Application for Financial Hardship

Important - please read.

If your application relates to loss of income as a result of COVID-19, please click here.

You will require your financial information to complete this form. To protect your privacy you must complete this form in one session, if you make no entries for more than 20 minutes the form will close and your data will be deleted.

To make the process easier, we suggest you print the form and manually complete it as you gather the information. You can then enter the data in one session. Much of this information will be available through your online banking.

Please Note: The recommended browsers for completing this form are Chrome and Safari and it may not work as expected on other browsers.

If you do not have access to Chrome and Safari please download the form then return the completed form via email, post or through any Westpac New Zealand Branch.

There are three sections to fill out: 

  1. Personal information
  2. Income and assets
  3. Expenses and liabilities

Date of birth

Please do not use spaces or brackets


Separate each with a comma (,)

Select if this is a joint application
Does the joint applicant live at the same address provided above?

What is your reason for applying?

(max 2,000 characters)

Please complete the following sections to help us to assess your financial circumstances and what assistance we may be able to provide. Missing information may delay our response and decision.


Joint applicant income


Property Owned by Applicant(s)

Motor vehicle(s)

Investments or Savings

Superannuation and KiwiSaver


Accommodation (Rent/Board)



Child care

Child support





Medical costs

Non-Westpac Liabilities

Credit card

Credit card

Personal loans and Overdraft

Personal loans and Overdraft

Hire purchase

Hire purchase

Store card

Store card

Any other regular payments or commitments?

We appreciate this is a difficult time and it’s important for us to reach you as soon as possible to discuss your application further so please check your contact details are correct before you submit.