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TO: / Broker Team / eMAIL: /PAGES: / dATE:
This is / a new application / an increase to an existing limit. This application is for
This application is for / Consumer (Private) or / Commercial (Business) or Investment purposes
I/We would like to borrow / $ / for / Loan Purpose
I/We would like a split
Home Loan product of / $ / Loan Product / Interest Rate
$ / Loan Product / Interest Rate
I/We would like to pay back the loan over a / mth/year / period.
weekly / over the counter / Repayments / Principal & Interest / Interest Only
I/We plan to make loan repayments / fortnightly / from my/our pay
Date loan required
monthly / transferred from another account
Applicant 1 / Applicant 2
Member no. / Member no.
Title / Miss / Mr / Mrs / Ms / Title / Miss / Mr / Mrs / Ms
Surname / Surname
First name(s) / First name(s)
Date of birth / Male / Female / Date of birth / Male / Female
Marital status / Marital status
Driver's Licence / Exp. Date / Driver's Licence / Exp. Date
Number of dependants / Ages / Number of dependants / Ages
Address / Address
Postcode / Postcode
Postal address / Postal address
Postcode / Postcode
Contact numbers / Hm. / Mob. / Contact numbers / Hm. / Mob.
email - Home/WorkHomeWork
/ email - Home/WorkHomeWork
Living arrangements / Home owner / Renting / Living arrangements / Home owner / Renting
Home buyer / Living with friends/relatives / Home buyer / Living with friends/relatives
Length of time at that address, from date / to date / Length of time at that address, from date / to date
Living in your current home for less than three years? If YES, please give your previous address details for the three year period. / Living in your current home for less than three years? If YES, please give your previous address details for the three year period..
Postcode / Postcode
Living arrangements / Home owner / Renting / Living arrangements / Home owner / Renting
Home buyer / Living with friends/relatives / Home buyer / Living with friends/relatives
Length of time at that address, from date / to date / Length of time at that address, from date / to date
Previous address: / Previous address:
Postcode / Postcode
Living arrangements / Home owner / Renting / Living arrangements / Home owner / Renting
Home buyer / Living with friends/relatives / Home buyer / Living with friends/relatives
Length of time at that address, from date / to date / Length of time at that address, from date / to date
Previous address: / Previous address:
Postcode / Postcode
Applicant 1 / Applicant 2
EMPLOYMENT DETAILS / EMPLOYMENT DETAILS
Status / Full time / Part time / Casual / Unemployed / Status / Full time / Part time / Casual / Unemployed
Self employed / Seasonal / Retired / Other / Self employed / Seasonal / Retired / Other
Occupation / Occupation
Employer / Employer
Address / Postcode / Address / Postcode
Contact / Tel. / Ext. / Mob. / Contact / Tel. / Ext. / Mob.
Since / Date / Since / Date
Employed at your current workplace for less than three years?
If YES, please give your previous employment details for the three year period: / Employed at your current workplace for less than three years?
If YES, please give your previous employment details for the three year period:.
Occupation / Occupation
Employer / Employer
Address / Postcode / Address / Postcode
Contact / Tel. / Ext. / Mob. / Contact / Tel. / Ext. / Mob.
From date / To date / Status / From date / To date / Status
Previous employment:: / Previous employment:
Occupation / Occupation
Employer / Employer
Address / Address
Contact / Tel. / Ext. / Mob. / Contact / Tel. / Ext. / Mob.
From date / To date / Status / From date / To date / Status
INCOME DETAILS / INCOME DETAILS
Current gross annual income / $ / Current gross annual income / $
Select periodper weekper fortnightper month / Select periodper weekper fortnightper month
Net amount / $ / Net amount / $
Gross YTD figure / $ / Gross YTD figure / $
Other income (for example, overtime, rent, child maintenance, commission, bonus): / Other income (for example, overtime, rent, child maintenance, commission, bonus):
Description / Description
Monthly average / $ / Monthly average / $
Description / Description
Monthly average / $ / Monthly average / $
Description / Description
Monthly average / $ / Monthly average / $
COMBINED FINANCIAL POSITION OF APPLICANTS (Combine the Assets, Liabilities and Expenses of all applicants)
Assets / Liabilities
Real Estate / Money owed on mortgage(s)
Address / Institution / To be paid out with this loan / yes no
Select Paymt frequencyweeklyfortnightlymonthly $ / Balance $
Insured with / Property value / $ / Institution / To be paid out with this loan / yes no
Select Paymt frequencyweeklyfortnightlymonthly $ / Balance $
Address
Personal Loans
Insured with / Property value / $
Institution / To be paid out with this loan / yes no
Vehicles / Select Paymt frequencyweeklyfortnightlymonthly $ / Term in months
Year / Make / Balance $
Model / Institution / To be paid out with this loan / yes no
Insured with / Value / $ / Select Paymt frequencyweeklyfortnightlymonthly $ / Term in months
Year / Make / Balance $
Model / Credit Cards (complete even if balance is nil)
Insured with / Value / $ / Card type & issuer / To be paid out with this loan / yes no
Cash and bank accounts / Credit Limit $ / Balance $
Institution / Card type & issuer / To be paid out with this loan / yes no
Account no. & type / Credit Limit $ / Balance $
Value $ / Store Cards (complete even if balance is nil)
Institution / Card type & issuer / To be paid out with this loan / yes no
Account no. & type / Credit Limit $ / Balance $
Value $ / Card type & issuer / To be paid out with this loan / yes no
Credit Limit $ / Balance $
Superannuation / Overdrafts
Institution/Broker / Institution / To be paid out with this loan / yes no
Cash value $ / Select Paymt frequencyweeklyfortnightlymonthly $ / Balance $
Shares / Institution / To be paid out with this loan / yes no
Institution/Broker / Select Paymt frequencyweeklyfortnightlymonthly $ / Balance $
Cash value $ / Other
Institution/Broker / Institution / To be paid out with this loan / yes no
Cash value $ / Select Paymt frequencyweeklyfortnightlymonthly $ / Balance $
Other Assets / Living Expenses
Description / Value $ / Food/Housekeeping / $ / Utilities / $
Description / Value $ / Insurance / $ / Transport / $
Description / Value $ / Education / $ / Dependant’s Support / $
Description / Value $ / Entertainment / $ / Other - Specify / $
Home contents / Rent/Board / $
Value $ / Total Monthly Living Expenses / $
Discretionary Expenses
Private/Tertiary Education / $ / Private Health Insurance / $
Overseas holiday / $ / Cleaners & Gardeners / $
Other - Specify / $ / Other - Specify / $
Total Monthly Discretionary Expenses / $
CREDIT INFORMATION / CREDIT INFORMATION
Have you been involved in any Bankruptcy, Legal Proceedings or Judgements in the last five years? / Have you been involved in any Bankruptcy, Legal Proceedings or Judgements in the last five years?
