This form is for use in the AAT’s General Division, Freedom of Information Division, Security Division, Small Business Taxation Division, Taxation & Commercial Division and Veterans’ Appeals Division to request a fee reduction on the basis that payment of a standard application fee has caused, or would cause, financial hardship to the applicant: section 21 of the Administrative Appeals Tribunal Regulation 2015.
You must complete items marked with an asterisk (*).
SECTION 1  CASE DETAILS	
AAT File Number
If known				
SECTION 2   PERSONAL DETAILS	
Full name	Mr     Mrs     Ms      Miss     Other:  	
	Family name:	
	Given name(s):	
		
Street address *		
		
		State:  	Postcode:	
Postal address
‘As above’ if also your street address		
		
	Suburb:	State:  	Postcode:	
		
Occupation *		
	
Name of employer 
If applicable		
Work address
If applicable		
		State:  	Postcode:	
	
Telephone *	Landline: (         )	Mobile: 	
Fax	(         )		
Email		
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Statement of Financial Position – Individual
In support of Request for Fee Reduction
(Administrative Appeals Tribunal Regulation 2015)

To make a decision on your request for a fee reduction, the Registrar needs information about your financial circumstances. Please answer ‘N/A’ (Not Applicable) if a question is not relevant to your circumstances.

WARNING
Under the Criminal Code, any person who knowingly makes an untrue representation or statement to obtain a benefit or advantage from the Commonwealth is guilty of an offence and, if found guilty, can be fined or imprisoned.	
SECTION A  DETAILS OF INCOME	
1. The details of my and my dependants’ (if any) income (including government pensions, benefits and allowances, workers' compensation, superannuation, rent, board, interest, dividends), calculated fortnightly, are as follows:
Note: 	if no other income, write "NIL" below:
Generally, dependants are persons who rely on you or on whom you rely for financial support and include spouse, de facto partner and children	
Nature of income	My amount per fortnight	My dependants’ amount per fortnight	
Fortnightly pay (after tax)	$	$	
Government pension, benefit or allowance (please specify)	$	$	
	$	$	
	$	$	
Workers’ compensation	$	$	
Superannuation received	$	$	
Interest on deposits/debentures	$	$	
Child support, spousal and child maintenance	$	$	
Other income (eg rent or board paid to you, share dividends)	$	$	
TOTAL:	$	$	
Please note you may be asked to provide documentary evidence to support your claim.	
	
2. The details for each of my dependants are as follows:	
Full name	Relationship to me	Age
(yrs)	

			

	
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3. I receive financial support or a financial contribution from family and others, calculated fortnightly, as follows: 
If no financial support or contribution write ‘NIL’ below.	
Name of person providing support	Nature of support	Value in $ per fortnight	

			
	TOTAL	$	
SECTION B   PROPERTY AND ASSETS	
"Property and assets" include land, houses, money in bank accounts and other investments, cars, boats, shares, moneys owed to you, interests in a deceased estate, or interests in a trust.  If any property or asset is owned jointly with someone other than a dependant, give the name of the other owner.	
4. My property and assets (other than bank accounts) are as follows: 
If no assets write ‘NIL’ below.	
		My details 
(my share/ interest)	My dependants’ details
(their share/interest)	
Liquid assets (other than bank accounts)	
A1 Cash (not in a bank account) 	$		
A2 Other investments (eg shares, debentures, bonds)	$		
A3 Money owed to you	$		
Subtotal – Liquid assets (A1 + A2 + A3)	$		
Non-liquid Assets	
B1 House / land	
	Market value	$			
	Amount of mortgage	$			
House/land net value (Market value – mortgage)			
B2 Motor vehicle	
	Market value	$			
	Amount owing on vehicle	$			
Net value motor vehicle (Market value – amount owing)	$		
B3 Value of household furniture & electrical goods	$		
B4 Other assets	$		
B5 Interest in a trust, business or partnership
	$		
Subtotal – Non-liquid assets (B1 + B2+ B3 + B4 + B5)	$		
TOTAL (A) + (B)	$		
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5. Money in bank, credit union, building society accounts and other financial institutions in my name or that of my dependants, or an account held jointly in my name, is as follows:	
Account Name and Number		Name of Bank	Amount in account	
		$	
		$	
		$	
TOTAL	$	
Please note you may be asked to provide documentary evidence to support your claim.	

	
SECTION C   EXPENSES	
6. My day-to-day living expenses (including living expenses of my dependants that are normally paid by me), calculated fortnightly, are as follows:	
	
Nature of expense	$ per fortnight 	Nature of expense	$ per fortnight	
Rent / board	$	Gas/electricity/other utilities	$	
Mortgage repayments	$	Telephone	$	
Other loan repayments	$	Health care	$	
Council / Water rates	$	Child care	$	
Insurance Premiums	$	Education	$	
Food	$	Other	$	
Clothing	$	Other	$	
Spouse / Child Maintenance	$	Other	$	
Travel and motor vehicle	$	Other	$	
TOTAL Column 1	$	TOTAL Column 2	$	
	
