Hardship Program Application Form

Overview:

Downer may be able to provide financial assistance to those who are experiencing serious financial hardship through the
Hardship Program. An applicant is considered to be in serious financial hardship when they are unable to afford the following
for themselves, their family or other dependants.

 Food
 Accommodation (including rental payments or mortgage repayments)
 Clothing
 Medical expenses (such medical treatment or medications)
 Education
 Other basic necessities (such as utilities bills)

Eligibility considerations:

 Employee must have completed at least 6 months service with the Downer Group
 Employee must be permanent (full time or part time)
 Employee must be currently stood down
 Employee must have exhausted all leave balances before accessing the hardship program
 Any other supporting information provided in support of the application

Please complete this form and return to corporatehrservices@downergroup.com. All applications will be treated as
confidential and will be reviewed for approval by the Hardship Program Assessment Committee.

Employee Details:

Please complete the mandatory employee details below:

Name: Krishna K C

Contact Phone number: 0416764699

Email address: Kkc.krishna99@gmail.com

Company (Downer / Spotless) Downer ☐ Spotless ☒

Business Unit:

Employment Type: Full Time ☒ Part Time ☐

Length of Service:1 6 months

Total Remuneration Package:

Employee Number 60104475

Employment Status:2 Employed ☐ Stood Down ☒ Not Rostered ☐

Leave Balance3: 16.96 hrs

1 Note: to be eligible to apply for assistance under the Hardship Program, Applicant’s must have completed at least 6 months service with the Downer Group
2 In order to qualify for the program an employee must be currently stood down
3 An employee must have exhausted all leave balances before accessing the hardship program

Private and Confidential

Description of financial hardship:

Please provide a short summary of the financial assistance you are seeking, and the circumstances that have contributed to it:

Applicant to seek own financial advice

The receipt of assistance under the Hardship Program may be relevant to, or affect, your eligibility for Government Assistance.

It is strongly recommended that you seek your own financial advice regarding the impact on you (and your family) of receiving
assistance under the Hardship Program before submitting your application.

Private and Confidential

Privacy statement

By submitting this form and any supporting documents or information, you acknowledge that they may disclose personal
information or sensitive information. By providing your personal information, you consent to Downer using, disclosing, storing
and otherwise handling that personal information for the purposes of assessing your Application under the Hardship Program in
accordance with the Downer Group Privacy Policy.

By providing Downer with the personal information of a third party, for example the personal details of a spouse, you confirm
that you have obtained the consent of that individual to:

 your disclosure of the individual's personal information to Downer; and

 Downer handling that personal information in accordance with the Downer Group Privacy Policy.

A copy of the Downer Group Privacy Policy is available on the Downer Group Intranet.

Authority to proceed

I…Krishna K C……hereby declare that to the best of my knowledge that all preceding information is correct.

Print name: ……Krishna K C………………………………………… Date…………2020/05/08…………………….

Signature: ……………………………………………………...

Submission

Please submit completed form to:

Attention: Hardship Program

Email: corporatehrservices@downergroup.com

Office Use only:

Application: Supported ☐ Not supported☐

Reasons:

Private and Confidential