Financial Hardship Application

Infringement Details

Details of the infringement for which you are seeking hardship consideration

Infringement Number

1234567890

Offence

Red Light Camera Offence

Location

Flinders St & Swanston St, Melbourne

Date & Time

10 May 2025, 08:45 AM

Fine Amount

$389.00

Due Date

14 June 2025

Financial Assessment

Help us understand your financial situation

Weekly Income (after tax)

Include all income sources (wages, Centrelink, etc.)

Weekly Essential Expenses

Rent, food, utilities, transport, medical costs

Hardship Application

Provide details about your financial hardship

Type of Financial Hardship

Unemployment or reduced income

Job loss, reduced hours, or significant income reduction

Medical expenses or illness

Significant medical costs or inability to work due to illness

Family crisis or emergency

Death in family, family violence, or other family emergency

Natural disaster impact

Property damage or income loss due to natural disaster

Mental health condition

Mental health condition affecting ability to work or manage finances

Other exceptional circumstances

Please provide details in the explanation below

Detailed Explanation of Circumstances

Household Size

Number of Dependents

Proposed Payment Arrangement

Supporting Documentation

Click to upload files or drag and drop

Centrelink statements, bank statements, medical certificates, employment letters

Support Services

If you're experiencing financial hardship, these services may be able to help:

• Financial counselling: 1800 007 007
• Centrelink: 132 850
• Emergency relief services: Contact your local council
• Legal aid: 1300 792 387

I declare that the information provided is true and correct. I understand that providing false or misleading information may result in my application being rejected and additional penalties.