: : Select Finance- Online Form : :

Your Personal Details: (First Applicant)
No. of Applicants:
Title:
First Name(s):
Surname:
Date of Birth:	dd/mm/yyyy
Marital Status:
No. of Dependants:
Drivers Licence Number:		expires:	dd/mm/yyyy
Address:
Suburb:
State:
Postcode:
No. of Years in Present Home:	Months:
Present Employer:
years & months with Employer:	eg 2 years 3 months
Previous Employer:
years & months with Previous Employer:	eg 2 years 3 months
Home Phone:
Work Phone:
Fax Number:
Mobile Phone:
Email Address:

Your Personal Details: (Second Applicant If applicable)
Title:
First Name(s):
Surname:
Date of Birth:	dd/mm/yyyy
Marital Status:
No. of Dependants:
Drivers Licence Number:		expires:	dd/mm/yyyy
Address:
Suburb:
State:
Postcode:
No. of Years in Present Home:	Months:
Present Employer:
years & months with Employer:	eg 2 years 3 months
Previous Employer:
years & months with Previous Employer:	eg 2 years 3 months
Home Phone:
Work Phone:
Fax Number:
Mobile Phone:
Email Address:

Type of Loan Required: Please fill in the required loan ONLY.
Home/Investment Loan for:
Please select one:
Amount Required :
Repayment Sought :
Term Sought :

If Refinance:	Existing Mortgage with:



	Existing Debts with/balance:



Type of Loan Product:


Personal Loan For:

Amount Required :
Repayment Sought :
Term Sought :

Business Loan For:

Amount Required :
Repayment Sought :
Term Sought :

Lease/Asset Purchase Loan For:

Amount Required :
Repayment Sought :
Term Sought :
Residual/Balloon:

Incomes: (First Applicant)
Annual Income (before tax):
Annual Income (after tax) :
Benefits/Centrelink:
Rental Income:
Other Details:
Total Monthly Income:(nett)

Incomes: (Second Applicant If applicable)
Annual Income (before tax):
Annual Income (after tax) :
Benefits/Centrelink:
Rental Income:
Other Details:
Total Monthly Income:(nett)

Liabilities
Name (eg bank name)	Amount/mth	Amount/Total
1.	$ mth	$
2.	$ mth	$
3.	$ mth	$
Bank Overdraft:
Bank name:

Overdraft Limit:		$
Overdraft Used:		$
Finance Companies/ Personal loans:
1.	$ mth	$
2.	$ mth	$
3.	$ mth	$
Credit Cards:
1.	Limit: $	$
2.	Limit: $	$
3.	Limit: $	$
Other Liabilities / Debits:
1.	$ mth	$
2.	$ mth	$

Total Liabilities:		$

Assets
Land and Buildings(incl. Address)		Value:
1.		$
2.		$
3.		$

Bank/Savings Accounts
		$
		$
Boat/Caravan/Trailer		$
Motor Vehicles (make & year)
1.		$
2.		$
3.		$
Furniture and Fittings/effects:		$
Other Assets:
1.		$
2.		$

Investments:		$
Superannuation:		$

Total Assets:		$

TOTAL PAYMENTS :

CREDIT RATING :

All information set out in the Application and in any form supplemental to the Application is to the best of the Applicants knowledge true and correct and Select Finance will rely on the accuracy and truth of such information and may cancel any approval or offer of a Banking Facility and/or the Financier may demand repayment of a loan or overdraft which has been provided or cancel Visa Debit Access Card, if it believes such information is not true and correct. Privacy Act Consent I/We authorise Select Finance Brokers P/L or other persons providing advice acting on their behalf to act as my/our agent in seeking access to consumer credit information. This authority applies to enquires made in connection with an application or proposed application by me/us for credit and/or advice in relation to all existing credit. I/We also authorise the disclosure of information in this questionnaire to finance providers to facilitate consideration/approval of the requested funding.
I agree with the above Terms and Conditions.