PERSONAL DETAILS
Who is applying for finance?
Type of applicant:
Individual applicant details.
Application 1 / Company details   Applicant 2 / Guarentor details  
Title: Title:
Surname: Surname:
First name: First name:
Middle name: Middle name:
Date of birth: 19 Date of birth: 19
No. of dependents: No. of dependents:
Marital status: Marital status:
Current address: Current address:
Suburb: Suburb:
City: City:
Residential status: Residential status:
How long have you lived here: How long have you lived here:
Previous address:
(if less than 3 years at current)		 Previous address:
(if less than 3 years at current)
Suburb: Suburb:
City: City:
How long were you there for: How long were you there for:
Home phone: Home phone:
Work phone: Work phone:
Mobile: Mobile:
Email address: Email address:
Current occupation: Current occupation:
Employer: Employer:
Address: Address:
City: City:
How long have you worked here: How long have you worked here:
Previous occupation: Previous occupation:
Previous employer:
(if less than 3 years at current)		 Previous employer:
(if less than 3 years at current)
How long did you work there: How long did you work there:
ASSETS, LIABILITIES AND EXPENSES(Prior to this loan)
Assets (Current Position)
  Value
Asset Type
Asset Type
Asset Type
Asset Type
Asset Type

Liabilities And Expenses (Prior to this loan)
  Finance Company Monthly Payment Outstanding
Liability Type
Other 
Liability Type
Other 
Liability Type
Other 
Liability Type
Other 
Liability Type
Other 
Liability Type
Other 

INCOME
Income Details
Applicant Income Type Net Monthly Income Gross Yearly Income


LOAN PURPOSE
Type of application Value
Finance Details
Purchase Price Deposit Cash
Accessories / on road costs Trade Net
Warranty Amount financed
PPI / CCI TERM (Months)
Insurance
 
Security Details
Year Make/ Model
Mileage Transmission AUTO/Manual REG NO.
TRADE DETAILS
Year Make/ Model REG NO.
ENCUMBERED To whom
 
Office Equipment
Make/ Model Value
ACCOUNTANT DETAILS
Contact
Firm
Address
Phone
Fax
AUTHORITY AND DECLARATION

I understand that the broker provides a finance consultancy service for its clients requiring finance. Further, I understand that the broker does not charge me for these services (unless specifically negotiated in advance), but receives a commission from the lender providing the loan. The broker is not an employee, agent, partner nor, joint venture partner of, nor does the broker act on behalf of, the lender.

I am aware that the personal information collected in this form and in the course of my dealings with the broker is collected initially for the purposes of assessing my application for mortgage finance and may be given to a number of lenders at the broker's discretion. If my application is successful, I understand that the information will be used by the lender for the purpose of administering the loan, and by the lender and broker for administering any ongoing commission payments to the broker. If the broker has an arrangement with the lender that the lender will pay an ongoing commission over the term of my loan, the lender will periodically disclose the loan balance to the broker. I understand that the broker and the lender might also use my personal information for the purposes of market research and from time to time to notify me of products or services that may be of interest to me.

The name and address of the broker firm that will hold the information is:
Name
Address

and any lenders approached by the broker in the course of arranging the loan. I understand that I am not required by law to provide any personal information to the broker, but that my failure to do so might prejudice my chances of obtaining finance.

By completing this form I authorise:

  1. the broker and/or lender to collect personal information about me from third parties including, but not restricted to credit reporting agencies, banks and employers and for those third parties to disclose information to the broker and/or lender.
  2. the broker and/or lender to disclose my personal information about me to credit reporting agencies (in the event of any default in any sum owing to the lender) and also to any third party making an authorised enquiry about me.
  3. the lender to disclose my personal information to the broker during the term of the loan in order to answer my queries or to assist me with my financial arrangements as my circumstances change.

I understand that pursuant to the Privacy Act 1993, I have a right to request access to and correction of any personal information held by the broker, or by the lender.

I also confirm;

that the information contained in this application is true or correct

that I am to meet legal and valuation costs

I am not registered for GST and will not be with respect to the security property 

I am/will be registered for GST but the security property is not/will not used for for the purposes of a taxable activity

I am/will be registered for GST and the security property is/will be used for the purposes of a taxable activity

I acknowledge that, as part of the intended financing transaction, I should review my personal risk insurance requirements. The signing of this application form in no way implies an application has been made to the broker for such a review. The broker may receive a commission for the writing or referral of any personal risk insurance.

I have read and accept the authority and declaration
Name
Date
I have read and accept the authority and declaration
Name
Date

In this statement singular terms (such as "I" "me" and "my") include the plural ("we" "us" and "our") where appropriate. The terms:

"broker" means the person and/or firm who is attempting to arrange mortgage finance on your behalf;

"Lender" includes a prospective lender from whom the broker seeks mortgage finance on your behalf, and includes banks, finance companies, lenders' mortgage insurers and all other financial institutions and financing sources.

Comments regarding your application:

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