Please complete all fields where appropriate to prevent delays with your application.

Loan Details
Loan Amount: Introducer Name:
Preferred loan period: Years I wish to have the funds in: other:
I am: I own:
Income from:
Personal Details
Applicant 1 Applicant 2
Title:
First Name
Middle Name
Surname
Drivers Licence
Place of birth
Marital Status
No. of dependants
Residential Status
Residential Address
Suburb
State and Postcode
Length of residence
Home Phone
Mobile Phone
Available contact time
Email Address
Bank Name
Bank Details
Personal Reference
Applicant 1 Applicant 2
Name of Partner
Contact number
1 Name of relative
Relationship
Home number
2 Name of Relative
Relationship
Home number
Business / Employment
Applicant 1 Applicant 2
Type of Employment
Business/Employer name
Address
Suburb
Postcode
Occupation
Years
Work Title
Contact person name
Contact person position
Work Phone
Work Fax
Previous Employer
Occupation
Years
After Tax Income
Centrelink / Rental Income
Assets and Liabilities
How much repayment can you make COMFORTABLY for this loan?
Exit Strategy (How will the loan be repaid?)
Assets and Liabilities
Type Current Value or Credit Limit Payment Per Month Amount Owing Bank/Financier Owners Name
Rent $ (if you are not the property owner)
Home/Property 1
Investment Property 2
Savings/Cash
Vehicle 1 (current Trade-in value)
Vehicle 2 (current Trade-in value)
Personal Loans 1
Personal Loans 2
Credit Card 1
Credit Card 2
Other
Total
Security
Motor Vehicle 1
Make/Brand (eg. Toyota, Holden, BMW): Year Model (eg. Camry, Barina, M6):
Any Finance on the vehicle? Transmission
Can you provide your spare key for this loan security?(You can keep driving)
Insurance
Motor Vehicle 2
Make/Brand (eg. Toyota, Holden, BMW): Year Model (eg. Camry, Barina, M6):
Any Finance on the vehicle? Transmission
Can you provide your spare key for this loan security?(You can keep driving)
Insurance
Home/Property 1
Address: Owner(s):
Debt:1st Mortgage: $ 2nd Mortgage/Caveat $
Type Owner occupied Investment
Description: No. of Bedrooms: No. of Bathrooms: Land Size:
Home/Property 2
Address: Owner(s):
Debt:1st Mortgage: $ 2nd Mortgage/Caveat $
Type Owner occupied Investment
Description: No. of Bedrooms: No. of Bathrooms: Land Size:
Declaration
Applicant 1Applicant 2
Have you ever been Bankrupted/Legal proceedings or Outstanding Claims against you in the past 5 years?
When was the last time you applied for a loan?
Do you have any bad credit ratings/Default payment? If yes, number: If yes, number: 
I have read the terms and conditions and wish to proceed with this application.
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