Client 1:

Client 2:

Home Phone Number:

Work Phone Number:

Mobile Phone Number:

Email:

Do You own your own property:
Please Select Yes No

Estimated Property Value:

Current Mortgage Value:

Current Mortgage Repayment:
Please Select Monthly Fortnightly Weekly

Current Loan Status:
Please Select Up To Date Repossession Dishonours in Last Months Arrears Letter of Demand Issued

Credit:
Please Select Clear Poor Adverse Bankruptcy

If Credit is not clear please provide details:

Total other debts:

Client 1 - Current Employment
Please Select Full Time Part Time Casual S/E Pen Other

Client 1 - Current Employment Years

Client 1 - Current Employment Months

Client 2 - Current Employment
Please Select Full Time Part Time Casual S/E Pen Other

Client 2 - Current Employment Years

Client 2 - Current Employment Months