Home/Get support/Ask or apply for help/Economic harm support form Economic harm support Our economic harm specialists can provide support with the financial challenges family violence. Economic harm support Please enter your details below if you would like to reach out to our Family Violence Economic Harm Specialist via our contact form. Step 1 of 2 50% Name* First Last Date of birth* Day Month Year Gender*FemaleMaleGender diversePrefer not to sayEmail* Phone*Is it safe for us to call you?* Yes No Where in New Zealand are you based?*Select optionAucklandBay of PlentyCanterburyGisborneHawke's BayManawatu-WhanganuiMarlboroughNelsonNorthlandOtagoSouthlandTaranakiTasmanWaikatoWellingtonWest CoastAre you completing this on behalf of a client?* Yes No Name of organisation*Your name*Your phone number*Your email address* Please tell us a little bit about your situation Do you have debts that you feel are unjust e.g. you were coerced to get / are not yours / are joint but you are the only one paying/ or you are not benefitting from?* Yes No Are any of these debts with a bank?* Yes No Are the financial challenges related to a mortgage?* Yes No Do you have debt with work and income you want to address?* Yes No Note: We may not be able to assist with government debt.Additional information you would like to share:Please tell us a little bit about youThis helps us ensure different groups within New Zealand are hearing about our services. Ethnicity Māori New Zealand European Other European Samoan Cook Islands Māori Tongan Niuean Tokelauan Fijian Other Pacific Peoples Southeast Asian Chinese Indian Other Asian Middle Eastern Latin American African Other Prefer not to say Please specify*How did you hear about our service?Select optionSocial mediaOur websiteFriend or familySearching onlineThrough another organisationThe newsOtherPlease specify*Please specify* If you need assistance with your day-to-day finances, please contact your local financial mentor for assistance via https://www.moneytalks.co.nz/. We can work with you and your financial mentor when we pick up your enquiry. NameThis field is for validation purposes and should be left unchanged.