FAM-1000

Payment Plan Application (FAM-1000)

IMPORTANT NOTES

Circumstances where a payment limit to a direct deposit agreement will assist families during periods of financial stress.
The limit must be at least the family’s portion plus an additional amount to ensure accrued debt is paid down over a nominated period.

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Form Submission Date

Centre(Required)

Primary Caregiver Name:(Required)

Email(Required)

Child 1 Name(Required)

Child 2 Name

Child 3 Name

Child 4 Name

Payment Plan Calculator

Current Statement Balance(Required)

Your current accrued debt

Please enter a number from 0 to 10000.

Payment Weeks

Enter your preferred number of payment weeks

Please enter a number from 1 to 30.

Projected Weekly Parent Gap Fee(Required)

Please enter a number from 0 to 10000.

Weekly Payment Amount

The Weekly Payment Amount = Projected Weekly Parent Gap Fee + Nominated Payment Plan Amount

Confirmation of Payment Plan Terms(Required)

I request the above limit to be applied to my account for the period stated in the nominated payment plan above. I agree that during this time any payments withdrawn from my bank account for childcare and related fees will not be dishonoured and understand that the centre may cancel care at any time should this occur. I agree to keep to this payment schedule and understand that failure to do so may likely result in cancellation of care. I also agree to alert the centre to any changes to my childcare benefit entitlements or anything else that may affect this limit.

Confirmation of Payment Plan Future Terms(Required)

I confirm that the amounts nominated in the Payment Plan Calculator are projections. I agree that any factor that changes the projections and affect debt levels over time, such as a change in childcare subsidy levels, planned fee increases and booking extra days are my responsibility to monitor and make extra payments accordingly.

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Office Use Only

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Scheduled Payment Ammended in the System(Required)

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Additional Information

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Sonas Centre Notification(Required)