Application Checklist

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1 Step 1
Broker Nameyour full name
Contact Numberyour full name
Broker Companyyour full name
Fax Numberyour full name
Referring Broker ACL Noyour full name
Referring Broker Name (Inc. Company name if applicable)your full name
Add some text or HTML here
CHOOSE ONE OF THE FOLLOWING:pick one!
Please ensure the following items are faxed back to us, along with your completed application form.pick one!
ADDITIONAL REQUIREMENTS (if applicable)pick one!

Application for Finance

Company Nameyour full name
ACNyour full name
ABNyour full name
For the purposes of this Application for Finance are you a Trustee?pick one!
Trust Nameyour full name
Business Description (i.e Carpentry, Medical etc.)your full name
Registered Addressyour full name
Stateyour full name
Postcodeyour full name
Principal Place of Businessyour full name
Stateyour full name
Postcodeyour full name
What form is the ASIC company registration?pick one!
How many directors does the company have?pick one!
Does individual (other than the Directors) own through one or more shareholding more than 25% of the issued capital in the company?pick one!

Applicant 1

Company Officer Rolepick one!
First Nameyour full name
Last Nameyour full name
Previous Nameyour full name
Circumstance of Name Changepick one!
Date of Birthof appointment
Driver’s License Number & Expiry Dateof appointment
Home Addressmore details
0 /
Stateyour full name
Postcodeyour full name
Previous Home Addressmore details
0 /
Stateyour full name
Postcodeyour full name
Postal Addressmore details
0 /
Stateyour full name
Postcodeyour full name
Home Phoneyour full name
Work Phoneyour full name
Mobileyour full name
Faxyour full name
Employeryour full name
Positionyour full name

Applicant 2

Company Officer Rolepick one!
First Nameyour full name
Last Nameyour full name
Previous Nameyour full name
Circumstance of Name Changepick one!
Date of Birthof appointment
Driver’s License Number & Expiry Dateof appointment
Home Addressmore details
0 /
Stateyour full name
Postcodeyour full name
Previous Home Addressmore details
0 /
Stateyour full name
Postcodeyour full name
Postal Addressmore details
0 /
Stateyour full name
Postcodeyour full name
Home Phoneyour full name
Work Phoneyour full name
Mobileyour full name
Faxyour full name
Employeryour full name
Positionyour full name

Proposed Loan Details

Loan Amount Requested $your full name
Loan Term Requestedyour full name
Days OR Expiry Dateof appointment
Funds Requested Byyour full name
ASAPyour full name

Loan Purpose (Please describe IN DETAIL the proposed purpose and use of funds)

1your full name
2your full name
3your full name
4your full name
5your full name
If the above ‘Loan Purpose” relates to property please provide the Address:your full name
Stateyour full name
Postcodeyour full name
If the above ‘Loan Purpose’ relates to a business please provide:your full name
Trading Nameyour full name
ABNyour full name
Company Nameyour full name
ACNyour full name
Why you have utilized short term funding in preference to long term funding?your full name
Please explain in detail the benefit this loan with have upon youyour full name

Repayment Strategy

Refinancepick one!
Sale of Assetpick one!
Otherpick one!
Alternate Loan Repayment Strategy (mandatory)your full name

Proposed Security

Property 1 (Address)more details
0 /
Stateyour full name
Postcodeyour full name
Property 1 Description (ie. Commercial property, Residential house etc)your full name
Building Size (Approx)your full name
Land size (Approx)your full name
Descriptionpick one!
Est. Value $your full name
Sourcepick one!
Outstanding $your full name
Type of Debtyour full name
Type of Debtpick one!
Outstanding $your full name
Lenderyour full name
Type of Debtpick one!

Proposed Security

Property 2 (Address)more details
0 /
Stateyour full name
Postcodeyour full name
Property 2 Description (ie. Commercial property, Residential house etc)more details
0 /
Building Size (Approx)your full name
Land size (Approx)your full name
Descriptionpick one!
Est. Value $your full name
Sourcepick one!
Outstanding $your full name
Type of Debtyour full name
Type of Debtpick one!
Outstanding $your full name
Lenderyour full name
Type of Debtpick one!

PLEASE NOTE: The remainder of this page has been intentionally left blank and another page follows.

