Payment Plan or Extension to Pay Application Form

Required fields are marked with an asterisk (*).

Conditions

No arrangement will be put in place until this completed form has been received by Council.

This agreement is in reference to outstanding rates on the listed assessment/s (as per the amount/s shown below) at the time of submitting. All future quarterly payments remain payable as they fall due.

I/we agree to make regular payments as shown below; if I/we am/are unable to make the agreed payment at the scheduled time I/we will contact Alexandrina Council in writing advising of missed payment. Failure to advise of missed payments will be regarded as an automatic default.

I/we are aware that the balance of arrears will continue to accrue fines and interest levied under the Local Government Act 1999 which are also payable.

All payments received will be allocated in the following order: Legal charges, fines, interest, rates in arrears, as per section 183 of the Local Government Act 1999.

Failure to honour the agreed payment arrangement may result in further action or the resumption of legal action without further notice.

Contact Details

Ratepayer/s Full Name *

Postal Address *

Email Address *

Mobile Number

Payment Arrangement Details

Outstanding amount to pay *

Property ID/s *

Regular payments of

Frequency of Payment *

Weekly
Fortnightly
Monthly
1 Month Extension

Method of Payment

FlexiPay (Direct Debit)
Manual Payment (refer to your Rates Notice, e.g. BPAY)

Payment Start Date *

Day Month Year

Agreement * Your rates payment plan request will be reviewed by the rates team, and you will receive a confirmation if this has been approved. You will be required to pay the agreed amount from the payment start date you entered and at the frequency you selected. You will need to pay in full by 30 June. You are welcome to pay more than the repayment amount at any time during your Plan. I agree to the above payment plan/extension to pay and if I do not adhere to this agreement, I acknowledge that fines and interest will be incurred. It may also result in further action or the commencement of legal action without further notice.

I agree