Personal Loan Referral: Application Form

Application Details
Date (DD/MM/YYYY)
/ /
Time (HH:MM)
/
Objectives and Requirements
To ensure that the Personal Loan is acceptable to your needs, please complete the information below:
What are the Purpose’s of the Loan? Amount Requested?
$
$
$
$
$
The loan that you are applying for has a fixed interest rate and is for a fixed term. Will this meet your requirements? YesNo

Personal Details - 1st Applicant
Borrower Details
Title Surname First Name Middle Name
Date of birth (DD/MM/YYY) Sex Number of dependents Marital Status Driver’s Licence number
/ /

Personal Details - 2nd Applicant
Borrower Details
Title        Surname First Name Middle Name
Date of birth (DD/MM/YYY) Sex Number of dependents Marital Status Driver’s Licence number
/ /

Current Residential Address Details - 1st Applicant
(Please complete where applicable)
Property Name
Lot Number
Unit Number
Street Number
Street Name
Street Type (e.g. Hwy, Rd, St, Ave)
 Suburb/City
Postcode
State
Length of Time at Address
Years : Months :
Telephone(Include area code)
 Mobile
Residency status (e.g. A Buyer/Renter/Boarder/Other)
 Mortgage/Agent/Landlord’s Name
  Rent or Mortgage Payments
$

Current Residential Address Details - 2nd Applicant
(Please complete where applicable)
Property Name
Lot Number
Unit Number
Street Number
Street Name
Street Type (e.g. Hwy, Rd, St, Ave)
 Suburb/City
Postcode
State
Length of Time at Address
Years : Months :
Telephone (Include area code)
Mobile
Residency status (e.g. A Buyer/Renter/Boarder/Other)
 Mortgage/Agent/Landlord’s Name

Previous Address Details
Property Name
Lot Number
Unit Number
Street Number
Street Name
Street Type (e.g. Hwy, Rd, St, Ave)
 Suburb/City
Postcode
State
Length of Time at Address
Years: Months :
Residency status (e.g. A Buyer/Renter/Boarder/Other)

Mortgage/Agent/Landlord’s Name


Employment Information - 1st Applicant
Occupation
Name of Employer
 Telephone (include area code)
 Suburb/City
Length of Employment
Years:  Months:
Employment Status (e.g. Full-Time, Part-time, Casual, Seasonal, Temporary)
 Hours Worked Per Week (Excluding Overtime)
Name of Previous Employer
 Telephone (include area code)
 Suburb/City
Length of Previous Employment Years: Months:             Net Monthly Income $
Second Job (if applicable)
Occupation
 Name of Employer
 Telephone (including area code)
Suburb/City
Length of Employment
Years: Months:
Employment Status (e.g. Full-Time, Part-time, Casual, Seasonal, Temporary)
Accountant’s Name (if self-employed)
 Accountant’s Telephone (if self-employed)
 Net Monthly Income $

Employment Information - 2nd Applicant
Occupation  
Name of Employer
 Telephone (include area code)
 Suburb/City
Length of Employment
Years: Months:
Employment Status (e.g. Full-Time, Part-time, Casual, Seasonal, Temporary)
Hours Worked Per Week (Excluding Overtime)
Name of Previous Employer
 Telephone (include area code)
 Suburb/City
Length of Previous Employment Years: Months:     Net Monthly Income $
Accountant’s Name (if self-employed)
 Accountant’s Telephone (if self-employed)
 Net Monthly Income $

Living Expenses - 1st Applicant
What is your Share of Household Living Expenses?
$		 What is your Share of Household Rent/Mortgage?
$		 Do you Share Living Expenses?
YesNo

Living Expenses - 2nd Applicant
What is your Share of Household Living Expenses?
$ 		What is your Share of Household Rent/Mortgage?
$ 		Do you Share Living Expenses?
YesNo


Liabilities
Tell us about your current financial commitments, including all credit cards, motor vehicle leases and store cards
Loan Type (e.g. Mortgages, Car Loan, Credit Cards,Personal Loans GE Money Loans) Loans/Debits with which company Limit/Amount Borrowed Current Balance Monthly Payment Original Loan Team
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $

Assets
Property Market Value

Home Building		 Value
$		 Insured (Yes/No)
 Insurer
 Insurance Expiry Month
 Insurance Expiry Year
Home Contents $
Other Assets $

Auto Details
Year Make Model & Variant (i.e. SS, XS) Klms Sedan/Wagon Insured (Yes/No) Insurer Insurance Expiry

5. INCOME VS EXPENDITURE CAPACITY
MONTHLY INCOME
Applicant 1(Net):
Net Income: $
Pension: $
Child Care $
Child Support: $
Rental: $
Other: $
Applicant 2(Net):
Net Income: $
Pension: $
Child Care $
Child Support: $
Rental: $
Other: $
 
TOTAL INCOME : $
MONTHLY EXPENDITURE
Rent/Board: $
Food $
Insurances: $
Fuel: $
Entertainment: $
Electricity: $
Gas: $
Other: $
LOANS
Mortgage: $
Rental Property Loan: $
Credit Cards: $
Car Loan1: $
Car Loan2: $
Other Loans: $
This Loan: $
 
TOTAL EXPENSES : $

SURPLUS/DEFECIT :$
# To work out monthly figures from fortnightly, simply multiply by 26 then divide by 12.
## To work out monthly figures from weekly, simply multiply by 52 then divide by 12.

BORROWING NEEDS
Is there anything in your credit history that would stop you getting a loan?Yes No
If yes, please explain:
Are you experiencing financial stress or hardship? Yes No
If yes, please explain:
Write Your Message to us:
Your Email Address:
By ticking this box, you acknowledge that you are submitting private information, subject to the Commonwealth Privacy Act, to Fortified Finance & Leasing Pty Ltd. Your information will not be passed on to any lender without your written consent. Financial Services Credit Guide, Client Acknowledgement and Privacy Consent Forms will be emailed to you automatically (to the email address above) once you submit this online application.

Australian Credit License Number 392149.

Fortified Finance and Leasing are Australia Credit License holders and as such, are qualified to provide you with unbiased, independent advice on seeking loans. You should only be dealing with qualified professionals.