If you are facing hardship and will struggle to pay your last rates instalment by 20 May, you can apply for the late fees to be waived via this form.

Ratepayer’s Name *

Ratepayer’s Contact Phone Number *

Ratepayer’s Email Address *

Property Number/s * This is listed on the rates invoice.

Property Address/es *

Instalment Number *

-- Please Select --Installment 1, 20th AugustInstallment 2, 20th NovemberInstallment 3, 20th FebruaryInstallment 4, 20th May

Rating Year *

-- Please Select --2019/20202020/20212021/20222022/20232023/20242024/20252025/2026

Reason for late payment *

-- Please Select --Significant Family DisruptionDeathIllnessAccidentGenuine MistakeFinancial Hardship

Explanation of the reason listed above

I am aware that I will be required to enter into a payment plan for the rates due for the penalty to be remitted and will be contacted by Ashburton District Council staff to have this payment plan set up *

• Yes