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(or to amend existing) (Services Australia)

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The (or to amend existing) (Services Australia) form is 3 pages long and contains:

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  • 108 other fields

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Services Australia, (previously DHS - Department of Human Services) is responsible for delivering services relating to health and welfare of Australian citizens. It processes payment of child support other services.

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FER002
Application for Time to Pay Order (or to amend existing) Page 1 of 3
Application for Time to Pay Order
(or to amend existing)
Fines, Penalties and Infringement Notices
Enforcement Act 1994 ss 21B, 21D and 32C, 34
Post:
GPO Box X2293 PERTH WA 6847
Phone: 1300 650 235 (from landlines) or
(08) 9235 0235 (from mobiles)
Fax: (08) 9425 7070
Email: ferttp@justice.wa.gov.au
Important: This is an application only and you should not begin driving until you receive written
confirmation from the Registrar that your application has been approved and your licence suspension has
been lifted. You may also be subject to other restrictions on your licence and are advised to check the status
of your licence with the Department of Transport.
To view your infringement(s) and/or court fine(s), make a payment, apply for an order or for more information
visit
www.justice.wa.gov.au/fer.
Means test over the page must be completed
Your details
Full name:
Address:
Suburb:
Postcode:
State:
Date of birth:
Phone:
Email:
Driver’s licence no:
Vehicle licence no:
Case details
Add all my fines
Total amount (if known):
$
If you have a fine/infringement that you don’t want added, list the case number/s:
NB: Any new fines/infringements registered with the Fines Enforcement Registry cannot
be automatically included in this order. If you wish to include newly registered matters
you will need to contact the Registry or complete a new application.
Previous
Time to Pay
Order
Was your last Time to Pay Order cancelled due to non-payment?
Yes (you need to contact FER)
No
Never had a Time to Pay Order
Registry use
only
FER Officer:
Upfront Payment
Amount to be paid (in full) prior to processing: $ _____________
Offer of
payment
and
undertaking
by applicant
• Pay the total amount due of
$
on or before
___/____/ 20___; or
• By instalments of
$
per fortnight
month
Payments start on
___/____/ 20___
until the amount outstanding is paid in full.
Note: The Registrar may require further information in support of the amount offered.
If a Time to Pay Order is made I understand:
• that this Time to Pay Order does not lift any suspension, disqualification or cancellation
given to me by a Magistrate or Justice of the Peace;
• that if I want to make any changes to my Time to Pay Order, I must contact the Fines
Enforcement Registry;
• if I get new fines/infringements that are with the Fines Enforcement Registry I must
contact the Registry to have them added to this Time to Pay Order;
• that if I do not pay the agreed amounts on the due date:
1. My driver’s and/or any vehicle licences may be suspended;
2. I may incur additional fees on my fines/infringements;
3.
Further action may occur to recover the amount outstanding.
Signature of
Applicant
Date:
Application for Time to Pay Order (or to amend existing) Page 2 of 3
FER002
Means Test
My employment details
I am employed/unemployed
Name of employer
Nature of employment
My fortnightly income and expenditure is as follows (whole $ only)
Income
Expenditure
Wages
$
Mortgage/rent/board
$
Centrelink
$
Child support
$
Rent assistance
$
Credit cards
$
Family tax A & B
$
Loans/Credit Corp
$
Investments
$
Centrelink debt
$
Rental income
$
Court order/fines
$
Zipay/Afterpay
$
Food
$
Utilities (electricity/gas/water)
$
Rates
$
Insurance
$
Medical expenses
$
Internet
$
Mobile/phone
$
Vehicle running costs
$
Public transport
$
Streaming services
$
Cigarettes/alcohol
$
Entertainment
$
Clothes/hair/beauty
$
Gym
$
Incidentals
$
Other
$
Total
$
Total
$
Money in the bank and investment in shares (whole $ only)
Institution(s):
$
$
$
Value of share portfolio
$
Total
$
Application for Time to Pay Order (or to amend existing) Page 3 of 3
FER002
Liabilities
(whole $ only)
Institution
Amount
owed
Mortgage
$
Credit card
$
Personal Loan(s)
$
Other
$
Other
$
Total
$
Assets
Total value
House / unit / other real property
Address:
$
Address:
$
Motor vehicle (car, utility, motor cycle, truck, trailer, caravan)
Make and model:
Reg no:
$
Make and model:
Reg no:
$
Make and model:
Reg no:
$
Recreational vehicle (boat, jet ski, bikes etc)
Make and model:
Reg no:
$
Make and model:
Reg no:
$
Make and model:
Reg no:
$
Home contents
Items including furniture, electronics, white goods, tools and collectibles
$
Total
$
Declaration
I declare that:
(a) to my knowledge, the information I have provided is true and correct
(b) to my knowledge, I have provided all relevant information
(c) I am aware that it is an offence to provide false and misleading information
(d) I am aware it is an offence to omit to provide information without which this means test is
misleading in a material particular.
Name
Signature
Date
Personal details provided on this form are essential for the Fines Enforcement Registry to conduct business
transactions on your behalf. Where relevant, details may be provided to third party agencies linked to your
fines and/or infringements enabling payments and/or services to reflect your request.
To view your infringement(s) and/or court fine(s), make a payment, apply for an order or for more
information visit www.justice.wa.gov.au/fer
.
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(or to amend existing) (Services Australia)

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Completed 13 April 2022

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