What is the financial hardship request form template?
Asking for help with payments is rarely easy, and a confusing form or a cold phone call can make it harder still. This financial hardship request template gives customers a calm, structured way to explain what's happened, share a rough picture of their income and outgoings, and say what kind of arrangement — lower payments, a short pause, or something else — would actually help.
An online form works well here because it lets someone take their time and gather documents like a redundancy letter without doing it under pressure on the phone. Conditional logic adjusts to the arrangement being requested — a proposed amount for reduced payments, months for a pause, or a figure for a settlement — so the customer isn't faced with irrelevant questions.
Every submission is saved as a PDF in your FileIt vault the moment it's sent, giving your team a private, complete record of the request and any supporting documents, ready to review without anyone needing to repeat their story.
- Best for
- Lenders, utilities, landlords or any business offering payment support
- Filled in by
- A customer, account holder or tenant experiencing financial difficulty
- Time to complete
- About 8–10 minutes
- Includes
- Conditional arrangement questions, supporting document upload, signature
Who uses a financial hardship request form?
- A utility customer asks for reduced monthly payments after losing their job
- A landlord's tenant requests a short payment pause after an unexpected medical bill
- A lender's customer proposes a one-off settlement figure to close an account
- A gym or subscription business offers a formal channel for members going through hardship
- A local authority collects requests for council tax or rent payment plans
- A finance team standardises how hardship requests arrive instead of fielding one-off phone calls
Questions on this financial hardship request form
27 questions over 5 pages · includes signature, file upload, conditional questions, multiple pages, consent checkbox.
1 About you
- Your name*
- Email*
- Phone*
- Account or reference number*
- Address
2 Your situation
- What has affected your ability to pay?* Job loss or redundancy · Reduced hours or income · Illness, injury or disability · Bereavement · Relationship breakdown · Caring responsibilities · Business downturn · Natural disaster or emergency · Unexpected large expense
- Tell us about your situation*
- How long do you expect this to last?* Less than 3 months · 3–12 months · More than a year · I'm not sure yet
- When do you expect things to improve? asked only when it applies
- Are you getting help from a debt or money adviser?
- Adviser's name and organisation asked only when it applies
3 Income & outgoings
- People in your household
- Sources of income Wages or salary · Self-employment · Benefits or government support · Pension · Partner's income · No income at the moment
- Total monthly household income*
- Total monthly essential outgoings*
- Do you have other debts or arrears?
- Other debts and what you pay each month asked only when it applies
4 What would help
- What kind of arrangement would help?* Lower payments for a while · A short payment break · Spread what I owe over longer · Stop interest or late fees · A one-off settlement · I'm not sure — please suggest
- What could you afford to pay?* asked only when it applies
- How often?* asked only when it applies Weekly · Every two weeks · Monthly
- How many months' break are you asking for?* asked only when it applies
- Settlement amount you can offer* asked only when it applies
- How should we contact you about this? Email · Phone · Letter
- Is there anything that would make it easier to deal with us?
- Supporting documents (optional)
5 Declaration
- Declaration*
- Signature
The financial hardship request form, page by page
1 About you
The customer gives their Name, Email, Phone, Account or reference number and an optional Address — the essentials needed to match the request to their account before anything else is discussed.
2 Your situation
A checklist covers What has affected your ability to pay — job loss, reduced hours, illness, bereavement, relationship breakdown, caring responsibilities, business downturn, a disaster, or an unexpected expense — followed by an open Tell us about your situation box. How long do you expect this to last shapes the arrangement, and answering anything but 'more than a year' reveals an optional date for when things might improve. A yes/no on getting help from a debt adviser reveals a field for their name and organisation.
3 Income & outgoings
Rough figures are enough here: People in your household, a checklist of Sources of income (wages, self-employment, benefits, pension, a partner's income, or none), and Total monthly household income against Total monthly essential outgoings. A yes/no question about other debts or arrears reveals a box to list them and what's paid on each every month, giving a fuller picture of the household's overall position.
4 What would help
The customer chooses What kind of arrangement would help — lower payments for a while, a short payment break, spreading what's owed over longer, stopping interest or late fees, a one-off settlement, or 'not sure, please suggest.' Each choice reveals only the relevant follow-up, such as a proposed amount for reduced payments or a settlement figure. A contact preference, an optional note on what would make it easier to deal with the business, and an optional upload for supporting documents complete the page.
5 Declaration
A closing declaration confirms the information given is true and complete, and makes clear that submitting the request doesn't by itself change what's owed or when payments are due until an arrangement is agreed in writing — an important, honest line for both sides. A signature is optional here, since some businesses prefer to confirm any agreement separately in writing.
Make the template yours
- Adjust the list of reasons and arrangement types to match the kinds of support your business actually offers
- Add your own signposting to free debt advice services in the confirmation message
- Set the vault folder so hardship requests are only visible to the specific team that handles them
- Add a field for the amount currently owed or in arrears if that's useful context for your team
- Turn on notification to a shared inbox so requests are picked up quickly regardless of who's on shift
- Consider making the signature required if your process needs a signed request before offering a plan
Tips for a better financial hardship request form
- Reassure people early — in your own message around the form — that reaching out won't automatically affect their account before an arrangement is agreed
- Only ask for supporting documents you'll actually use; requiring too much evidence can put people off asking for help at all
- Respond promptly — financial stress is already difficult, and a quick reply matters more here than almost any other form
- This form and any resulting arrangement are not financial, legal or tax advice — encourage customers dealing with wider debt problems to also speak to an independent money adviser
- Keep the tone throughout respectful and non-judgemental; the wording on this template is a starting point you should adapt to your own brand voice
Every response becomes a PDF in your vault
As soon as a customer submits their request, FileIt turns the whole thing — including any uploaded documents — into a PDF and files it in the vault folder you've set up, with an immediate email notification to your team so nothing sits unseen during an already stressful time for the customer.
From there, most businesses review the request in the Responses table and follow up using the customer's stated contact preference to agree a plan. Because the original submission is kept as a PDF, there's a clear record of exactly what was asked for, useful if the arrangement is ever questioned later.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Financial hardship request form: frequently asked questions
Is this financial hardship request form template free?
Yes — it's included in the Forms app on every FileIt account, including the free plan, and every question can be edited to fit your business.
Does a customer need a FileIt account to submit a hardship request?
No. They can fill it in and submit from a shared link or an emailed invitation without ever creating a FileIt account.
How do we get hardship requests as PDFs?
Every submission, including any uploaded documents, is automatically saved as a PDF in the vault folder you choose for this form.
Does submitting this form change what a customer owes right away?
No — the declaration makes clear that sending the request doesn't by itself change payment terms until an arrangement is agreed in writing, which the form's wording is careful to explain.
Is this form legal or financial advice for the customer?
No. It only collects information so your business can consider a payment arrangement; customers with wider debt concerns should also be pointed towards independent money advice.
Can customers attach evidence like a redundancy letter or medical note?
Yes, there's an optional file upload for supporting documents, accepting PDFs, images, Word and Excel files.
Can we require a signature before considering a request?
The signature field is optional by default, but you can make it required in the designer if your process needs a signed request.