Alternative Payment Options » Shire of Exmouth, WA

Alternative Payment Arrangement Application for Owner Occupier

Download Example 'Proposed Payment Plan'

If you are an owner-occupier within the Shire of Exmouth and are unable to pay your rates in full or as per the instalment option offered on your rates notice, please submit this form and supporting documents to request an alternative payment arrangement.

Special arrangements must be confirmed in writing, stating the amount proposed to be paid, the commencement date, the frequency, and the method of payment.

Interest on rate payments in the 2024/25 financial year may be applied up to the date the payment plan is in place if an Alternative Payment Plan is entered after the due date on your rates notice.

Special arrangements must clear the outstanding balance by 30 June of the financial year the plan is entered.

Note: Seniors and pensioners do not need to submit this form, as they can defer rates without interest being charged.

First name*

Postal Address

Street Address :*

City:*

State:*

Post Code:*

Country:*

Residential Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Surname*

Mobile

Telephone

Email*

Assessment Number*

Property Address

Street Address:*

City:*

State:

Post Code:*

Country:

Reasoning*

Proposed Payment Plan (Please use the example plan provided)*

Max File Size: 10.00 MB
Allowed File Types: .doc, .docx, .pdf

It is hereby declared that:*

I/we are the owners and occupiers of the rated property
The property is not used for any accommodation/income producing purposes.
If this application is made on behalf of a Corporation, Company or Trustee I am the authorised officer/s
I am/we are not bankrupt or subject to a bankruptcy petition.
I/we will advise the Shire of Exmouth if there is any change to my/our financial circumstances.

Signature*

Welcome to the Shire of Exmouth

Alternative Payment Arrangement Application for Owner Occupier

General Office:

Address