What is the purpose of the loan?
Select One
Home Improvements
Debt Consolidation
Consumer Goods
Other
Marital Status
Single
Married
Separated
Divorced
Single
Married
Separated
Divorced
Length of time at this address
Are you:
Renting
Purchasing
Boarding
Renting
Purchasing
Boarding
Monthly accommodation cost:
$
$
If at this address less than 3 years, provide previous address.
Length of time at that address
Were you
Renting
Purchasing
Boarding
Renting
Purchasing
Boarding
Employment Status
Fulltime
Pension
Casual
Part-time
Fulltime
Pension
Casual
Part-time
Length of time with employer
Length of time with employer
Length of time with employer
Assets - include home, contents, investments, vehicles, etc.
Description
Value
Liabilities - include personal loans, store cards, credit cards, etc.
Other income(overtime etc):
$
Have you ever had, or are there now judgements or legal proceedings against you?
Do you have any defaults or judgements against you? If so, what are they?
Details of the nearest relative not living with you:
Relationship to this Relative
Please give 2 personal references:
Reference 1
Reference 2
How did you find us?
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TV
Radio
Newspaper
Internet Search
Word of Mouth
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