Questionnaire

Please complete the following questionnaire and send it to us by email. This will put you in touch with us, help us to determine whether you are eligible for a debt agreement, and enable us to send you more information.

The information you provide will be absolutely confidential – you can complete it anonymously if you wish.
How would you like us to contact you?
Mail
Email
Phone
Who should we address the information to?
Your PO Box or mailing address

Your email address
Your phone number
Do you want us to call you?

Yes

No
Have you been bankrupt, used a debt agreement or given an authority under Part X of the Bankruptcy Act in the last 10 years?
Yes
No
Is your after tax income less than $56,306.00 per annum?
Yes
No
Are your credit card and other unsecured debts less than $75,075.00 in total?
Yes
No
Other than your household goods, superannuation and personal car, do you own property worth less in total than $75,075.00?
Yes
No
Detailed information and assistance on the next steps will be mailed to you, within 3 days, at a cost of $19.95 AUD.
Send your completed questionnaire here

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