No Yes; please give details. / No Yes; please give details.
SECURITY OFFERED - REAL ESTATE
Address of property / Volume / Folio
Provide the name of current owner/guarantor OR if property to be purchased provide the Solicitor/Land Broker’s details / Estimated property value $
SECURITY OFFERED - OTHER
V1.0-0517-FRM 7.11.10
Page 4 of 7
Privacy Information and Declaration Form(incorporating consent to receive documents electronically for National Consumer Credit Protection Act purposes) /
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Purpose of this permissionThe purpose of this permission is to notify you of the type of personal information People’s Choice Credit Union, a trading name of Australian Central Credit Union Limited ABN 11 087 651 125 Australian Credit Licence 244310 ('we', 'us', 'our') and other applicable persons may collect about you and to obtain your consent to that collection and also to our use and disclosure of that information.
What information can be disclosed?
The Privacy Act allows us and other applicable persons to:
· collect personal information about you where that information is reasonably necessary for, or directly related to, one or more of our or their functions or activities; and
· use or disclose that personal information for:
o the function or activity for which it was collected; or
o a secondary purpose provided you either consent to the use or disclosure or you would reasonably expect that information to be used for that secondary purpose and that secondary purpose is related to the primary purpose for which it was collected.
In connection with providing credit to you, personal information may include credit information, such as:
· details to identify you and verify your identity, such as your name, sex, date of birth, current and 2 previous addresses, your current and last known employer, and your driver's licence number
· the fact that you have applied for credit and the amount or that we are a current credit provider to you, or that you have agreed to be a guarantor
· advice that payments previously notified as unpaid are no longer overdue
· information about your current or terminated consumer credit accounts and your repayment history
· payments overdue for at least 60 days and for which collection action has started
· in specified circumstances, that in our opinion you have committed a serious credit infringement
· the fact that credit provided to you by us has been paid or otherwise discharged, and
· other information about credit standing, worthiness, history or capacity that credit providers can disclose under the Privacy Act, including a credit report.
Your sensitive information (eg, membership of a professional or trade association) may also be disclosed where relevant to this application.
Why do we obtain information?
Before, during or after the provision of our products and services to you, we may obtain your personal information for the purpose of providing products and services to you and managing our business. When providing credit to you, this may include assessing your application for consumer or commercial credit or to be a guarantor for the applicant, assessing your credit worthiness, managing your loan or the arrangements under which your loan is funded, obtaining insurance in respect of your loan or collecting overdue payments.
If you do not provide us with the personal information that we request, we may not be able to consider your application for credit or provide other services.
Who can give or obtain information?
For the purpose of providing products and services to you and managing our business, we may give information to:
· external service providers to us, such as organisations which we use to verify your identity, payment systems operators, mailing houses and research consultants
· insurers and re-insurers, where insurance is provided in connection with our services to you
· superannuation funds, where superannuation services are provided to you
· debt collecting agencies, if you have not repaid a loan as required
· our professional advisors, such as accountants, lawyers and auditors
· state or territory authorities that give assistance to facilitate the provision of home loans to individuals
· other credit providers and their professional advisors
· your representative, for example, lawyer, mortgage broker, financial advisor or attorney, as authorised by you, or
· government and regulatory authorities, if required or authorised by law.
In addition, in connection with providing credit to you, we and the Credit Providers mentioned below may:
· obtain a commercial and consumer credit report containing personal information about you from a credit reporting body
· obtain personal information about you from your employer and any referees that you may provide
· exchange credit information about you with each other, and
· exchange credit information about you with any credit reporting body and any other provider of credit to you named in your credit application or a credit report from a credit reporting body.
V1.6–1217-FRM 7.1.4
Page 7 of 7
Privacy Information and Declaration Form(incorporating consent to receive documents electronically for National Consumer Credit Protection Act purposes) /
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Credit Providers can mean:· us
· our related companies
· any introducer, dealer or broker referred to in a loan application
· any agent or contractor of ours assisting in processing a loan application, and
· other entities that may be involved in a securitisation arrangement with us
Overseas disclosures
We, and our lenders’ mortgage insurers (see “Disclosure to insurers and guarantors” below), may disclose your personal information overseas. The countries to which your personal information may be disclosed include Philippines, USA, Canada and the United Kingdom. However, if we do disclose this information outside Australia, we will do so on the basis that the information will be used only for the purposes set out in this document.
Important information about credit reporting bodies