Title:
First Name:  
Middle Name:  
Surname:  
Date of birth:  
Gender:
Marital Status:
Dependents:  
Email address:  
Drivers Licence no.: exp date:
Home No.:  
Mobile No.:  
Work No.:  
Address:  
Suburb: Post Code:
Moved in: Month Year
Postal Address:  
Address:  
Suburb: Post Code:
Residential Status:
If paying rent/board: $ per month
If you have lived in your current address for less than 3 years, what was your previous address:
Address:  
Suburb: Post Code:
Moved in: Month Year
Do you have good credit history:
Loan Term:
Employment Status:
   
   
B Loan Purpose Amount  
Purpose of loan:  
Loan Amount:  
Loan term:  
   
   
C. Employment Details:  
Job Occupation and Industry:  
Employment Status:  
Date commenced:  
Employer Name:  
Employer Address:  
Suburb: Post Code:  
Employer contact name:  
Employer contact number:  
Employer address must be as found in white pages and contact number must be landline.
Your contact work no.:  
   
   

D. Bank Details:

What bank accounts do you currently have?

  
Bank Branch BSB Account No. Latest Balance
         
         
         
         
   
   
E. Income Details:  
Please list all your incomes, including wages, rent, dividends, pensions etc
Type of Income Description Monthly After Tax
     
     
     
     
   
   
F. Assets:  
Type of Asset Description Value
     
     
     
     
If you listed a car in Assets, please complete:  
Make:    
Model:    
Year:    
Is the car under finance:    
     
   
G. Liabilities:
Include your mortgage and any other loans/debts ie credit, store cards.
Type Lender Amt Owing Repayment Limit Do you intend to
close this account?