{"id":21110,"date":"2024-03-13T10:01:37","date_gmt":"2024-03-12T23:01:37","guid":{"rendered":"https:\/\/www.letsbemates.com.au\/mate\/?page_id=21110"},"modified":"2024-09-18T12:06:18","modified_gmt":"2024-09-18T02:06:18","slug":"financial-hardship-assistance","status":"publish","type":"page","link":"https:\/\/www.letsbemates.com.au\/mate\/financial-hardship-assistance\/","title":{"rendered":"Financial Hardship Assistance &#8211; Application Form | MATE"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_58' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_58'  action='\/mate\/wp-json\/wp\/v2\/pages\/21110' data-formid='58' >\n                        <div class='gform-body gform_body'><ul id='gform_fields_58' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_58_35\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_58_35\"><h2 class=\"gsection_title\"><\/h2><div class='gsection_description' id='gfield_description_58_35'><h2 style=\"text-align: center;\">MATE Financial Hardship Assistance Application<\/h2>\n<p style=\"text-align: center;\"><em>(Note: Evidence that we request from you under paragraph 15 of our Payment Assistance Policy counts as part of this application, and your application is not complete until the evidence has been provided to us.)<\/em><br><br>If you have any questions about this policy or application, contact us by calling 02 8357 0513 during the following days and hours:  Monday to Friday \u2013 8:30 AM to 7 PM AEST\/AEDT; or email hardship@letsbemates.com.au.<br><\/div><\/li><li id=\"field_58_15\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_58_15\"><h2 class=\"gsection_title\"><\/h2><div class='gsection_description' id='gfield_description_58_15'><h4><span style=\"color: #00b26b\t;\">Part 1: Customer Details<\/span><\/h4><\/div><\/li><li id=\"field_58_61\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_61\"><label class='gfield_label gform-field-label' for='input_58_61' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_61'><b>Enter your full name below<\/b><\/div><div class='ginput_container ginput_container_text'><input name='input_61' id='input_58_61' type='text' value='' class='small'  aria-describedby=\"gfield_description_58_61\"  placeholder='Name' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_58_2\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_2\"><label class='gfield_label gform-field-label' for='input_58_2' >Account number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_2'><b>Enter your MATE account number below. You can find your account number on your invoice (this may also be referred to as your MATE code)<\/b><\/div><div class='ginput_container ginput_container_text'><input name='input_2' id='input_58_2' type='text' value='' class='small' maxlength='8' aria-describedby=\"gfield_description_58_2\"  placeholder='Account number' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_58_39\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_39\"><label class='gfield_label gform-field-label' for='input_58_39' >Invoice number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_39'><b>Enter the tax invoice number your application relates to below<\/b><\/div><div class='ginput_container ginput_container_text'><input name='input_39' id='input_58_39' type='text' value='' class='small' maxlength='9' aria-describedby=\"gfield_description_58_39\"  placeholder='Invoice number' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_58_18\"  class=\"gfield gfield--type-text gf-col-6 gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_18\"><label class='gfield_label gform-field-label' for='input_58_18' >Phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_18'><b>*Enter your preferred phone number below. Please provide the number associated with your MATE account<\/b><\/div><div class='ginput_container ginput_container_text'><input name='input_18' id='input_58_18' type='text' value='' class='medium' maxlength='10' aria-describedby=\"gfield_description_58_18\"  placeholder='Phone number' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_58_17\"  class=\"gfield gfield--type-email gf-col-6 gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_17\"><label class='gfield_label gform-field-label' for='input_58_17' >Email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_17'><b>*Enter your preferred email address below. Please provide the email associated with your MATE account<\/b><\/div><div class='ginput_container ginput_container_email'>\n                            <input name='input_17' id='input_58_17' type='text' value='' class='medium'   placeholder='Email address' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_58_17\" \/>\n                        <\/div><\/li><li id=\"field_58_62\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_58_62\">* Unless you request otherwise, we may contact you via any of these contact points.<br><\/li><li id=\"field_58_67\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_67\"><label class='gfield_label gform-field-label' for='input_58_67' >Do you have existing financial hardship assistance from MATE?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_67'><b>Do you have existing financial hardship assistance from MATE?<\/b><\/div><div class='ginput_container ginput_container_select'><select name='input_67' id='input_58_67' class='small gfield_select'  aria-describedby=\"gfield_description_58_67\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select yes or no<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_58_42\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_42\"><label class='gfield_label gform-field-label' for='input_58_42' >If \u2018yes\u2019, provide details<\/label><div class='gfield_description' id='gfield_description_58_42'>If \u2018yes\u2019, provide details below<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_42' id='input_58_42' class='textarea large'  aria-describedby=\"gfield_description_58_42\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_58_64\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_58_64\"><h2 class=\"gsection_title\"><\/h2><div class='gsection_description' id='gfield_description_58_64'><br><\/div><\/li><li id=\"field_58_16\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_58_16\"><h2 class=\"gsection_title\"><\/h2><div class='gsection_description' id='gfield_description_58_16'><h4><span style=\"color: #00b26b\t;\">Part 2: Assistance eligibility<\/span><\/h4>Please complete this part of the application by ticking each box that is next to a statement that is correct.  