Declaration and Signature

Company Officer 1

Have you ever been declared bankrupt or insolvent, or entered into any arrangement for the benefit of creditors?pick one!
Have you personally, or as an officer of a company, had a court judgment entered against you or defaulted on previous loans?pick one!
Have you ever been a shareholder or officer of any company in relation to which a manager, receiver or liquidator has been appointed or have there been any court judgments against such a company?pick one!
I have read, understood and agree to the acknowledgements and consents relating to Credit and Personal Information Privacypick one!
First Namesyour full name
Last Nameyour full name

Signature : ....................................

Dateof appointment
Company Officer Rolepick one!

Company Officer 2

Have you ever been declared bankrupt or insolvent, or entered into any arrangement for the benefit of creditors?pick one!
Have you personally, or as an officer of a company, had a court judgment entered against you or defaulted on previous loans?pick one!
Have you ever been a shareholder or officer of any company in relation to which a manager, receiver or liquidator has been appointed or have there been any court judgments against such a company?pick one!
I have read, understood and agree to the acknowledgements and consents relating to Credit and Personal Information Privacypick one!
First Nameyour full name
Last Nameyour full name

Signature ...........................

Dateof appointment
Company Officer Roleapick one!

Declaration as to purpose of CreditI declare the credit to be provided to me is to be applied wholly or predominantly for:

•Business purposes; or

•Investment purposes other than investment in residential property

IMPORTANT 


You should ONLY sign this declaration if the loan is wholly or predominantly for:

•Business purposes; or

•Investment purposes other than investment in residential propertyBY SIGNING THIS DECLARATION YOU MAY LOSE YOUR PROTECTION UNDER THE NATIONAL CONSUMER CREDIT CODE

This declaration has been made before I signed, or entered into, a credit relating to this intended transaction AND I MAKE THIS SOLEMN DECLARATION conscientiously believing the contents to be true

Applicant 1

Signature ...........................

Dateof appointment
Nameyour full name
Positionyour full name

Applicant 2

Signature ...........................

Dateof appointment
Nameyour full name
Positionyour full name

Applicant 3

Signature ...........................

Dateof appointment
Nameyour full name
Positionyour full name

Applicant 4

Signature ...........................

Nameyour full name
Dateof appointment
Positionyour full name

STATEMENT OF ASSETS & LIABILITIES

(APPLICANT 1)

(EACH APPLICANT MUST COMPLETE THEIR OWN STATEMENT AND SIGN OFF ON THE BOTTOM OF THE PAGE)
ASSETS VALUE LIABILITIES PYMTS (PER MONTH) Amount Owed Income
PROPERTY ADDRESS   CURRENT LENDER      
1)    
2}    
3}    
4}    
5}    
6}    
7}    
8}    
VEHICLE    
VEHICLE    
SAVINGS   CREDIT CARD
SAVINGS   CREDIT CARD
FURNITURE & PERSONAL EFFECTS   CREDIT CARD
BUSINESS VALUE (Income)   CREDIT CARD
TOTAL ASSETS   TOTAL LIABILITIES
           

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

Signature(s) of Applicant(s) ...................................

Dateof appointment
Nameyour full name

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

STATEMENT OF ASSETS & LIABILITIES

(APPLICANT 2)

(EACH APPLICANT MUST COMPLETE THEIR OWN STATEMENT AND SIGN OFF ON THE BOTTOM OF THE PAGE)
ASSETS VALUE LIABILITIES PYMTS (PER MONTH) Amount Owed Income
PROPERTY ADDRESS   CURRENT LENDER      
1)    
2}    
3}    
4}    
5}    
6}    
7}    
8}    
VEHICLE    
VEHICLE    
SAVINGS   CREDIT CARD
SAVINGS   CREDIT CARD
FURNITURE & PERSONAL EFFECTS   CREDIT CARD
BUSINESS VALUE (Income)   CREDIT CARD
TOTAL ASSETS   TOTAL LIABILITIES
           

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

STATEMENT OF ASSETS & LIABILITIES

(Company)

(As per page 2 of the attached)

(EACH APPLICANT MUST COMPLETE THEIR OWN STATEMENT AND SIGN OFF ON THE BOTTOM OF THE PAGE)
ASSETS VALUE LIABILITIES PYMTS (PER MONTH) Amount Owed Income
PROPERTY ADDRESS   CURRENT LENDER      
1)    
2}    
3}    
4}    
5}    
6}    
7}    
8}    
VEHICLE    
VEHICLE    
SAVINGS   CREDIT CARD
SAVINGS   CREDIT CARD
FURNITURE & PERSONAL EFFECTS   CREDIT CARD
BUSINESS VALUE (Income)   CREDIT CARD
TOTAL ASSETS   TOTAL LIABILITIES
           

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

Signature(s) of Applicant(s) ...................................