TOTAL Column 1 and Column 2	$	                                  per fortnight	
Please note you may be asked to provide documentary evidence to support your claim.	
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SECTION D   LIABILITIES	
7. My liabilities are as follows: 
‘Liabilities’ include outstanding mortgages, credit card debts and other moneys owed by you.  If any liabilities are owed jointly with someone other than a dependant, give the name of the other person.
If no liabilities write ‘NIL’ below.	
	My details	My dependants’ details	
Amount owing on my mortgage	$	$	
Amount owing on other loans	$	$	
Amount owing on credit card(s)	$	$	
Amount owing to any businesses or individuals
(please include details of each liability)
	$	$	
	$	$	
	$	$	
	$	$	
Other, please specify	$	$	
TOTAL	$	$	
	
Credit card(s) limit	$	$	
Please note you may be asked to provide documentary evidence to support your claim.	
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SECTION E   ADDITIONAL INFORMATION	
Please set out any other information concerning your financial position which you believe will help the Registrar decide your request for a fee reduction.	

	

	

	

	

	

	

	

	

	

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SECTION F   DECLARATION	
I declare that to the best of my knowledge and belief the information set out in this form is true and 
that, where any estimate is given, it is given in good faith. I can verify the information with original documents. 
	
Applicant’s signature	

	Date	dd   /    mm      /  yyyy	
	
WARNING
Any person who knowingly makes an untrue representation or statement to obtain a benefit or advantage from the Commonwealth is guilty of an offence and, if found guilty, can be fined or imprisoned.	
	
AAT USE ONLY	
DECISION ON REQUEST FOR FEE REDUCTION	

	I make an order under subsection 21(h) of the Administrative Appeals Tribunal Regulation 2015 that I consider the payment of the standard application fee would cause, or has caused, financial hardship to the applicant. This means that a reduced fee of $100 is payable instead of the standard application fee.

I do not make an order under subsection 21(h) of the Administrative Appeals Tribunal Regulation 2015. This means that the applicant must pay the standard application fee.

Reason for refusal: 

	
	
Signed	

	Date	dd   /    mm      /  yyyy	
	Registrar / Delegate			

AAT USE ONLY	
Notice of request for more information
Having considered your request, the AAT requests that you provide documentary evidence of your income, assets, liabilities and day-to-day living expenses to support your claim. In particular, you will need to provide the following:

	

	

	

	

	

	

	
The documents listed above must be provided within 14 days of the date on which this notice was issued.  You can provide the originals or photocopies to the AAT attached to the back of this document.
	
Signed	

	Date	dd   /    mm      /  yyyy	
	Signature of officer		Date issued	

WHAT WE DO WITH INFORMATION GIVEN TO US	
We collect information from you to process and consider your request under the Administrative Appeals Regulation 2015. 
The information that you give in this form will usually only be seen by AAT staff who are involved in processing your application.
We can order that information be kept confidential if we believe there is good reason to do so. You can apply for an order by writing to us stating what information you want kept confidential and why. 
Our Privacy Policy includes information about how you can access and seek correction of your personal information, make a complaint about the way we have handled your personal information and how we will deal with such a complaint. Our Privacy Policy is on our website or is available from your local AAT registry.
MORE INFORMATION ABOUT THE AAT
For more information about the AAT and how we conduct reviews go to our website or call us. Our staff can give you information about procedures but cannot give you legal advice.
How do i submit this form?	

You can send us your form by email, post, or fax, or deliver it to a registry.	

Email:	
generalreviews@aat.gov.au	

Post:	
AAT, GPO Box 9955, Your capital city (Northern Territory residents should write to Adelaide) or    
AAT, c/- Supreme Court of Norfolk Island Registry, Kingston, Norfolk Island 2899	

In person or by fax:	

Adelaide 
Level 2
1 King William St
ADELAIDE SA 5000	
Brisbane
Level 6
295 Ann St
BRISBANE QLD 4000	
Canberra
Level 8
14 Moore St
CANBERRA CITY ACT 2600	
Hobart
Edward Braddon Building
Commonwealth Law Courts
39–41 Davey St
HOBART TAS 7000	

Fax (08) 8128 8099	
Fax (07) 3052 3001	
Fax (02) 6243 4600	
Fax (02) 9276 5597	

Melbourne
Level 4
15 William St
MELBOURNE VIC 3000	
NORFOLK ISLAND
Supreme Court of Norfolk Island
KINGSTON 
Norfolk Island 2899	
Perth
Level 13
111 St Georges Terrace
PERTH WA 6000	
Sydney
Level 6
83 Clarence St
SYDNEY NSW 2000	

Fax (03) 9454 6998	
Tel +61 2 9391 2400
Fax +61 2 9283 4881	
Fax (08) 6222 7299	
Fax (02) 9276 5599	

If you want more information or assistance, call us on 1800 228 333 (calls are free from landline phones, however calls from mobiles may be charged). Residents of northern NSW (postcodes 2460–2490) will be connected to the Brisbane registry and residents of the Northern Territory will be connected to the Adelaide registry.
Non-English speakers can call the Translating and Interpreting Service on 131 450 and ask them to call the AAT.
If you are deaf or have a hearing or speech impairment, contact us through the National Relay Service. For more information visit www.relayservice.gov.au
Website: www.aat.gov.au	
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