| * mandatory
|
|
| Title |
|
| First Name *
|
|
| Last Name * |
|
| Birth Date * |
|
| Drivers
licence number |
|
| Drivers
licence expiry date |
|
| |
|
| Gender * |
|
| Marital Status * |
|
| Mother's
maiden name
* |
|
| |
|
| Address |
|
| Street Number * |
|
| Street Name * |
|
| Suburb * |
|
| Postcode * |
|
| |
|
| Email Address * |
|
| Daytime Phone Number * |
|
| Mobile Number |
|
| Home Phone Number |
|
| Work Phone Number |
|
| |
|
| How Long have you been at your
address? * |
years/months |
| Approximate
value of the property |
|
| How much is
owing on the property |
|
| Who is your
current lender |
|
| |
|
| Occupation?
* |
|
| Employment
Status * |
|
| Time with
Current Employer? * |
|
| Net Income per week * |
|
| Credit
Rating: * |
|
| Amount you
wish to borrow? * |
|
| Purpose of
your loan? |
|
| |
|
WHAT YOU OWN (ASSETS)
Bank Accounts
(whole $, no commas) |
|
$
|
|
$
|
|
$
|
|
$
|
|
$
|
| Other Assets, Investments &
other Property
(whole $, no commas) |
|
$
|
|
$
|
|
$
|
|
$
|
|
$
|
| Total Assets |
|
|
$
|
| |
|
WHAT YOU OWE
(LIABILITIES)
Real estate mortgages and equity
loans (whole $, no commas) |
|
$
|
|
$
|
|
$
|
|
$
|
|
$
|
|
Car loans, credit cards, store cards, personal
loans & other debt |
|
$
|
|
$
|
|
$
|
|
$
|
|
$
|
| Other Liabilities
(whole $, no commas) |
|
|
$
|
|
$
|
|
$
|
|
$
|
|
$
|
| Total Liabilities |
|
|
$
|
| |
|
| CALCULATE NET WORTH |
(Total Assets - Total Liabilties) |
$
|
| |
|
| Would you
like to receive our e-Newsletter? |
Yes No
|
Where did you hear about us? *
(You may select more than one option. If you
did hear about us through our newsagency program, please
let us know which newsagency in the Comments field).
|
|
Comments
(Provision of more information relating to
your personal circumstances will speed up the process
and increase the likelihood of you gaining approval.
Please include details of any loans you may have repaid
in the past ). |
|
| |
|
| *
mandatory fields |
|
