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Loan Amount:
Loan Term:

1General Questions

Title:
Mr.Mrs.Miss.Ms.
First Name:
Surname:
Email-Address:
Mobile Number:
Home Telephone:
Date of Birth:

2Address Information

House No/ Name:
Street Name:
City:
State:*
QueenslandNew South WalesAustralian Capital TerritoryTasmaniaSouth AustraliaWestern AustraliaNorthern TerritoryVictoria
ZIP Code:
Home Status:*
OwnRentLiving with friends / family
Time at this address:*
Less Than 1 Year1 - 2 Years2 - 3 Years3 - 4 Years4 - 5 YearsMore Than 5 Years

Previous Address Information

House No/ Name:
Post Code:
Street Name:
Home Status:*
OwnRent
Town:
Time at this address:*
Less Than 1 Year1 - 2 Years2 - 3 Years3 - 4 Years4 - 5 YearsMore Than 5 Years
Suburb:

3Employment Status

Employment Status:*
Full Time EmploymentPart Time EmploymentSelf EmployedUnemployedCentrelink Benefits
Industry You Work In:
Employer Name:
Job position:
Pay Frequency:*
WeeklyBi-WeeklyFour WeeklyLast Working Day of monthSpecific DateLast Monday of monthLast Tuesday of monthLast Wednesday of monthLast Thursday of monthLast Friday of monthOther
Work Telephone Number:
Next Pay Date:
Second Pay Date:
Time At Employer:*
Less than 3 months3 months to 1 yearMore than 1 year
Monthly Income:

4Financial Details

Account Holder:
Account Number:
Bank BSB Number:
Account Type:*
ChequeSavings
Bank name:

5Expenditure Information

Loan Purpose:
Existing Loan Repayments (Monthly):
Rent (Monthly):
Other Expenditure (Monthly):
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