Application for Crisis Payment - Extreme Circumstances and Domestic or Family Violence

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This form is used to apply for a crisis payment by pensioners forced to leave their home due to extreme circumstances, or victims of domestic/family violence who remain in the home after the perpetrator has left or been removed.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

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