Nameyour full name
Dateof appointment

Privacy Statement and Consent

Name of Applicant(s):your full name
Name of Guarantor(s)your full name

Your privacy is important to us. In order to manage our business professionally and efficiently we need to obtain and use personal information about prospective and existing borrowers and guarantors.The purpose of this privacy consent form is for you to consent to us obtaining and using information about you in the manner we have specified in this form and in accordance with the Privacy Act (Cth) 1988. The Privacy Act regulates the way in which personal information about customers can be used by credit providers. If you would like more information on Australian privacy legislation, please visit: www.privacy.gov.au.In this document “we”, “us” and “our” refers to the entity who collects on whose behalf your personal information is collected, Purpose of Collection and UseCertain personal information is required to enable us to:•Assess your application for credit and/or credit worthiness and/or become a guarantor, and where your application is made in relation to a master credit facility, assess any subsequent applications you may make for credit under that facility;•Administer any credit facility which is subsequently provided by us including managing any account in connection with the Credit facility, administering insurance claims, recovering any money owed to us, maintaining the value and protecting any assets provided as security for any obligations under credit facility and for use in connection with the outsourcing of any functions;•Assist you to avoid defaulting on your credit obligations;•Notifying other credit providers of any default by you; or•Identifying and sending you any information about our other related products or services that may be of interest to you.The following tells you what information might be required and how the information might be used. PLEASE READ THIS CAREFULLY. If you do not provide us with the personal information requested, we will be unable to assess your application, obtain credit or become a guarantor.Disclosure of Personal InformationThe types of organizations to which we usually disclose personal information include credit reporting agencies, government departments and authorities, insurers and underwriters, guarantors, agents, contractors, proposed assignees of our assets and other third parties associated with us to enable us to carry out our functions, for example, mailing houses, debt collection agencies, mercantile agents, archive companies, valuers, call centre operators, solicitors, accountants, other funders, introducers, brokers and suppliers of goods to be financed.You consent to us collecting your personal information and using it for the purposed outlines in this document including disclosing your personal information to the types of organizations set out above.Disclosure of Information to a Credit Reporting AgencyYou authorize us to give a credit reporting agency certain personal information about you for the purposes of enabling us to obtain consumer or commercial credit reports about you and/or to allow the credit reporting agency to create or maintain a credit information file containing information about you.These reports and credit information may be obtained and referred to by us for any of the purposed referred to in the document, including:a)assessing your application or credit and/or to become a guarantor; orb)where your application is granted in relation to a master credit facility, assessing subsequent applications you may make for credit under that facility.The information which we may disclose to the credit reporting agency is limited to:•your identification :including your name, sex, address and the previous two addresses, date of birth, name if employer and driver’s license number);•the fact that credit has been applied for and the amount;•the fact that we are a current credit provider to you; •details of payments which become overdue for more than 60 days and for which collection action has commenced;•the fact that payments are no longer overdue;•details of cheques drawn by you which have been dishonoured more than once;•the fact that in our opinion you have committed a serious credit infringement; and•the fact that credit provided to you by us has been paid or discharged.Authority to Obtain Credit InformationYou authorize us to obtain from:a)a credit reporting agency: a credit reporting agency containing personal or commercial information about you in relation to personal or commercial credit provided to you; andb)a business which provides information about the commercial credit worthiness of persons: information about your commercial activities or commercial credit worthiness in relation to your application for credit and, where applicable in relation to any subsequent applications for credit under a master facility.


Other Acknowledges and Consents

I/We have read and understood this privacy consent form and authorize Lender to collect and use my/our personal information in the manner described in this document.

Name of Applicanyour full name
Dateof appointment

Signature: ...........................

Name of Applicanyour full name
Dateof appointment

Signature: ...........................

Name of Applicanyour full name
Dateof appointment

Signature: ...........................

Name of Applicanyour full name
Dateof appointment

Signature: ...........................

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