You can leave any untrue statement boxes blank.<\/div><\/li><li id=\"field_58_49\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_49\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Section 1<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_49'>Section 1<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_58_49'><li class='gchoice gchoice_58_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='1. You are an individual person, and you mainly use your MATE service for personal or domestic purposes.'  id='choice_58_49_1'   aria-describedby=\"gfield_description_58_49\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_58_49_1' id='label_58_49_1' class='gform-field-label gform-field-label--type-inline'>1. You are an individual person, and you mainly use your MATE service for personal or domestic purposes.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_49_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.2' type='checkbox'  value='2. You are a not-for-profit organisation.'  id='choice_58_49_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_49_2' id='label_58_49_2' class='gform-field-label gform-field-label--type-inline'>2. You are a not-for-profit organisation.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_49_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.3' type='checkbox'  value='3. You are a business, and when you entered your MATE contract, you didn\u2019t have a genuine and reasonable opportunity to negotiate the terms, and your expected annual telco spend was $40,000 or less.'  id='choice_58_49_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_49_3' id='label_58_49_3' class='gform-field-label gform-field-label--type-inline'>3. You are a business, and when you entered your MATE contract, you didn\u2019t have a genuine and reasonable opportunity to negotiate the terms, and your expected annual telco spend was $40,000 or less.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_58_59\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_59\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Section 2<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_59'>Section 2<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_58_59'><li class='gchoice gchoice_58_59_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.1' type='checkbox'  value='4. You don\u2019t sell the use of your service to anyone else.'  id='choice_58_59_1'   aria-describedby=\"gfield_description_58_59\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_58_59_1' id='label_58_59_1' class='gform-field-label gform-field-label--type-inline'>4. You don\u2019t sell the use of your service to anyone else.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_58_60\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_60\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Section 3<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_60'>Section 3<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_58_60'><li class='gchoice gchoice_58_60_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.1' type='checkbox'  value='5. You owe us or will owe us, money that you can&#039;t pay.'  id='choice_58_60_1'   aria-describedby=\"gfield_description_58_60\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_58_60_1' id='label_58_60_1' class='gform-field-label gform-field-label--type-inline'>5. You owe us or will owe us, money that you can't pay.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_58_51\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_51\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Section 4<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_51'>Section 4<br>The reason you can\u2019t pay is because: (select at least one option)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_58_51'><li class='gchoice gchoice_58_51_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.1' type='checkbox'  value='(a) you are ill, or you have been ill (recently)'  id='choice_58_51_1'   aria-describedby=\"gfield_description_58_51\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_1' id='label_58_51_1' class='gform-field-label gform-field-label--type-inline'>(a) you are ill, or you have been ill (recently)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.2' type='checkbox'  value='(b) someone in your household is ill or has been ill'  id='choice_58_51_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_2' id='label_58_51_2' class='gform-field-label gform-field-label--type-inline'>(b) someone in your household is ill or has been ill<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.3' type='checkbox'  value='(c) you are unemployed or have been unemployed'  id='choice_58_51_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_3' id='label_58_51_3' class='gform-field-label gform-field-label--type-inline'>(c) you are unemployed or have been unemployed<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.4' type='checkbox'  value='(d) your income is low'  id='choice_58_51_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_4' id='label_58_51_4' class='gform-field-label gform-field-label--type-inline'>(d) your income is low<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.5' type='checkbox'  value='(e) you don\u2019t have enough income'  id='choice_58_51_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_5' id='label_58_51_5' class='gform-field-label gform-field-label--type-inline'>(e) you don\u2019t have enough income<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.6' type='checkbox'  value='(f) your access to income has reduced'  id='choice_58_51_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_6' id='label_58_51_6' class='gform-field-label gform-field-label--type-inline'>(f) your access to income