Note: All form fields are mandatory, if you need to skip a field please enter N/A.

	Primary Applicant	Co-Borrower
First Name
Middle Name
Surname

Date of Birth
Licence Number
Licence Expiry
Marital Status
Dependants

Mobile
Home Phone
Email
Minimum 3 Years Address History Required
Current Address
Time at Address
Status
Landlord / Lender

Previous Address
Time at Address
Status
Landlord / Lender

Previous Address
Time at Address
Status
Landlord / Lender

Occupation
Employer
Work Phone>
Contact Person>
Time at Job
Income
Frequency
Status
Minimum 3 Years Employment History Required
Occupation
Employer
Work Phone
Contact Person
Time at Job
Status	Full-Time Part-Time Casual Self-Employed Contractor	Full-Time Part-Time Casual Self-Employed Contractor

Occupation
Employer
Work Phone
Contact Person
Time at Job
Status	Full-Time Part-Time Casual Self-Employed Contractor	Full-Time Part-Time Casual Self-Employed Contractor

Occupation
Employer
Work Phone
Contact Person
Time at Job
Status	Full-Time Part-Time Casual Self-Employed Contractor	Full-Time Part-Time Casual Self-Employed Contractor

Rent / Board
Landlord	Per Week Per Fortnight Per Month


General Living Expenses – Basics (Monthly)
Groceries		Registration
Electricity / Gas Utilities		Clothing
Water / Land Rates		Mobile / Internet
Transport / Petrol		Child Maintenance


General Living Expenses – Discretionary (Monthly)
Restaurants / Take Away		Entertainment
Childcare		Insurance (Home, Life, Car)
Private School Fees		Other
Alcohol / Tobacco		Other


General Living Expenses – Luxury (Monthly)
Holiday		Donations
Housekeeping		Other
Gambling		Other

Details of Nearest Relative (Not Living at Same Address)
First Name
Surname
Relationship
Address
Phone / Mobile
Email

Bank Account Details for Direct Debit
Bank
BSB Number
Account Number

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