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FINANCE ASSESSMENT/ENQUIRY

CONTACT DETAILS

PARTNER/CO-BORROWER
Title: Mr Mrs Miss Ms Other Title: Mr Mrs Miss Ms Other
Name: Name:
Occupation: Occupation:
Period with current Employer: Period with current Employer:
Married Single Number of Children Married Single Number of Children
Telephone AH: BH: Mobile

INCOME DETAILS

CLIENT 1

 CLIENT 2
  2005200620052006
Employee: Annual Gross Wages
Self-employed: ABN: Annual Net Profit
Rental Property: Annual Gross Rent
Other Income (2nd Job, shares, dividends, etc)Annual Gross Other Income

Do you have the following documents to verify income(s)?
Tax Returns: Y N
Financials: Y N
Group Cert: Y N
Payslips: Y N
Tax Returns: Y N
Financials: Y N
Group Cert: Y N
Payslips: Y N

Property Owned - Existing Mortgage(s)
P/Code Value Balance Owing Monthly Payment Interest Rate Current Purpose Original Loan Amount Date Taken Out

Proposed Property Purchase(s)
P/Code Value Amount Required Property Type Property Use Property Income

OTHER COMMITMENTS

Finance Type Bank/Institution Balance Owed Card Limit/Loan Amount Interest Rate Repayments Date Taken Out
Personal Loan
Lease
Credit Card 1
Credit Card 2
Credit Card 3
Credit Card 4

WHAT DO YOU WISH TO ACHIEVE?

Do you have a deposit?
Y N 		How much? Are You eligible for FHOG? Y N
Credit history issues? Y N If yes Date: Amount
Paid Y N

ACCESS TO YOUR PERSONAL INFORMATION

Personal information held by Licorice Finance Soloutions will be used and disclosed in accordance with the Licorice Finance Solutions Privacy Policy. Subject to the provisions of the Privacy Act 1988, you can arrange access to your personal information held by Licorice Finance Solutions by calling on 03 9568 4011.

I/we acknowledge that I/we have read the above and agree that my/our personal information may be used by Licorice Finance Solutions for the purpose of preparing a finance assessment and making subsequent recommendations to myself/ourselves. I/we also ackowledge that as our information will be transmitted over the Internet via email there is a small risk it could be read by a 3rd party.
Client 1 Name Date
Client 2 Name Date