at least one of the following documents - Notice of Natural Disaster Declaration issued by the NSW Government, Bureau of Meteorology report, letter from NSW Food Authority (disease) or a letter from a rural financial at the end of this application.

Applicant details

Are you acting on behalf of the applicant?

YesNo

Authorised representative details

Your full name

Relationship to the applicant

For example lawyer or a type of relative i.e son.

Your preferred contact method

Your email address

Your phone number

Your postal address

All correspondence to be sent to

You onlyApplicant onlyBoth you and the applicant

Applicant contact details

Full name

Preferred contact method

Email address

Phone number

Postal address

Applicant contact details

Full name

Preferred contact method

Email address

Phone number

Postal address

Supporting documentation

Upload at least one of the following documents - Notice of Natural Disaster Declaration issued by the NSW Government, Bureau of Meteorology report, letter from NSW Food Authority (disease) or a letter from a rural financial.

Upload evidence that you are authorised to act on behalf of the account holder.

Upload any documentation to support your application

To receive an email copy of your application enter your email address here or alternatively you can either print or save a copy on the next page.

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