Loan Claim Form


Section 1 of 3

Applicant details




Include spaces, e.g: 12 312 312 312

Numbers only, beginning with 2 (e.g. 2545678)





Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
You can add multiple invoices by answering "Yes" to the queston Would you like to add an additional invoice? at the bottom of the page.
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less


Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
You can add multiple invoices by answering "Yes" to the queston Would you like to add an additional invoice? at the bottom of the page.

If you do not have an additional invoice to add, please return to the previous page and select “No” to the question Would you like to add an additional invoice?
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less


Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
You can add multiple invoices by answering "Yes" to the queston Would you like to add an additional invoice? at the bottom of the page.

If you do not have an additional invoice to add, please return to the previous page and select “No” to the question Would you like to add an additional invoice?
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less


Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
You can add multiple invoices by answering "Yes" to the queston Would you like to add an additional invoice? at the bottom of the page.

If you do not have an additional invoice to add, please return to the previous page and select “No” to the question Would you like to add an additional invoice?
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less


Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
You can add multiple invoices by answering "Yes" to the queston Would you like to add an additional invoice? at the bottom of the page.

If you do not have an additional invoice to add, please return to the previous page and select “No” to the question Would you like to add an additional invoice?
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less


Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
You can add multiple invoices by answering "Yes" to the queston Would you like to add an additional invoice? at the bottom of the page.

If you do not have an additional invoice to add, please return to the previous page and select “No” to the question Would you like to add an additional invoice?
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less


Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
You can add multiple invoices by answering "Yes" to the queston Would you like to add an additional invoice? at the bottom of the page.

If you do not have an additional invoice to add, please return to the previous page and select “No” to the question Would you like to add an additional invoice?
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less


Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
You can add multiple invoices by answering "Yes" to the queston Would you like to add an additional invoice? at the bottom of the page.

If you do not have an additional invoice to add, please return to the previous page and select “No” to the question Would you like to add an additional invoice?
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less


Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
You can add multiple invoices by answering "Yes" to the queston Would you like to add an additional invoice? at the bottom of the page.

If you do not have an additional invoice to add, please return to the previous page and select “No” to the question Would you like to add an additional invoice?
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less


Section 2 of 3

Please note: Claims are paid exclusive of GST. Please take this into account when submitting a claim request.
If you do not have an additional invoice to add, please return to the previous page and select “No” to the question Would you like to add an additional invoice?
Invoice

$


Please ensure file sizes are 2.5MB or less




Include spaces, e.g: 12 312 312 312









Please upload proof of payment documents here. Proof of payment can consist of receipts, bank statements, internet banking payment receipts, etc.

Please ensure file sizes are 2.5MB or less

Please Note: You can upload a maximum of 10 invoices in this submission. If you need to upload more than 10 invoices, please complete and submit this form first, then start a new submission to upload additional invoices.


Section 2 of 3

Supporting documentation
Please upload any other relevant documentation/information

Please ensure file sizes are 2.5MB or less

Step 3 of 3

You are no longer able to update your bank account details via this form. If you would like to update your bank account for payments please contact the RAA by calling 1800 678 593 or email rural.assist@raa.nsw.gov.au.
General Statement & Privacy
General Statement *
Any person who knowingly and with intent to defraud the NSW Rural Assistance Authority (‘the Authority) or another person, files a claim request for assistance containing any materially false information or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent act, which is a crime under the Crimes Act 1900 and subjects the person to criminal penalties.

Privacy Collection Notice *
The information in this claim request is provided voluntarily and is being collected by the NSW Rural Assistance Authority (‘the Authority) for purposes related to the administration of the scheme of assistance under which you have applied, including the assessment of the effectiveness of the scheme. This may involve disclosing the information in this claim request to a third party engaged by the Authority or to either State or Commonwealth government agencies. The Authority will supply you with details of those parties that the Authority has disclosed information to if you apply to the Authority in writing. Information regarding this claim request may also be discussed and exchanged by the Authority with the authorised nominated contact persons listed by you as part of your application.

The Authority agrees to take all reasonable measures to ensure that the personal information collected by the Authority is stored securely.

You may access or correct your personal information by contacting the Authority by telephone on 1800 678 593 (toll free) or by writing to: Manager Administration, NSW Rural Assistance Authority, Locked Bag 23, ORANGE, NSW, 2800. Calls to "1800" numbers from your home phone are free. Calls from public phones and mobiles may be timed and attract charges.

   
Thank you for your claim.
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