has reduced<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.7' type='checkbox'  value='(g) you suffer, or have suffered, domestic violence'  id='choice_58_51_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_7' id='label_58_51_7' class='gform-field-label gform-field-label--type-inline'>(g) you suffer, or have suffered, domestic violence<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.8' type='checkbox'  value='(h) you suffer, or have suffered, family violence'  id='choice_58_51_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_8' id='label_58_51_8' class='gform-field-label gform-field-label--type-inline'>(h) you suffer, or have suffered, family violence<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.9' type='checkbox'  value='(i) there has been a death in your family'  id='choice_58_51_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_9' id='label_58_51_9' class='gform-field-label gform-field-label--type-inline'>(i) there has been a death in your family<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.11' type='checkbox'  value='(j) there has been a change in your personal circumstances'  id='choice_58_51_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_11' id='label_58_51_11' class='gform-field-label gform-field-label--type-inline'>(j) there has been a change in your personal circumstances<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.12' type='checkbox'  value='(k) there has been a change in your family circumstances'  id='choice_58_51_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_12' id='label_58_51_12' class='gform-field-label gform-field-label--type-inline'>(k) there has been a change in your family circumstances<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.13' type='checkbox'  value='(l) there is, or has been, a natural disaster'  id='choice_58_51_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_13' id='label_58_51_13' class='gform-field-label gform-field-label--type-inline'>(l) there is, or has been, a natural disaster<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.14' type='checkbox'  value='(m) an unexpected event or unforeseen change has reduced your income'  id='choice_58_51_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_14' id='label_58_51_14' class='gform-field-label gform-field-label--type-inline'>(m) an unexpected event or unforeseen change has reduced your income<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.15' type='checkbox'  value='(n) an unexpected event or unforeseen change has increased your expenditure'  id='choice_58_51_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_15' id='label_58_51_15' class='gform-field-label gform-field-label--type-inline'>(n) an unexpected event or unforeseen change has increased your expenditure<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_51_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.16' type='checkbox'  value='(o) there is some other reasonable cause'  id='choice_58_51_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_51_16' id='label_58_51_16' class='gform-field-label gform-field-label--type-inline'>(o) there is some other reasonable cause<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_58_52\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_52\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Section 5<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_52'>Section 5<br>You believe that you will be able to pay if we agree: (select at least one option)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_58_52'><li class='gchoice gchoice_58_52_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.1' type='checkbox'  value='(a) to allow you more time to pay a bill'  id='choice_58_52_1'   aria-describedby=\"gfield_description_58_52\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_58_52_1' id='label_58_52_1' class='gform-field-label gform-field-label--type-inline'>(a) to allow you more time to pay a bill<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_52_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.2' type='checkbox'  value='(b) to accept a payment plan tailored to your ability to pay'  id='choice_58_52_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_52_2' id='label_58_52_2' class='gform-field-label gform-field-label--type-inline'>(b) to accept a payment plan tailored to your ability to pay<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_52_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.3' type='checkbox'  value='(c) to put controls on you incurring charges e.g. spend controls'  id='choice_58_52_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_52_3' id='label_58_52_3' class='gform-field-label gform-field-label--type-inline'>(c) to put controls on you incurring charges e.g. spend controls<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_52_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.4' type='checkbox'  value='(d) to put restrictions on your service'  id='choice_58_52_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_52_4' id='label_58_52_4' class='gform-field-label gform-field-label--type-inline'>(d) to put restrictions on your service<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_52_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.5' type='checkbox'  value='(e) to remove non-essential service features, without any cost penalty to you'  id='choice_58_52_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_52_5' id='label_58_52_5' class='gform-field-label gform-field-label--type-inline'>(e) to remove non-essential service features, without any cost penalty to you<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_52_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.6' type='checkbox'  value='(f) to transfer you to a different product that better suits your circumstances'  id='choice_58_52_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_52_6' id='label_58_52_6' class='gform-field-label gform-field-label--type-inline'>(f) to transfer you to a different product that better suits your circumstances<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_52_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.7' type='checkbox'  value='(g) to adjust internal threshold limits so that you are not disconnected'  id='choice_58_52_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_52_7' id='label_58_52_7' class='gform-field-label gform-field-label--type-inline'>(g) to adjust internal threshold limits so that you are not disconnected<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_58_53\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_53\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Section 6<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_53'>Section 6<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_58_53'><li class='gchoice gchoice_58_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='You wish to access one or more of the assistance options you have ticked above.'  