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Please note that a small commission fee will apply for the process of this loan (included in the loan amount). This fee will only apply once the loan is settled. You will be advised of this upon completion of this form.

Loan Details

Loan Details
Debt Consolidation Motor Vehicle / Bike / Boat
Home Improvement Travel
Furniture Purchase Other
Loan Amount
 Loan Term
1 5
2 7
3 Years
If purchasing a Motor Vehicle / Bike / Boat, please provide the following information
Make Model Year Purchase Price $ Deposit $

Applicant Details

    Tick to Enable
  Applicant 1 Applicant 2
Title
Mr Miss
Mrs Ms
Mr Miss
Mrs Ms
First Name
Middle Name
Surname
Gender
Male Female
Male Female
Date Of Birth Select Date Select Date
Martial Status
Single Married
Divorced Widowed
Single Married
Divorced Widowed
Number Of Dependants
Drivers Lic #
Expiry Date Select Date Select Date
Address
Years At Address
Previous Address
(if current less than 2 years)
Years At Previous
Phone Home
Mobile
E-Mail
Employment Status
Full Time Part Time Casual
Student Self Employed Housewife
Unemployed Centerlink  
Full Time Part Time Casual
Student Self Employed Housewife
Unemployed Centerlink
Employer Name
Employment Address
Occupation
Years Employed
Contact Person
Position
Phone Work
Previous Employer
(if more than 2 years)
Nearest relative
not living with you
Relative Full Address
Relative Phone

Monthly Income Details

  Applicant 1 Applicant 2
Gross Salary
Combined Rental Income
Other Income
Total Income    

Assets & Liabilities

Type Value / Limit Payment Per Month Amount Owing Financier Owned by Refinance
Home / Rent Yes No N/A
Investment Property Yes No N/A
Savings  
Motor Vehicle Yes No N/A
Superannuation  
Personal Assets  
Personal Loans Yes No N/A
Credit Card One Yes No N/A
Credit Card Two Yes No N/A
Credit Card Three Yes No N/A
Other Yes No N/A
Total



   

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