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Your details

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Invalid entry. Mobile number must be 10 digits long and start with '04'.

Alternative contact number if your Telstra service disconnected.

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Invalid entry. Email must be in the format of 'user@example.com'.

Please enter date in dd/mm/yyyy
Please type in your reason if it does not match any of those listed below.

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  • Change in financial circumstances
  • Loss of employment

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Please enter your expenses in $

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Please enter your total in $

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