foxtel

Financial Hardship Application

Personal Details
Furr Name
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Foxter Account Number A-8 PS O 1 X

Any Frevious Foxtel Account Number(s)

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Address &D
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Work Telephone

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The space below is provided for you to detail the circumstances of your case and provide reasons why you consider you are unable
to meet the current terms of your Foxtel account, including any documentation to evidence these circumstances.

If you are eligible under our Financial Hardship policy, we will work with you to come to an alternative arrangement in relation to the
payment of your bill. Please provide us with information on what alternative arrangements you believe would assist you, using the
New Terms section below. lf you need assistance call us on 151 999 Monday to Friday 9am-7pm.

Details of Claim
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Print Name
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Date
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Please email completed form to hArdgbip(Qfoxtel,sqm.au.