General Loan Information

What is the purpose of your loan?
Loan amount *
$
For loans of $1500, no security is required. For greater amounts, security of a vehicle which is less than 10 years old, and is warranted, registered, and fully insured is required, or real estate security which may have a 1st mortgage of not greater than 40% of the value



 

Personal Information - Primary Applicant
Title
First Name: *
Middle Name:
Last Name : *
Date of Birth Sex
*
Marital status
Number of dependants:
Drivers Licence Number: Version:
Residential status *
Home Address:*
How long have you lived at this address?
Home Phone:
Work Phone:
Email Address:*
Mobile Phone number:
Employment status:
Current Employer:
Time at current employer:

Husband/Wife/Partner or Secondary Applicant
Title
First Name:
Middle Name:
Last Name:
Date of Birth Sex
Drivers Licence Number: Version:
Residential status
Home Address:
How long have you lived at this address?
Home Phone:
Work Phone:
Email Address:
Mobile Phone number:
Employment status:
Current Employer:
Time at current employer:



 

Preferred payment frequency* Preferred payment amount*
$
Next pay date being

Financial Information - Income
Primary Applicant income (after tax)
$
Secondary Applicant income (after tax)
$
Details:
Total Income (after tax)*
$

Expenses
Mortgage/Rent
$
HP/Credit Card/Loan Payments
$
Other
$
Details:
Total Expenses*
$


 

Setting up your payments


 

Additional Information

I have read and accept the terms of this Declaration and Privacy Waiver: *

Applicant/s:

 

Are you an un-discharged bankrupt? *
 

Have you ever made application to the Official Assignee for a "No Asset Procedure" form of bankruptcy? *
Additional Comments:

 

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