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Application details |
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| Amount you would like remitted* |
Invalid Input |
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| Instalment number* |
Invalid Input |
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| Assessment number* |
Invalid Input |
This is available on your rates invoice |
| Reason you are requesting a penalty waiver:* |
Invalid Input |
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Applicant's details |
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| First name* |
Invalid Input |
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| Middle name* |
Invalid Input |
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| Surname* |
Invalid Input |
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| Phone number* |
Invalid Input |
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| Email* |
Invalid Input |
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| Property address* |
Invalid Input |
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| Postal address (if different from above) |
Invalid Input |
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| Please tick the box:* |
Invalid Input |
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