| Purchase Price : |
$ |
Less Deposit |
| Accessories : |
$ |
Cash : |
$ |
| Other Charges : |
$ |
Trade : |
$ |
| Total Gross Cost : |
$ |
Total Deposit : |
$ |
|
|
Amount Financed : |
$ |
|
|
Term |
Mths |
|
|
Interest Rate |
% |
|
|
|
|
|
|
|
|
| Year |
|
CC Rating |
|
| Make / Model |
|
| Accessories |
|
| Reg. No. |
|
Milage |
|
|
| Trade Details |
|
|
|
| Year |
|
Encumbered |
|
| Make / Model |
|
| Reg. No. |
|
Milage |
|
| To Whom. |
|
|
|
|
|
| Applicant |
Surname
|
Christian Name
|
Gender
|
| 2nd Applicant |
Surname
|
Christian Name
|
Gender
|
| Spouse / Partner |
Surname
|
Christian Name
|
|
| Relationship |
|
|
|
| Number of Dependents |
|
Dependents Age(s) |
|
| Date of Birth Applicant |
|
Spouse/Partner |
|
| Drivers Licence Type |
Applicant
|
Spouse/Partner
|
|
| Drivers Licence No. |
Applicant
|
Spouse/Partner
|
|
| Current Address |
|
| Years there |
|
|
|
| Phone No. |
|
Mobile No. |
|
| Tenancy |
|
If Other |
|
| Previous Address |
|
|
|
|
|
| Employment Type |
|
|
|
| Applicant |
Present Employer
|
Years
|
Months
|
|
Address
|
Phone No.
|
Occupation
|
|
Previous Employer
|
Years
|
Months
|
|
Address
|
Phone No.
|
Occupation
|
| Spouses / Partners |
Present Employer
|
Years
|
Months
|
|
Address
|
Phone No.
|
Occupation
|
|
Previous Employer
|
Years
|
Months
|
|
Address
|
Phone No.
|
Occupation
|
|
|
|
|
| These contacts must have phone numbers |
|
| Parents / Nearest Relative (not living with you) |
Name
|
Phone
|
|
Address
|
Relationship
|
| Personal Contact |
Name
|
Phone
|
|
Address
|
|
|
| Account References |
1. (previous/existing loans, credit cards)
|
Account No.
|
Current/When finalised
|
|
2. (previous/existing loans, credit cards)
|
Account No.
|
Current/When finalised
|
|
Finance Company History
|
|
|
Previous/existing finance to
|
|
Is Account still current
|
Account No.
|
|
|
| Insurance Company |
|
Insurance Type |
|
| Paid |
|
|
|
| Bankers |
|
Branch |
|
| Types of Accounts |
|
A/C Number |
|
|
|
|
|
| Average Monthly Net Income |
Less Average Monthly Expenditure |
| Applicant |
$ |
Rent / Mortgages |
$ |
| Spouse / Partner |
$ |
Other Loans & C.Cards |
$ |
| Other / Source |
$ |
Rates, Power, Phone |
$ |
| Total |
$ |
Insurance (life, House, Contents) |
$ |
|
|
Other |
$ |
|
|
Other |
$ |
|
|
Total Expenditure |
$ |
|
|
Net Surplus Per Month |
$ |
|
|
|
|
| Statement of Financial Position |
|
| Assets |
|
Liabilities |
|
| House |
$ |
Mortgage Outstanding |
$ |
| Furnishings |
$ |
Credit Cards |
$ |
| Investments |
$ |
Bank Overdraft |
$ |
| Bank |
$ |
Other Creditors |
$ |
| Car |
$ |
Loans |
$ |
| Other |
$ |
Other |
$ |
| Total |
$ |
Total |
$ |
|
|
|
|
| Have you ever had or are there now any attachments or legal proceeding against you, or any action for payment default? |
|
| If yes, state details |
|
| I/We apply for a loan of $ over a term of months and certify that the particulars above and overleaf are true and correct and that I am over the age of 18 years and am not an undischarged bankrupt. Pursuant to the Privacy Act 1993 I/We authorise any finance company to contact any credit reporting agencies, credit providers, my/our employer/s, accountant/s, or any other source, to obtain, check and exchange (both now and in the future) such personal, financial and commercial information and references about me/us as is necessary for the purpose of considering this application, the protection and administration of any loan arising out of this application, and to assist in the enforcement of any agreement between me/us and any finance company. I/We agree that you may produce this authority to such parties for the purposes of collecting such information. Under the provisions of the Privacy Act 1993, you are entitled to have access and request correction to personal information held. |
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