Please select the Emergency Type.
Enter your ABN
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Do you have an Australian Business Number (ABN)?
Entity Name
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Select your Business Name
ABN Status
ABN Status Effective Date
Entity Type
Goods and Services (GST) From
ACN
Postcode
Address State
Please provide the date that your business was first impacted by this emergency event. *
From the date nominated to now, what do you estimate your loss of turnover to be (excluding GST)?
* Annual turnover is the total ordinary income that you derive in the income year in the course of running your business.
What do you estimate the damage to your property and stock to be (if not applicable, leave at $0.00)
Please provide a brief description of the damage to your property and stock (if not applicable, write N/A)
Is there any other information you would like to provide?
Are you insured?
Please provide details, e.g. yes for damage to property but not for loss of income
How many people work in your business (including yourself)?
How many people are now out of work as a result of the emergency event (including yourself)?
Business Name *
ABN
Business Address *
Unit number
Street number
Street name *
Street type
Suburb *
Postcode *
State *
Business Contact: First Name *
Business Contact: Last Name *
Business or other email (we will email you with any updates regarding support services) *
Confirm email address *
Contact Phone Number
Choose your Industry
Are you a small business (employ the equivalent of 19 full time employees or less)? *