Title
First Name
Middle Name
Surname
Date of Birth (DD/MM/YYYY)
Work Number
Mobile Phone Number
Marital status SingleMarriedDe facto
Age of Dependents
Driver's Licence Number
Driver's License Card Number
Expiry Date
Australian Residency Status Citizen or Permanent ResidentVisa
Visa (specify type)
Residential Address
Suburb
State
Postcode
Residential Status Own (outright)Own (mortgage)RentBoardingLive with relatives
Time At Address
Years
Month(s)
If less than 2 years at current address please fill below Yes
Previous address
Time At Previous Address
Months
If Renting Please Fill Below
Landlord Name
Landlord Phone Number
References
Nearest Relative Not Living With You:
Name
Address
Phone
Relationship
-+
Employer
Occupation
Basis of Employment: S/EmployF/TimeP/TimeCasual
Period of Employment:
$
Nett Weekly Income
Other Income
Total Income
Previous Employment Details Applicant:
Prev Occupation
Home
Value
Owned outrightYesNo
Balance
Loan Limit
Monthly payments
Financier
Add An Investment Property
Motor Vehicle
Owned OutrightYesNo
Recreational assets (boats/RVs/jet skis)
Shares/trust/managed funds
Cash in bank
Institution
Superannuation
Home Contents *If not owned outright please ensure that corresponding liability fields are filled correctly
Margin loan
Personal Loan
Credit Card
Limit
Firm Name
Contact Name
Business Land Line Number
Mobile Number
Email Address
Have all the loans in your name (regardless of whether the repayments are made by you or not) been disclosed in the liabilities section of this application? YesNo
There are no foreseeable changes to your circumstances that could impact on your financial situation ( for example, retirement plans, seasonal employment, changes under your other loan arrangements, expecting a child)? YesNo
