Consumer Credit Application

Personal Details - Applicant 1

Surname			First Names/s	Mr Mrs Miss Ms
Date of Birth			Gender
Marital Status	Single Married De-Facto Divorced Civil Union		Dependents - No.	Ages
Phone Number	Home
	Business
	Mobile
	Fax
Email Address
Driver Licence Number (5a)			Version Number (5b)
Tenancy	Own Home Board Rent Family Home Other   Please Specify
Current Address			How long at address?	Years Months
Postal Address (if different from above)			Post Code
Previous Address			How long at address?	Years Months
Current Occupation			Employer & Address
Previous Occupation			Employer & Address
Current Employment	How long employed?		Years	Months
Previous Employment	How long employed?		Years	Months

Personal Details - Applicant 2

Surname			First Names/s	Mr Mrs Miss Ms
Date of Birth			Gender
Marital Status	Single Married De-Facto Divorced Civil Union		Dependents - No.	Ages
Phone Number	Home
	Business
	Mobile
	Fax
Email Address
Driver Licence Number (5a)			Version Number (5b)
Tenancy	Own Home Board Rent Family Home Other   Please Specify
Current Address			How long at address?	Years Months
Postal Address (if different from above)			Post Code
Previous Address			How long at address?	Years Months
Current Occupation			Employer & Address
Previous Occupation			Employer & Address
Current Employment	How long employed?		Years	Months
Previous Employment	How long employed?		Years	Months

Security Details - if known

Asset to be funded
Type	Car Boat Commercial Property Other
Purchase	New Asset Purchase Existing owned Asset
Make
Model
Year of Manufacture
Registration No

Trade Goods
Make
Model
Year of Manufacture
Registration No
Balance Outstanding on Trade	$
Trade Balance Payable to

Financial Details

Amount Required $
+ Deposit/Equity$
TOTAL COST $
Preferred repayment amount $
Preferred repayment frequency	weekly fortnightly monthly

Income and Expenditure

Income / Expenditure Frequency

weekly fortnightly monthly

Income (After tax)	($)	Expenditure		($)
Applicant 1 average take home pay		Rent/Mortgage/Board Payments
Applicant 2 average take home pay		Hire Purchase Payments
		Credit Card Payments
Other Income (Specify)		Car/Other Expenses
		Insurance	- Life
			- Home & Contents
		Living Expenses (Food/Clothing/Sundry)
		Rates
		Telephone/Power
TOTAL INCOME		TOTAL EXPENSES
Less: Total Expenses
UNCOMMITTED INCOME

Assets and Liabilities *

Assets	Value ($)	Liabilities	Balance ($)
Home		Mortgage
Bank Branch		Bank O/D (Limit: )
Vehicles (No. of )		Credit Card (Limit: )
Investments		Hire Purchase
Furnishings		Other Loans/Creditors
Other (Specify)		Other (Specify)
TOTAL ASSETS		TOTAL LIABILITIES
Less: Total Liabilities
NET WORTH

*Exclude Business/Company/Trust held assets and liabilities.

PRIMARY PURPOSE OF CREDIT REQUESTED (SELECT ONE):
(a) Personal, domestic or household; or
(b) Business and/or investment

AUTHORISATION FOR COLLECTION, USE AND DISCLOSURE OF INFORMATION
1. I/We authorise Mutual Credit Finance Limited to collect personal information about me/us from any other person or agency and to disclose information about this application, any agreement, my/our payment history and any default to any person to whom Mutual Credit Finance Limited thinks fit to make disclosure. I/We agree that this information may be provided to credit reporting agencies from time to time and I/we agree that the credit reporting agency may use this information to update their credit reporting database and/or may make that information available to that credit reporting agency’s customers.

2. I/We agree that Mutual Credit Finance Limited may use any information provided in, or in connection with, this application or any agreement to assist Mutual Credit Finance Limited to carry out its usual business activities. Mutual Credit Finance Limited may use credit reporting services in the future for purposes related to the provision of credit to me/us. This may include using monitoring services to receive updates if any of the information held about me/us changes.

3. I/We acknowledge that any information about me/us received by Mutual Credit Finance Limited will be held by Mutual Credit Finance Limited and that I/we am/are entitled to have access to this information, and to request correction of this information pursuant to the Privacy Act 1993 and any relevant code of practice issued under that Act.

4. The authorisations granted in clauses 1, 2 and 3 above are agreed to be ongoing and irrevocable. That is to say that Mutual Credit Finance Limited may rely on these authorisations at any time that Mutual Credit Finance Limited considers necessary in connection with this application for credit, including once credit has been granted.

5. I/We confirm that I/we am/are aged 18 years or older.

6. I/We would would not like to be kept informed of products and services offered by Mutual Credit Finance Limited from time to time, whether by e-mail or otherwise.

  I/we have read, understood and accept the above 6 authorisation statements.

DECLARATION

7. I/We warrant that the information I/we have provided above is true and correct and I/we acknowledge that it will be relied upon by Mutual Credit Finance Limited when considering this application.

  I/we have read, understood and accept above declaration, Statement 7.