id='choice_58_53_1'   aria-describedby=\"gfield_description_58_53\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_58_53_1' id='label_58_53_1' class='gform-field-label gform-field-label--type-inline'>You wish to access one or more of the assistance options you have ticked above.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_58_54\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_58_54\"><h2 class=\"gsection_title\"><\/h2><div class='gsection_description' id='gfield_description_58_54'><h4><span style=\"color: #00b26b;\">Part 3: What financial hardship assistance do you request?<\/span><\/h4><\/div><\/li><li id=\"field_58_71\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_58_71\"><p><strong>What we can do to help you get your telco contract payments up to date;<\/strong><\/p>\n<p><strong>What you can do to get them up to date;<\/strong><\/p>\n<p><strong>For how long you feel you need help. <\/strong><\/p><br><\/li><li id=\"field_58_69\"  class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_69\"><label class='gfield_label gform-field-label' for='input_58_69' >I believe I am able to pay the following amount:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_69'>I believe I am able to pay the following amount:<\/div><div class='ginput_container ginput_container_number'><input name='input_69' id='input_58_69' type='text'    value='' class='large'    placeholder='Enter an amount here' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_58_69\" \/><\/div><\/li><li id=\"field_58_72\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_72\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >I believe I can pay this amount every:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_72'>I believe I can pay this amount every:<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_58_72'><li class='gchoice gchoice_58_72_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.1' type='checkbox'  value='Week'  id='choice_58_72_1'   aria-describedby=\"gfield_description_58_72\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_58_72_1' id='label_58_72_1' class='gform-field-label gform-field-label--type-inline'>Week<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_72_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.2' type='checkbox'  value='Fortnight'  id='choice_58_72_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_72_2' id='label_58_72_2' class='gform-field-label gform-field-label--type-inline'>Fortnight<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_58_72_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.3' type='checkbox'  value='Month'  id='choice_58_72_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_58_72_3' id='label_58_72_3' class='gform-field-label gform-field-label--type-inline'>Month<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_58_70\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_70\"><label class='gfield_label gform-field-label' for='input_58_70' >I believe I can pay this amount from the following date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_58_70'>I believe I can pay this amount from the following date:<\/div><div class='ginput_container ginput_container_date'>\n                            <input name='input_70' id='input_58_70' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='Choose a date from today onwards' aria-describedby=\"input_58_70_date_format gfield_description_58_70\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_58_70_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_58_70' class='gform_hidden' value='https:\/\/www.letsbemates.com.au\/mate\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_58_57\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_58_57\"><h2 class=\"gsection_title\"><\/h2><div class='gsection_description' id='gfield_description_58_57'><h4><span style=\"color: #00b26b;\">Part 4:  Special instructions \u2013 sensitive circumstances<\/span><\/h4><\/div><\/li><li id=\"field_58_58\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_58_58\"><label class='gfield_label gform-field-label' for='input_58_58' >Special instructions Summary<\/label><div class='gfield_description' id='gfield_description_58_58'><p>Your financial hardship situation might arise from domestic or family violence, an illness or other sensitive circumstances. Perhaps that means you can&rsquo;t easily take phone calls, but you can call us back if we text you. Or perhaps it&rsquo;s best that we email you. <strong>If there&rsquo;s anything that you want us to know in order to deal with your application safely and sensitively, please let us know below.<\/strong><\/p>\n<p>(This is optional, but this information may help us to help you more safely and sensitively.)<\/p><\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_58' id='input_58_58' class='textarea large'  aria-describedby=\"gfield_description_58_58\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_58_65\"  class=\"gfield gfield--type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_58_65\"><label class='gfield_label gform-field-label' for='input_58_65' >CAPTCHA<\/label><div id='input_58_65' class='ginput_container ginput_recaptcha' data-sitekey='6Le7CdcZAAAAAPY4jMCO2nQR_vq3CgmIYz0le-3M'  data-theme='light' 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