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| Title |
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| First Name *
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| Last Name * |
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| Birth Date |
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| Drivers
licence number |
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| Drivers
licence expiry date |
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| Gender * |
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| Marital Status * |
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| Number of
Children * |
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| Mother's
maiden name |
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| Address |
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| Street Number * |
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| Street Name * |
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| Suburb * |
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| Postcode * |
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| Email Address * |
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| Daytime Phone Number * |
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| Mobile Number |
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| Home Phone Number |
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| Work Phone Number |
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| How long have you been at your
address? * |
years/months |
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| Approximate
value of the property * |
no $ or
commas |
Enter monthly repayment below |
| How much is
owing on the property * |
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| Who is your
current lender |
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About how long have you had this
loan |
years/months |
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Occupation
* |
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| Employment
Status * |
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| Time with
Current Employer? * |
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| Net Income per week
(all applicants) * |
leave blank if not declaring |
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| Credit
Rating: * |
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Extra Cash you
wish to borrow? |
blank if
just refinancing |
if you would like extra cash, say to buy a car or do
renovations. |
| Purpose of
your loan? |
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consolidate debt, refi investment, pay less than now, etc |
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WHAT YOU OWN (ASSETS) Bank Accounts
(whole $, no commas) |
|
$
balance |
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$
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$
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$
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$
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| Other Assets, Investments &
other Property
(whole $, no commas) |
|
$
value |
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$
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$
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$
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$
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| Total Assets |
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$
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Enter monthly repayments below |
WHAT YOU OWE
(LIABILITIES) Real estate mortgages and equity
loans (whole $, no commas) |
|
$
balance |
$
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$
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$
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$
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$
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$
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$
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$
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$
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Car loans, credit cards, store cards, personal
loans & other debt |
|
$
balance |
$
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$
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$
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$
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$
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$
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$
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$
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$
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| Other Liabilities
(whole $, no commas) |
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$
balance |
$
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$
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$
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$
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$
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$
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$
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$
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$
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| Total Liabilities
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$
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$
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| CALCULATE NET WORTH |
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$
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| Would you
like to receive our e-Newsletter? |
Yes No
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Where did you hear about us? * |
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Comments Give us more information relating to your
personal circumstances and include details of any loans
you may have repaid in the past. |
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| *
mandatory fields
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