Applying for Member Assistance

To apply for member assistance, please complete the form below.

Please fill out the fields below. All items marked with a * are required in order for the form to submit.

Part #1: Type of Assistance

Additional Information
Special Assistance - Payment being made under clause 9 of the WYMAC
Hardship - Food Voucher

Part #2: Personal Details


Part #3: Expenses Requested

Please provide details of the expenses requested.

If you have requested vouchers please enter 'vouchers' or 'food vouchers' in the Item field. Then specify in the field that displays. For example; Woolworths.

Part #4: Why Do You Need Help?

Click or drag files to this area to upload. You can upload up to 5 files.

Part 5: Declaration